This ICR is
approved consistent with revised supporting statement and revised
instruments, in response to public comments. Because the public
specifically noted that it would have liked to have had the chance
to comment on reporting requirements which CMS finalizes in its
"technical specifications," CMS agrees to include the technical
specifications document in the ICR package in the future and to
make it available to the public during the public comment periods.
ICR packages that do not contain this information and were not made
available for public comment will be considered incomplete. CMS
also understands that all burden-impacting changes--even technical
changes like procedure and diagnosis codes that are revised
annually--are subject to the PRA and require an opportunity for
public comment before they are implemented. This includes changes
that would require respondents to change their workflow processes
or computer programs in order to accommodate those changes.
Inventory as of this Action
Requested
Previously Approved
12/31/2011
36 Months From Approved
12,709
0
0
286,944
0
0
0
0
0
CMS' regulatory authority to establish
reporting requirements for Part C Medicare Advantage (MA)
organizations is described in 42 CFR ?422.516 (a). It is noted that
each MA organization must have an effective procedure to develop,
compile, evaluate, and report to CMS, to its enrollees, and to the
general public, at the times and in the manner that CMS requires,
and while safeguarding the confidentiality of the doctor-patient
relationship, statistics and other information with respect to the
following: (1) The cost of its operations. (2) The patterns of
utilization of its services. (3) The availability, accessibility,
and acceptability of its services. (4) To the extent practical,
developments in the health status of its enrollees. (5) Other
matters that CMS may require. With both growth in the number of
participating organizations and the types of plan "packages"
available to Medicare beneficiaries, the need for more extensive,
in depth, and effective monitoring has increased. Therefore, CMS is
requesting a 3 year OMB approval of additional Part C data
reporting.
CMS has received many inquiries
pertaining to the performance of Medicare Advantage Organizations
(MAOs). CMS has not been able to address many of these inquiries
because of an absence of data. CMS needs to initiate data
collection in these and other areas that have been the subject of
recent inquiries by both governmental and private groups in order
to improve its performance monitoring of MAOs. In response to this,
CMS has identified a set of 13 measures for collection beginning in
2009. CMS is requesting a three-year Office of Management and
Budget (OMB) approval of the reporting of these measures from MAOs.
MAOs will be required to collect these data beginning on January 1,
2009. The supporting statement provides more elaboration on the
reasons that these reporting requirements are needed including
statutory and regulatory requirements. However, some of the changes
include: CMS included cost plans in its reporting requirements
outlined in the Federal Register notice on June 26, 2008. After
careful consideration, CMS has determined that because of the
unique operation of cost plans, CMS will not require cost plans to
comply with the following reporting requirements: benefit
utilization; procedure frequency; and serious reportable adverse
events. The other significant revisions to Part C reporting
requirements are due to statutory and regulatory revisions that
have occurred after June 26, 2008. Besides the 12 measures reported
in the June 26, 2008 Federal Register Notice, in this notice, an
additional measure has been added: Special Needs Plans (SNPs) Care
Management. This measure was added because of Section 164 of the
Medicare Improvements for Patients and Providers Act of 2008
(MIPPA) requires all SNPs to have an evidenced-based model of care
with appropriate networks of providers and specialists. In
addition, several measures , including agent commission structure,
training and testing of agents, and plan oversight of agents, were
revised as a result of MIPPA and the finalization of our regulation
entitled, Medicare Program; Revisions to the Medicare Advantage and
Prescription Drug Program" (CMS 4131-F)
$300,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless
4107865666
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-10261 Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)
OMB.TRK.Comments-9-25-09..doc
TRK-Attachment III-changes.xls
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)