Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PII Attachment 1.doc	Supplementary Document	Uploaded 2009-03-20	Available
CMS-10062.SST Part A - CLEAN-7-13-09.doc	Supporting Statement A	Uploaded 2009-07-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8704	Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G		Modified

ICR Details

OMB Control No: 0938-0878	ICR Reference No: 200904-0938-003
Status: Historical Active	Previous ICR Reference No: 200602-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/14/2009
	Date Received in OIRA: 04/02/2009
Terms of Clearance: This ICR is approved consistent with revised supporting statement. CMS certifies that nothing in this ICR (i.e., neither the requested data elements nor the usage of that data) is changing or has changed since the previous renewal that was approved in 2005. CMS is reminded, per the PRA--that even when new uses or data elements are explicitly authorized by legislation, CMS shall submit an ICR Revision request specifying these new uses and/or data elements prior to implementation.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved	07/31/2009
Responses	22,097,070	0	14,091,370
Time Burden (Hours)	10,826	0	8,351
Cost Burden (Dollars)	0	0	0

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Abstract: CMS requires hospital inpatient, hospital outpatient and physician diagnostic data from Medicare Advantage organizations to continue making payment under the risk adjustment methodology as required by the Social Security Act of 1967 as amended by the Balanced Budget Act of 1997; the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000; and the Medicare Prescription Drug Benefit, Improvement and Modernization Act of 2003.

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Authorizing Statute(s): US Code: 42 USC 1395 w-23 Name of Law: Data Collection
   US Code: 42 USC 1395 w-23 Name of Law: Risk Adjusted Part D Payment
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 903	01/09/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 11732	03/19/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	22,097,070	14,091,370	0	0	8,005,700	0
Annual Time Burden (Hours)	10,826	8,351	0	0	2,475	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $5,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/02/2009

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