Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10237 Medicare Advantage Applications - Part C (CY 2011)	Form	Modified	Available
2011_MA_Application_Comment_Tracking_Tool_V24_09142009_60 Day Comment MASTER.xlsx	Supplementary Document	Uploaded 2009-10-02	Available
High Level Sum- Changes from 60 30 Comment Period_V3.docx	Supplementary Document	Uploaded 2009-10-02	Available
HSD Instructions _09112009_REDLINED.docx	Supplementary Document	Uploaded 2009-10-02	Available
2011PartC_MA_AppV15_09142009_REDLINED_Draft.docx	Supplementary Document	Uploaded 2009-10-02	Repair queued
Supporting Statement for Applications 12-22-2009 Revised (Redlined).doc	Supporting Statement A	Uploaded 2009-12-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8785	Medicare Advantage Applications - Part C (CY 2011)	Form	Modified

ICR Details

OMB Control No: 0938-0935	ICR Reference No: 200910-0938-008
Status: Historical Active	Previous ICR Reference No: 200906-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/23/2009
	Date Received in OIRA: 10/21/2009
Terms of Clearance: This ICR is approved consistent with revised supporting statement and ICR data. We note that while this ICR is implementing ARRA-related changes, not all of the burden changes are attributable to ARRA. Specifically, this ICR accounts for the burden associated with the act of providing an attestation that the applicant will comply with section 13101 of ARRA. While the act of attestation itself imposes minimal burden, we understand that CMS plans to account for the time and capital costs of complying with this requirement elsewhere. CMS also agrees to pull out all references to "forthcoming guidance" before this instrument is implemented. Consistent with the PRA, this ICR should be re-submitted along with the publication of the draft "forthcoming guidance" documents to the extent the guidance document will result in new information collection, recordkeeping, or disclosure requirements or result in changes to burden or capital cost from existing requirements. Previous terms of clearance remain in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	12/31/2010
Responses	291	0	267
Time Burden (Hours)	9,547	0	6,490
Cost Burden (Dollars)	0	0	0

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Abstract: Health plans must meet regulatory requirements to enter into a contract with CMS; in order to provide health benefits to Medicare beneficiaries. The MA applications are the collection receptacles required.

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Authorizing Statute(s): PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage

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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 30574	06/26/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 50799	10/01/2009
Did the Agency receive public comments on this ICR? Yes

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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
Medicare Advantage Applications - Part C (CY 2011)	CMS-10237, CMS-10237	HSD Tables ,   Part-C Medicare Advantage Application

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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	291	267	24	0	0	0
Annual Time Burden (Hours)	9,547	6,490	3,057	0	0	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: Increase in Respondent: For contract year 2011 and subsequent contract years, MIPPA requires that non-employer/union sponsored PFFS plans that are operating in a "network area" must meet the access requirements described in section 1852(d)(4)(B) of the Act through contracts with providers. Due to this new MIPPA requirement, CMS does envision a slight increase in the number of respondents in order to comply with this new provision. Increase Burden of Hours: MIPPA provides that all SNPs must have in place an evidenced-based model of care with appropriate networks of providers and specialists. MIPPA In addition to the collection, analysis, and reporting of HEDIS and Structure and Process measures, MIPPA also requires that SNPs evaluate their care management system within their internal performance improvement program. Due to this new MIPPA requirement, CMS does envision an increase in burden of hours for respondents that complete the SNP proposal. CMS estimates that it would take MAOs approximately two hours to complete the attestations and upload documents required in the 2011 SNP Proposal. In addition, MAOs must prepare and upload two substantive documents: 1) Overall care management plan that describes policies, procedures, and systems to implement the model of care; and 2) overall quality improvement program that describes the internal performance improvement activities and how the MAO will meet the external required reporting submissions such as HEDIS measures and Part C monitoring elements. CMS estimate that it would take two hours each to prepare and upload the narrative descriptions of the care management plan and the quality improvement program.

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Annual Cost to Federal Government: $864,600

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)? Yes

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: 10/21/2009

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