Evaluation of the Medicare Care Management Performance Demonstration and the Electronic Health Records Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10273 Office System Survey	Form and Instruction	Unchanged	Available
Form CMS-10273 Office System Survey Validation Form	Form and Instruction	Unchanged	Available
Updated timelines.docx	Supplementary Document	Uploaded 2010-03-09	Available
PRApkgCMS-10273;OMB0938-1072.docx	Supplementary Document	Uploaded 2010-03-09	Available
1-EHRDPRAOMB_C.pdf	Supporting Statement B	Uploaded 2010-02-05	Available
1-EHRDPRAOMB_A_B.pdf	Supporting Statement A	Uploaded 2010-02-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192045	Evaluation of the Electronic Records Demonstration ( Discussion Guide for pratices that withdrew)	Other-GUIDE FOR WITHDRAWN TREATMENT GROUP PRACTICES	New
192044	Evaluation of the Electronic Health Records Demonstration (Discussion Guide for participating pratices)	Other-GUIDE FOR PARTICIPATING TREATMENT GROUP PRACTICES	New
192043	Evaluation of the Electronic Health Records Demonstration (CMS-10273) -Discussion Guide for Community Partners	Other-GUIDE FOR COMMUNITY PARTNER SITE COORDINATORS	New
191859	Evaluation of the Electronic Health Records Demonstration (Office System Survey)	Form and Instruction	Unchanged	Office System Survey
191858	Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form)	Form and Instruction	Unchanged	Office System Survey Validation Form
189571	Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey)		Modified

ICR Details

OMB Control No: 0938-1072	ICR Reference No: 201002-0938-006
Status: Historical Active	Previous ICR Reference No: 201001-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Evaluation of the Medicare Care Management Performance Demonstration and the Electronic Health Records Demonstration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/05/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/19/2010
Terms of Clearance: OMB approval is granted only for the site visit interview protocols associated with this demonstration project. Previous terms of clearance remain in effect. All future surveys/interview protocols associated with this demonstration project (e.g. upcoming the patient/consumer survey) should be submitted under this OMB control number.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2013	36 Months From Approved	01/31/2013
Responses	1,659	0	1,577
Time Burden (Hours)	905	0	844
Cost Burden (Dollars)	0	0	0

---

Abstract: CMS is conducting an evaluation of the Medicare Care Management Performance (MCMP) Demonstration. The MCMP demonstration is a pay-for performance demonstration with physician practices that provide primary care for at least 50 traditional fee-for-service (FFS) Medicare beneficiaries with congestive heart failure, coronary artery disease, diabetes, and other selected chronic diseases. The goals of the demonstration are to (1) improve quality of care to eligible fee-for-service Medicare beneficiaries and (2) to encourage the implementation and use of health information technology (HIT). Participating practices will receive an incentive payment for improving quality of care and an additional bonus for electronic submission of quality measures. CMS is also conducting an evaluation of the Electronic Health Records Demonstration (EHRD) which expands upon the MCMP demonstration and has the same goals. The demonstration also targets physician practices providing primary care to at least 50 Medicare beneficiaries with congestive heart failure, coronary artery disease, diabetes and other chronic conditions. In this demonstration, physician practices will receive an incentive payment for using electronic health records and an incentive payment for improving quality of care.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 649 Name of Law: Medicare Care Management Performance Demonstration
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 4202	01/23/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 27040	06/05/2009
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of the Electronic Health Records Demonstration (CMS-10273) -Discussion Guide for Community Partners
Evaluation of the Electronic Health Records Demonstration (Discussion Guide for participating pratices)
Evaluation of the Electronic Health Records Demonstration (Office System Survey Val Form)	CMS-10273	Office System Survey Validation Form
Evaluation of the Electronic Health Records Demonstration (Office System Survey)	CMS-10273	Office System Survey
Evaluation of the Electronic Records Demonstration ( Discussion Guide for pratices that withdrew)
Evaluation of the Medicare Care Management Performance Demonstration (Office System Survey)

---

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	1,659	1,577	0	82	0	0
Annual Time Burden (Hours)	905	844	0	61	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The Electronic Health Records Demonstration is an agency initiated demonstration.

---

Annual Cost to Federal Government: $425,312

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

---

Common Form ICR:  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:

(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: 02/19/2010

---