The Medicare Acute Care Episode Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ACE OMB Social Security Act.pdf	Supplementary Document	Uploaded 2010-09-09	Available
ACE OMB MMA.pdf	Supplementary Document	Uploaded 2010-09-09	Available
ACE OMB SiteVisit_2_Correspondence.pdf	Supplementary Document	Uploaded 2010-09-09	Available
ACE OMB SiteVisitCorrespondence.pdf	Supplementary Document	Uploaded 2010-09-09	Available
ACE OMB Supporting Statement A 100908.docx	Supporting Statement A	Uploaded 2010-09-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194759	The Medicare Acute Care Episode Demonstration (CMS-10317)	Other-Focus Group and Interview Protocols	New

ICR Details

OMB Control No: 0938-1117	ICR Reference No: 201009-0938-019
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: The Medicare Acute Care Episode Demonstration
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/10/2011
	Date Received in OIRA: 09/30/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved
Responses	509	0	0
Time Burden (Hours)	764	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Five hospitals/health systems in Medicare Administrative Contractor (MAC) jurisdiction 4 were selected, through a competitive bidding process, to participate in a demonstration to evaluate the impact of bundling physician and hospital payment for selected cardiac and orthopedic Medicare severity-based diagnosis-related groups (MS-DRGs). The demonstration includes discounts to CMS, allowance of gainsharing between physicians and hospitals, and beneficiary financial incentives. The evaluation of the demonstration will include quantitative and qualitative analysis (interviews and focus groups).

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Authorizing Statute(s): PL: Pub.L. 108 - 173 646 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act (MMA)
   US Code: 42 USC 1395cc-3 Name of Law: HEALTH CARE QUALITY DEMONSTRATION PROGRAM
  

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:
	75 FR 34740	06/18/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 54150	09/03/2010
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
The Medicare Acute Care Episode Demonstration (CMS-10317)

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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	509	0	0	509	0	0
Annual Time Burden (Hours)	764	0	0	764	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: CMS is conducting a new information collection to evaluate the impact of bundling physician and hospital payment for selected cardiac and orthopedic Medicare severity-based diagnosis-related groups (MS-DRGs). While this effort builds on previous CMS demonstrations, this project has unique features that require its participants to be queried about its impact on them. The proposed data collection is necessary because no other information would provide enough data for this purpose. This information collection does not duplicate any other effort, and the information cannot be obtained from any other source.

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Annual Cost to Federal Government: $347,151

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 09/30/2010

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