Evaluation of Practice Models for Dual Eligibles and Medicare Beneficiaries with Serious Chronic Conditions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10356 In-person Discussions	Form and Instruction	New	Available
Form CMS-10356 Pre-site Discussions	Form and Instruction	New	Available
CMS-10356.Emergency Justification(1-21-11).docx	Supplementary Document	Uploaded 2011-01-24	Available
CMS-10356.Supporting Statement Part B (1-14-11).docx	Supporting Statement B	Uploaded 2011-01-24	Available
CMS-10356.Duals_ProjectDescription_FieldWork.doc	Supplementary Document	Uploaded 2010-11-26	Available
CMS-10356.Duals_SiteVisitInvitationPACE_Final.doc	Supplementary Document	Uploaded 2010-11-26	Available
CMS-10356.Emergency Justification.docx	Supplementary Document	Uploaded 2010-11-26	Available
CMS-10356.Duals_SiteVisitGenericInvitation.doc	Supplementary Document	Uploaded 2010-11-26	Available
CMS-10356.REVISED - Supporting Statement Part A (1-14-11).docx	Supporting Statement A	Uploaded 2011-01-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195445	In-person Discussions	Form and Instruction	New
195444	Pre-site Discussions	Form and Instruction	New

ICR Details

OMB Control No: 0938-1120	ICR Reference No: 201011-0938-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Evaluation of Practice Models for Dual Eligibles and Medicare Beneficiaries with Serious Chronic Conditions
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/29/2010
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/24/2011
	Date Received in OIRA: 11/26/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	6 Months From Approved
Responses	368	0	0
Time Burden (Hours)	494	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Affordable Care Act (ACA) established the Federal Coordinated Health Care Office (FCHCO) to more effectively integrate benefits under Medicare and Medicaid and improve federal and state coordination for dual-eligible beneficiaries (duals). Duals are among the most vulnerable beneficiaries - most face multiple and severe chronic conditions that require complex and intense care - and because they receive both Medicare and Medicaid coverage, they must navigate two separate health care programs, often leading to fragmented, inefficient, and costly care. The Centers for Medicare & Medicaid Services (CMS) Office of Policy (OP) has contracted L&M Policy Research and its partner Thomson Reuters to explore variations in patterns of care and best practices for duals and other Medicare beneficiaries with complex health needs. This project comprises qualitative information-gathering through open-ended, in-person discussions with providers, local health care and community leaders, patient advocates, and professionals involved in implementing care coordination initiatives. To determine factors associated with high quality and cost effective care as well as better understand the barriers to delivering it, the research team will hold in-person discussions during visits to 16 hospital referral regions (HRRs). In two of these HRRs, there will be a particular focus on the role of the Program for All-Inclusive Care for the Elderly (PACE). Many different organizations and types of programs will be explored during this field work, varying in their approach to health care delivery and the extent to which they are directly involved in the coordination of care for vulnerable populations. Lessons learned, to include critical challenges and success factors, will be used to inform the pressing work of the FCHCO to support initiatives and policies that improve care coordination for duals, as well as other priorities outlined in the ACA.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2602 Name of Law: Providing Federal coverage and payment coordination for dual eligible beneficiaries
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2602 Name of Law: Providing Federal coverage and payment coordination for dual eligible beneficiaries

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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 70928	11/19/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 70928	11/19/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Pre-site Discussions	CMS-10356	Pre-site Protocol
In-person Discussions	CMS-10356	Discussion Guide

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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	368	0	368	0	0	0
Annual Time Burden (Hours)	494	0	494	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: This is a new information collection request.

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Annual Cost to Federal Government: $0

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]? Yes

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: 11/26/2010

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