Supporting Statement for Paperwork Reduction Act
OMB 0938-0933 / CMS-10120
A. Background
The template outlines the information a state must include in its Medicaid state plan to ensure compliance with the statutory provisions of section 1932(a)(1)(A) and the regulations requirements of 42 CFR 438.50.
Section 1932(a)(1)(A) of the Social Security Act (the Act) grants states the authority to enroll Medicaid beneficiaries on a mandatory basis into managed care entities (managed care organization (MCOs) and primary care case managers (PCCMs)). Under this authority, a state can amend its Medicaid state plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without being out of compliance with provisions of section 1902 of the Act on statewideness (42 CFR 431.50), freedom of choice (42 CFR 431.51) or comparability (42 CFR 440.230). This template may be used by states to easily modify their state plans if they choose to implement the provisions of 1932(a)(1)(A).
B. Justification
Need and Legal Basis
Section 1901 of the Act (42 U.S.C. 1396) requires that states must establish a state plan for medical assistance that are approved by the Secretary to carry out the purpose of title XIX. The collection of information is defined in section 1932(a)(1)(A) of the Act and in 42 CFR 438.50.
Information Users
The State Medicaid Agencies will complete the template. CMS will review the information to determine if the state has met all the requirements of 1932(a)(1)(A) and 42 CFR 438.50. If the requirements are met, CMS will approve the amendment to the state’s title XIX plan giving the state the authority to enroll Medicaid beneficiaries on a mandatory basis into managed care entities (managed care organization (MCOs) and primary care case managers (PCCMs)). For a state to receive Medicaid (title XIX) funding, there must be an approved title XIX state plan.
Improved Information Technology
This form is available in electronic format. We expect every submittal to be forwarded to our agency using the electronic format. The document is completed in a user friendly format.
Duplication of Similar Information
There is no duplication of similar information.
Small Businesses
This collection does not impact small businesses.
Less Frequent Collection
Once the amendment is approved, there is no need to resubmit unless changes are made to the program. Without this information, CMS cannot grant a state the authority to implement mandatory managed care programs in the absence of waiver authority.
Special Circumstances
Had time permitted, CMS would have revised this state plan preprint to provide greater opportunity to obtain program information necessary to approve State plan requests, and minimize the number and extent of supplemental information requests sent to a State. Although we are requesting a 3-year extension of this collection so that the authority does not expire, we intend to revise this preprint within the next year.
Federal Register Notice/Outside Consultation
A 60-day Federal Register notice published on December 10, 2010 (75 FR 76988). No comments were received.
Payment/Gift To Respondent
There is no payment/gift to respondent.
Confidentiality
There is no personal identifying information collected in the document. All the information is available to the public.
Sensitive Questions
There are no questions of a sensitive nature.
Burden Estimate (Total Hours & Wages)
Hours
The template has 12 pages. We estimate that it will take no longer than 10 hours for a state to complete and submit the template to CMS. The potential number of respondents is 56 (50 states, D.C., and 5 territories); however, we estimate only 10 states will submit annually.
10 hr x 10 respondents = 100 Annual hours
Once approved, the state will only need to resubmit to amend the prior submission. We estimate it would take 5 hours per state to complete and submit an amendment.
Cost
To complete and submit the template for a new program, it would cost a state no more than $300 ($30/hr x 10 hrs). To amend an existing template it would cost $150 ($30/hr x 5 hrs).
$30/hr wage represents the hourly wage of the State employee filling out the preprint (based on an annual salary of approximately $60,000).
Capital Costs (Maintenance of Capital Costs)
There are no capital costs.
Cost to Federal Government
There is no cost to the Federal Government.
Program or Burden Changes
There are no program/burden changes.
Publication and Tabulation Dates
There are no plans to publish the information for statistical use.
Expiration Date
CMS does not oppose the display of the expiration date.
Certification Statement
There are no exceptions to the certification statement.
C. Collection of Information Employing Statistical Methods
The use of statistical methods does not apply to this form.
| File Type | application/msword |
| File Title | Supporting Statement for Paperwork Reduction Act |
| Author | CMS |
| Last Modified By | Mitch |
| File Modified | 2011-02-19 |
| File Created | 2011-02-19 |