Medicaid Emergency Psychiatric Demonstration

Forms and Documents

Document Name	Status
Form CMS-10382 Application Process Form and Instruction	Modified
CMS-10382.(0938-1131).REVISED Solicitation (7-26-11).docx Supplementary Document	2011-07-26
CMS-10382.Justification of Nonmaterial Change.docx Justification for No Material/Nonsubstantive Change	2011-06-16
CMS-10382.Supporting Statement Part A.pdf Supporting Statement A	2011-06-16

IC Document Collections

IC ID	Document Title	Status
197223	Application Process Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1131	ICR Reference No: 201106-0938-015
Status: Historical Active	Previous ICR Reference No: 201104-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicaid Emergency Psychiatric Demonstration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/09/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/27/2011
	Date Received in OIRA: 06/16/2011
Terms of Clearance: Previous terms of clearance continue: Approval is granted for the demonstration application. A separate ICR will be necessary for the collection and reporting information to the Centers for Medicare & Medicaid Services (CMS) about the conduct of the Demonstration in the State.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	11/30/2011	11/30/2011
Responses	54	0	54
Time Burden (Hours)	2,160	0	2,160
Cost Burden (Dollars)	0	0	0

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Abstract: Section 2707 of the Patient Protection and Affordable Care Act was enacted to implement a demonstration to study the effects of allowing Medicaid payment for the inpatient stabilization of a more serious mental health related problem. That is, to provide payment for inpatient stabilization for psychiatric patients aged 21 to 64 who express suicidal or homicidal gestures and are considered a danger to themselves or others. By allowing coverage for inpatient admission for emergency psychiatric treatment otherwise prohibited by the Medicaid institutions for mental diseases exclusion, the Demonstration may improve access to appropriate psychiatric care, improve quality of care for Medicaid patients, and encourage greater availability of inpatient psychiatric beds, thereby reducing the necessity of psychiatric boarding. As a condition for receiving payment under this Demonstration, a State shall be responsible for collecting and reporting information to the Centers for Medicare & Medicaid Services (CMS) about the conduct of the Demonstration in the State for the purposes of providing Federal oversight and the evaluation of the Demonstration and required to cooperate with the CMS evaluation team. CMS is also required to submit to Congress, a recommendation as to whether the Demonstration project should be continued after December 31, 2013, and expanded on a national basis. The statute requires that a State seeking to participate in this Demonstration project shall submit an application that includes such information, provisions, and assurances necessary to assess the State's ability to conduct the Demonstration as compared with other State applicants. The State Medical Director will submit the Demonstration application proposal.

Emergency Justfication: Please see the attached emergency justification

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2707 Name of Law: MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application Process	CMS-10382	CMS-10382-APPENDIX-1-Guidelines

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ICR Summary 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	54	54	0	0	0	0
Annual Time Burden (Hours)	2,160	2,160	0	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:

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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: 06/16/2011

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