Medication Therapy Management Program Improvements - Standardized Format

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10396 MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT	Form and Instruction	New	Available
Form CMS-10396 MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT	Form and Instruction	New	Available
Form CMS-10396 MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT	Form and Instruction	New	Available
CMS-10396.Response to 30-day Comments.docx	Supplementary Document	Uploaded 2011-12-12	Available
6_Responses to 60 Day Comments_CMS-10396.docx	Supplementary Document	Uploaded 2011-10-05	Available
CMS-10396_REVISED_Supporting Statement.pdf	Supporting Statement A	Uploaded 2011-10-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199672	Conducting CMRs with the standardized format and Fulfillment burden	Form and Instruction	New	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT
199671	Training MTM providers to use the standardized format	Form and Instruction	New	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT
199670	Programming the standardized format	Form and Instruction	New	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT

ICR Details

OMB Control No: 0938-1154	ICR Reference No: 201110-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medication Therapy Management Program Improvements - Standardized Format
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: 01/20/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/05/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved
Responses	1,876,346	0	0
Time Burden (Hours)	1,179,894	0	0
Cost Burden (Dollars)	1,706,250	0	0

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Abstract: The MMA of 2003 under title 42 CFR Part 423, Subpart D, established the requirements that Part D sponsors must meet with regard to medication therapy management (MTM) programs. Beginning in 2010, sponsors must offer an interactive, person-to-person comprehensive medication review (CMR) by a pharmacist or other qualified provider at least annually. A CMR is a review of a beneficiary's medications, including prescription and over-the-counter (OTC) medications, herbal therapies, and dietary supplements, which is intended to aid in assessing medication therapy and optimizing patient outcomes. Sponsors must summarize the CMR and provide an individualized written or printed summary to the beneficiary. The burden associated with the time and effort necessary for Part D sponsors to conduct CMRs with written summaries was estimated previously (RIN 0938-AP77, OCN: 0938-0964).The ACA under Section 10328 specifies that the Secretary, in consultation with relevant stakeholders, develop a standardized format for the action plan and written or printed summary that are given to beneficiaries as a result of their CMRs. The standardized format will replace whatever formats Part D sponsors are using for their written CMR summaries and action plans prior to 2013. Beginning in January, 2013, Part D sponsors will collect information required by the new standardized format, and provide that information to Medicare beneficiaries after their CMRs on forms that comply with the requirements specified by CMS for the standardized format (RIN 0938-AQ00). The use of the standardized format will support a uniform and consistent level of MTMP communications with beneficiaries, improve the ability of beneficiaries to understand and manage their medications safely and effectively, and support improved healthcare outcomes and lower overall healthcare costs. The final standardized format will be posted in the 2013 Call Letter for implementation by Part D sponsors in January 2013.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 10328 Name of Law: Improvement In Part D Medication Therapy Management (MTM) Programs
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 10328 Name of Law: Improvement In Part D Medication Therapy Management (MTM) Programs

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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:
	76 FR 31338	05/31/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60843	09/23/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Conducting CMRs with the standardized format and Fulfillment burden	CMS-10396	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT
Programming the standardized format	CMS-10396	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT
Training MTM providers to use the standardized format	CMS-10396	MEDICATION THERAPY MANAGEMENT PROGRAM STANDARDIZED FORMAT

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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	1,876,346	0	1,876,346	0	0	0
Annual Time Burden (Hours)	1,179,894	0	1,179,894	0	0	0
Annual Cost Burden (Dollars)	1,706,250	0	1,706,250	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 collection.

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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: 10/05/2011

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