Collection of Encounter Data from Medicare Advantage Organizations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Encounter-Data-FAQs.pdf	Supplementary Document	Uploaded 2011-12-30	Available
EDFS_UserGuide_v2_092811.pdf	Supplementary Document	Uploaded 2011-12-30	Available
CMS-10340 Response to 30-day comments 121312.docx	Supplementary Document	Uploaded 2011-12-14	Available
CMS-10340.Comment Categories 081711.docx	Supplementary Document	Uploaded 2011-10-18	Available
Revised PRA with comments for OMB v1 122911 sc-clean.docx	Supporting Statement A	Uploaded 2011-12-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199936	Collection of Encounter Data from Medicare Advantage Organizations	Instruction	New

ICR Details

OMB Control No: 0938-1152	ICR Reference No: 201110-0938-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Collection of Encounter Data from Medicare Advantage Organizations
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 with change	Conclusion Date: 12/30/2011
	Date Received in OIRA: 10/27/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved
Responses	517,793,438	0	0
Time Burden (Hours)	34,520	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Given the increased importance of the accuracy of our Medicare Advantage risk adjustment methodology, we amended ? 422.310 in August of 2008 to announce that CMS would collect data from MA organizations regarding each item and service provided to an MA plan enrollee. This would allow CMS to incorporate the Medicare Advantage utilization in the development of risk adjustment models for the Medicare Advantage program.

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Authorizing Statute(s): US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
   US Code: 42 USC 1395w-23 Name of Law: Data Collection
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part D Payment
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP15	Final or interim final rulemaking	73 FR 48650	08/19/2008

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 79000	12/17/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 62414	10/07/2011
Did the Agency receive public comments on this ICR? Yes

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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
Collection of Encounter Data from Medicare Advantage Organizations

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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	517,793,438	0	0	517,793,438	0	0
Annual Time Burden (Hours)	34,520	0	0	34,520	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: This is a new information collection request.

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Annual Cost to Federal Government: $25

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: 10/27/2011

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