Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10422 - Supporting Statement part A [rev 05-10-2012].doc	Supporting Statement A	Uploaded 2012-05-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202304	Methodology to Identify Rate Differential (FFP for Managed Care Payments) in sec. 438.804(a)(2) and (a)(3)		New
202303	Contract Requirements in sec. 438.6(c)(3)(v) and (c)(5)(vi)		New
202302	State Plan Requirements in sec. 447.410		New
202301	Eligible Services in sec. 447.400(a)		New

ICR Details

OMB Control No: 0938-1170	ICR Reference No: 201205-0938-003
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410
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: Comment filed on proposed rule	Conclusion Date: 08/08/2012
	Date Received in OIRA: 05/16/2012
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12/31/2014
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Medicaid payment to providers is funded jointly by states and the federal government according to a statutorily set formula that determines the Federal Medical Assistance Percentage (FMAP) for individual states. The FMAP varies among states but cannot be less than 50 percent. This provision of the Affordable Care Act modified the FMAP to equal 100 percent for the difference between the rate in effect July 1, 2009, and in CYs 2013 and 2014. In order to receive this enhanced funding, states must submit information to document any expenditure eligible for 100 percent federal matching funds. In this request, the collection of information will be used to document expenditures for the specified primary care services in the baseline period and to calculate the expenditure eligible for 100 federal matching funds in calendar years 2013 and 2014. Without that baseline, states would not have a supportable basis for claiming 100 percent federal matching funds.

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Authorizing Statute(s): PL: Pub.L. 111 - 152 1905(dd) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 152 1902(jj) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 152 1902(a)(13) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 152 1932(f) Name of Law: Health Care and Education Reconciliation Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 152 1932(f) Name of Law: Health Care and Education Reconciliation Act
PL: Pub.L. 111 - 152 1902(a)(13) and (jj) Name of Law: Health Care and Education Reconciliation Act
PL: Pub.L. 111 - 152 1905(dd) Name of Law: Health Care and Education Reconciliation Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ63	Proposed rulemaking	77 FR 27671	05/11/2012

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 27671	05/11/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Eligible Services in sec. 447.400(a)
State Plan Requirements in sec. 447.410
Contract Requirements in sec. 438.6(c)(3)(v) and (c)(5)(vi)
Methodology to Identify Rate Differential (FFP for Managed Care Payments) in sec. 438.804(a)(2) and (a)(3)

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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: 05/16/2012

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