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 11-09-2012 by OSORA PRA].doc	Supporting Statement A	Uploaded 2012-11-09	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)		Removed
202303	Primary Care Provider Payment Increases		Modified
202302	State Plan Requirements - Amending FFS Rate		Modified
202301	Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality		Modified

ICR Details

OMB Control No: 0938-1170	ICR Reference No: 201211-0938-002
Status: Historical Active	Previous ICR Reference No: 201205-0938-003
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: Approved without change	Conclusion Date: 12/21/2012
	Date Received in OIRA: 11/13/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	12/31/2014
Responses	126,059	0	0
Time Burden (Hours)	68,185	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: States must submit information to document any expenditure eligible for 100 percent Federal matching funds. The collection of information required under this rule would conform to the new requirements in sections 1902(a)(13), 1902(jj), 1932(f), and 1905(dd) of the Social Security Act, as amended by the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148; the Affordable Care Act).

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Authorizing Statute(s): PL: Pub.L. 111 - 152 1905(dd) Name of Law: Health Care and Education Reconciliation
   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	Final or interim final rulemaking	77 FR 66670	11/06/2012

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 27671	05/11/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 66670	11/06/2012
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
Primary Care Provider Payment Increases
Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality
State Plan Requirements - Amending FFS Rate
Methodology to Identify Rate Differential (FFP for Managed Care Payments) in sec. 438.804(a)(2) and (a)(3)

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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	126,059	0	126,059	0	0	0
Annual Time Burden (Hours)	68,185	0	68,185	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: 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: 11/09/2012

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