Community Based Care Transitions Program (CCTP) Implementation and Monitoring

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10433 Initial and Terminal Administration of the Survey	Form and Instruction	Modified	Available
CMS-10403.Supporting_Statement_Part_B_final_06_01_12.docx	Supporting Statement B	Uploaded 2013-01-03	Available
0938-1167. Justification of Non-material change.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-01-03	Available
Revised Burden Tables only.docx	Supplementary Document	Uploaded 2013-01-03	Available
CMS-10403.Supporting_Statement_Part_A_final_06_01_12.docx	Supporting Statement A	Uploaded 2013-01-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199899	Initial and Terminal Administration of the Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1167	ICR Reference No: 201301-0938-003
Status: Historical Active	Previous ICR Reference No: 201110-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Community Based Care Transitions Program (CCTP) Implementation and Monitoring
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/15/2013
	Date Received in OIRA: 01/04/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	06/30/2013	06/30/2013
Responses	432,000	0	1,900
Time Burden (Hours)	54,000	0	475
Cost Burden (Dollars)	0	0	0

---

Abstract: The Medicare Community-Based Care Transitions Program (CCTP), authorized by Section 3026 of the 2010 Affordable Care Act, is a major component of the Partnership for Patients initiative, one goal of which is to decrease preventable complications during transition from a care setting, such as a hospital, to home, community, or another care setting. Appendix A contains a copy of the relevant portion of the legislation. The CCTP will provide funding to test models for improving care transitions from the hospital to the community for high-risk Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) initiated the CCTP in early 2011 and will operate the program for five years. Congress has authorized $500 million to cover the cost of the program. CMS expects that program agreements will be in place to authorize community-based organizations (CBOs), in partnership with acute care hospitals, to begin providing care transition services in November 2011 and, if successful, continue doing so for up to five years. The planned collection of a participant experience survey is part of the implementation and monitoring strategy that will review the performance of organizations contracted to provide transitional care services under the CCTP. This clearance package seeks approval for the participant experience survey.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 3026 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44009	07/22/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 65514	10/21/2011
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Initial and Terminal Administration of the Survey	CMS-10403, CMS-10403, CMS-10433	Appendix C_CCTP 1st Admin Participant Exp Survey ,   CCTP -Spanish Version ,   CCTP_2nd_Admin_Participant_Exp_Survey

---

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	432,000	1,900	0	0	430,100	0
Annual Time Burden (Hours)	54,000	475	0	0	53,525	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:

---

Annual Cost to Federal Government: $960,850

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

---

Common Form ICR:  No

---

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: 01/03/2013

---