Medicare Advantage Quality Bonus Payment Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10445 Medicare Advantage Quality Bonus Payment Demonstration MAO mail survey	Form and Instruction	New	Available
CMS-10445 Supporting Statement B.docx	Supporting Statement B	Uploaded 2013-02-25	Available
MA QBP Demo Eval Survey_Changes Table 02012013.doc	Supplementary Document	Uploaded 2013-02-25	Available
CMS-10445 Response_to_Public_Comments.doc	Supplementary Document	Uploaded 2013-02-25	Repair queued
Appendix B_Letters to health plans.docx	Supplementary Document	Uploaded 2013-02-25	Available
Appendix E_FAQ.docx	Supplementary Document	Uploaded 2013-02-25	Available
CMS-10445 Supporting Statement A_02082013.docx	Supporting Statement A	Uploaded 2013-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206030	Medicare Advantage Quality Bonus Payment Demonstration MAO mail survey	Form and Instruction	New

ICR Details

OMB Control No: 0938-1195	ICR Reference No: 201303-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 18919
Title: Medicare Advantage Quality Bonus Payment Demonstration
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: 06/10/2013
	Date Received in OIRA: 03/05/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved
Responses	620	0	0
Time Burden (Hours)	610	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This data collection effort is part of the evaluation of the Medicare Advantage Quality Bonus Payment Demonstration, which accelerates the phase-in of QBPs mandated by the Affordable Care Act (ACA). The data collection is needed by CMS as part of the evaluation of the QBP demonstration to better understand what impact the demonstration has had on Medicare Advantage Organization (MAO) operations and their efforts to improve quality. The data collection instrument for the survey is a survey questionnaire designed to capture information on how MAOs perceive the demonstration and are planning for or implementing changes in quality initiatives and to identify factors that help hinder the capacity to achieve quality improvement and that influence the decision calculus to make changes. The research team plans to conduct this data collection effort in the form of a survey of MAOs and up to 10 case studies with MAOs in order to supplement what can be learned from the research team's analyses of administrative and financial data for MAOs. The case studies will be conducted as a series of open-ended discussions with MAO staff that will be guided by a discussion protocol.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3201 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3201 Name of Law: Affordable Care Act

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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:
	77 FR 57090	09/17/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 12757	02/25/2013
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
Medicare Advantage Quality Bonus Payment Demonstration MAO mail survey	CMS-10445, CMS-10445, CMS-10445	Initial Call Form ,   Reminder Call Script ,   QBP MAO Survey

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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	620	0	620	0	0	0
Annual Time Burden (Hours)	610	0	610	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: $610,117

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

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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: 03/05/2013

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