Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10436 Protocol - DAAS care managers	Form and Instruction	New	Available
Form CMS-10436 Protocol - State Officials	Form and Instruction	New	Available
Form CMS-10436 Protocol - SASH	Form and Instruction	New	Available
Form CMS-10436 Protocol - Networks	Form and Instruction	New	Available
Form CMS-10436 Protocol - Community Health Teams	Form and Instruction	New	Available
Form CMS-10436 Protocol - Advocates	Form and Instruction	New	Available
Form CMS-10436 Protocol - Payers	Form and Instruction	New	Available
Form CMS-10436 Protocol - Physician Associations	Form and Instruction	New	Available
Form CMS-10436 Protocol - Provider Organization	Form and Instruction	New	Available
Form CMS-10436 Protocol-Organized Delivery	Form and Instruction	New	Available
Form CMS-10436 Protocol - Practice	Form and Instruction	New	Available
CMS_Response_4-19-13_tables.pdf	Supplementary Document	Uploaded 2013-04-29	Available
CMS_Response_4-19-13_text.pdf	Supplementary Document	Uploaded 2013-04-29	Available
Supporting_Statement.pdf	Supporting Statement A	Uploaded 2013-04-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206743	MAPCP - State Officials	Form and Instruction	New	Protocol - DAAS care managers
206743	MAPCP - State Officials	Form and Instruction	New	Protocol - State Officials
206742	MAPCP - Individuals Representing Community Health Teams and Networks	Form and Instruction	New	Protocol - SASH
206742	MAPCP - Individuals Representing Community Health Teams and Networks	Form and Instruction	New	Protocol - Networks
206742	MAPCP - Individuals Representing Community Health Teams and Networks	Form and Instruction	New	Protocol - Community Health Teams
206741	MAPCP - Individuals Representing Office of Aging and Patient Advocates	Form and Instruction	New	Protocol - Advocates
206740	MAPCP - Individuals Representing Payer Organizations	Form and Instruction	New	Protocol - Payers
206739	MAPCP - Individuals Representing Physician Associations	Form and Instruction	New	Protocol - Physician Associations
206738	MAPCP -- Practice/Health System Physicians and Administrators	Form and Instruction	New	Protocol - Provider Organization
206738	MAPCP -- Practice/Health System Physicians and Administrators	Form and Instruction	New	Protocol-Organized Delivery
206738	MAPCP -- Practice/Health System Physicians and Administrators	Form and Instruction	New	Protocol - Practice

ICR Details

OMB Control No: 0938-1211	ICR Reference No: 201304-0938-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 19380
Title: Evaluation of the Multi-Payer Advanced Primary Care Practice 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: 08/23/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2013
Terms of Clearance: Comments were addressed. Revisions made to interview questions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	472	0	0
Time Burden (Hours)	478	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration was announced by Secretary Kathleen Sebelius in September 2009 to allow Medicare to join state Medicaid programs and private insurers in participating states to improve the delivery of primary care. CMS selected eight states to participate in this demonstration: Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. CMS is conducting an evaluation of the demonstration to assess the effects of advanced primary care practice when supported by Medicare, Medicaid, and private health plans. As part of this evaluation, n person, semi-structured interviews with be conducted with (1) physicians and administrators of medical home practices and/or health systems (including North Carolina's care managers and community based care networks, Pennsylvania's physician organizations, and Michigan's provider organizations, (2) individuals representing physician associations, (3) individuals representing payer organizations, (4) individuals representing Office of Aging Staff and patient advocates; (5) leaders of community health teams and networks including respondents from Vermont's Support and Services at Home program; and (6) state officials including respondents from North Carolina's Division of Aging and Adult Services.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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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 32118	05/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 24753	04/26/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
MAPCP -- Practice/Health System Physicians and Administrators	CMS-10436, CMS-10436, CMS-10436	Protocol - Practice ,   Protocol-Organized Delivery ,   Protocol - Provider Organization
MAPCP - Individuals Representing Community Health Teams and Networks	CMS-10436, CMS-10436, CMS-10436	Protocol - Community Health Teams ,   Protocol - Networks ,   Protocol - SASH
MAPCP - Individuals Representing Office of Aging and Patient Advocates	CMS-10436	Protocol - Advocates
MAPCP - Individuals Representing Payer Organizations	CMS-10436	Protocol - Payers
MAPCP - Individuals Representing Physician Associations	CMS-10436	Protocol - Physician Associations
MAPCP - State Officials	CMS-10436, CMS-10436	Protocol - State Officials ,   Protocol - DAAS care managers

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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	472	0	0	472	0	0
Annual Time Burden (Hours)	478	0	0	478	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 collection.

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Annual Cost to Federal Government: $1,105,182

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: 04/30/2013

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