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pdfSUPPORTING STATEMENT FOR FORM
CMS–276: PREPAID HEALTH PLAN COST REPORT
A.
1.
Background
CMS is requesting approval of a revised version of the currently approved Form CMS 276
(OMB No.0938-0165). This Cost Report outlines the provisions for implementing Section
1876 (h) and Section 1833 (a)(1)(A) of the Social Security Act. The purposes of the
revisions were to implement some changes in response to the Affordable Care Act, clarify
certain instructions, and update outdated issues within the Cost Report.
B.
Justification
1.
Need and Legal Basis
Health Maintenance Organizations and Competitive Medical Plans (HMO/CMPs)
contracting with the Secretary under Section 1876 of the Social Security Act are required to
submit a budget and enrollment forecast, semi-annual interim report, interim final cost
report, and a final certified cost report in accordance with 42 CFR 417.572 – 417.576.
Health Care Prepayment Plans (HCPPs) contracting with the Secretary under Section 1833
of the Social Security Act are required to submit a budget and enrollment forecast, semiannual interim report, and final cost report in accordance with 42 CFR 417.808 and 42
CFR 417.810
2.
Information Users
An HMO/CMP is a health care delivery system that furnishes directly or arranges for the
delivery of the full spectrum of Part A and/or Part B health services to an enrolled
population. If it elects and qualifies to contract with the Secretary, it can receive
reimbursement for all covered services furnished to a Medicare enrollee.
An HCPP is a health care delivery system that furnishes directly or arranges for the
delivery of certain physician and diagnostics services up to the full spectrum of nonprovider Part B health services to an enrolled population.
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3.
Improved Information Technology
No technology improvements since last submission.
4.
Duplication of Similar Information
This report will be used to establish the reasonable cost of delivering covered services
furnished to Medicare enrollees. This will be done on a prospective, interim and
retrospective basis to insure that payment to these organizations does not exceed
reasonable cost of services. At this time, no other forms have been developed that can be
used to establish the reasonable cost of providing covered services to a Medicare enrollee
by an HMO/CMP or HCPP.
5.
Small Businesses
The cost report has been developed with a view toward minimizing the reporting for small
businesses.
6.
Less Frequent Collection
Without these worksheets, the Centers for Medicare & Medicaid Services (CMS) would
not have documentation needed to reimburse the organizations on a reasonable cost
basis. All physician services would have to be billed through the area carrier on a fee-forservice basis. In addition, the organizations could not be reimbursed for any service
furnished by a provider of service (hospital, SNF, and HHA). Legislation as it now exists,
could not be implemented.
7.
Special Circumstances
The submission dates for the cost reports differ depending on the type of delivery system:
A.
HMO/CMP
a. Budget - Due 90 days prior to the beginning of the contract period
b. Semi-Annual Interim - Due 60 days after the close of each quarter
c. Interim Final – Due 60 days after the close of the contract period
d. Final - Due 180 days after the close of the contract period; the report must be
certified
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B.
HCPP
a. Budget - Due 60 days prior to the beginning of the contract period
b. Semi-Annual Interim - Due 45 days after the close of the first six-month period
of a contract period
c. Final - Due 120 days after the close of the contract period
Health Care Plans are required to retain financial records relating to their cost reports for
three years after final settlement has occurred. Note that this period is longer than three
years after date of submission.
8.
Federal Register Notice/Outside Consultation
The 60-day Federal Register notice published on ________________.
9.
Payments/Gifts To Respondents
There has been no decision to provide any payment or gift to respondents.
10.
Confidentiality
Medicare cost reports are subject to requests made under the Freedom of Information Act;
however, they have been protected from disclosure under 42 CFR 5.65 Exemption four: Trade
secrets and confidential commercial or financial information. The report includes commercial and
financial information considered confidential but that is mandatory for an organization to
report to seek reimbursement on a reasonable cost basis as an HMO and as an HCPP.
11.
Sensitive Questions
This report form does not request any information that is of a sensitive nature. No
questions were asked dealing with religious or political beliefs, sex behavior and attitudes,
or other matters commonly considered private.
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12.
Burden Estimate (Total Hours & Wages)
1.
For HMO/CMPs
Interim Final Semi-Annual
& Final
Interim
Total
Budget
Avg. Completion Time
Per Report (Hours)
24
80
4
47*
Times Estimated Number of
Respondents for FY 12
19
19
19
76*
1
2
1
4
Times Annual Frequency
= Burden
456
3,040
76
3,572
* 47 is the average completion time ((24+80+80+4)/4) for total.
* 76 includes the Interim and Final being submitted twice (19+19*2+19) in total.
Total HMO/CMP hours
Cost Per Hour
Total Annual Cost
2. For HCPPs
3,572
$80
$285,760
Budget
Semi-Annual
Interim
Final
Total
Avg. Completion Time
Per Report(Hours)
16
60
4
26.67*
Times Estimated Number of
Respondents for FY 12
10
10
10
30
1
1
1
160
600
Times Annual Frequency
= Burden
40
*26.67 is the average completion time ((16+60+4)/3) for total.
Total HCPP hours
Cost Per Hour
Total Annual Cost
4
3
800
800
$ 80
$ 64,000
13.
Capital Costs
There is no capital costs associated with this collection.
14.
Cost to the Federal Government
These annual costs are incurred in processing information contained on the form,
particularly with regard to the collection of the additional data necessary to meet the law.
Effective fiscal year 2006, this function has been contracted out due to A-76 study.
Cost to the Federal Government
Interim Final
Budget
& Final
& Semi-Annual Interim
1.
2.
3.
4.
Estimated Number of
Respondents - HMO/CMP
Responses per Respondents
Total # of Responses
Processing Hours Per Response
19
2
38
20
5.
Total # of Hours - HMO/CMP
6.
Total
19
2
38
8
19
4
76
28
760
304
1064
7.
Estimated Number of
Respondents - HCPP
Responses Per Respondents
10
1
10
2
10
3
8.
9.
Total # of Responses
Processing Hours Per Response
10
16
20
8
30
24
160
160
320
10. Total # of Hours - HCPP
11. Grand Total (Line 5 + Line 10)
920
464
1384
12. Avg. Cost Per Hour
114.00
114.00
114.00
13. Line 11 x 12 (Rounded)
14. Estimated Printing
104,880
52,896
157,776
2,000
15. Total Cost to Government
$159,776
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15.
Program Changes
There were no program changes. There were only minor changes to the worksheets and
instructions. The burden hours were not impacted because these changes do not impact the
preparation time to complete the worksheets.
16.
Publication and Tabulation Dates
There are no publication plans for this data.
17.
Expiration Date
The expiration date will be displayed on the form.
18.
Certification Statement
There are no exceptions to the certification statement.
C.
Collections of Information Employing Statistical Methods
This information collection does not employ statistical methods.
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| File Type | application/pdf |
| File Title | SUPPORTING STATEMENT FOR FORM |
| Author | CMS |
| File Modified | 2012-12-17 |
| File Created | 2012-12-17 |