Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

Forms and Documents

Document Name	Status
CMS-10062 - Supporting_Statement_A [rev 7-25-2013 by OSORA PRA].doc Supporting Statement A	2013-08-02

IC Document Collections

IC ID	Document Title	Status
8704	Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G	Modified

ICR Details

OMB Control No: 0938-0878	ICR Reference No: 201308-0938-015
Status: Historical Active	Previous ICR Reference No: 200904-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: 20210
Title: Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/20/2013
	Date Received in OIRA: 08/14/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	36 Months From Approved
Responses	82,830,000	0	0
Time Burden (Hours)	40,650	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CMS requires hospital inpatient, hospital outpatient and physician diagnostic data from Medicare Advantage organizations to continue making payment under the risk adjustment methodology as required by the Social Security Act of 1967 as amended by the Balanced Budget Act of 1997; the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000; and the Medicare Prescription Drug Benefit, Improvement and Modernization Act of 2003.

---

Authorizing Statute(s): US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
   US Code: 42 USC 1395 w-23 Name of Law: Data Collection
   US Code: 42 USC 1395 w-23 Name of Law: Risk Adjusted Part D Payment
  

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:
	78 FR 27400	05/10/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42957	07/18/2013
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

---

ICR Summary 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	82,830,000	0	0	0	60,732,930	22,097,070
Annual Time Burden (Hours)	40,650	0	0	0	29,824	10,826
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: Our estimate of time and cost burden to submitters has increased due to increased enrollments in plans and beneficiaries.

---

Annual Cost to Federal Government: $8,000,000

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

---

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: 08/14/2013

---