HEDIS Information Collection Request (CMS-10219)

Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection for Medicare Advantage

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1028 can be found here:

Documents and Forms

Document Name Document Type
HEDIS 2013 Volume 3.09.21.12.zip Other-HEDIS 2013 Volume 3: Specifica
HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13.docx HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13 IC Document
Updated hedis hos cahps 2013_20120801.pdf Memo - Updated Requirements for Reporting of 2013 Measures IC Document
HEDIS 2013 Volume 5.10.31.12.zip HEDIS 2013 Volume 5, Compliance Audit -- Standards, Policies and Procedures IC Document

Information Collection (IC) Details

IC Title:	HEDIS Information Collection Request (CMS-10219)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.152

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HEDIS 2013 Volume 3: Specifications for Survey Measures			HEDIS 2013 Volume 3.09.21.12.zip		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 573	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	573	90	483
Annual IC Time Burden (Hours)	184,320	29,760	154,560
Annual IC Cost Burden (Dollars)	0	-7,245,000	7,245,000

Documents for IC

Title	Document	Date Uploaded
HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13	HEDIS 2013 and HEDIS 2010 Crosswalk for PRA package 8-27-13.docx	08/27/2013
Memo - Updated Requirements for Reporting of 2013 Measures	Updated hedis hos cahps 2013_20120801.pdf	08/27/2013
HEDIS 2013 Volume 5, Compliance Audit -- Standards, Policies and Procedures	HEDIS 2013 Volume 5.10.31.12.zip	08/27/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.