Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration: Focus Group Protocols

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10479 MAPCP Demonstration: Focus Group Protocols	Form and Instruction	New	Available
FR60day_CMSresp8-2-13.pdf	Supplementary Document	Uploaded 2013-09-09	Available
FR60day_CMSresp8-2-13crosswalk.pdf	Supplementary Document	Uploaded 2013-09-09	Available
BeneFG-RecruitLetter_Medicare.pdf	Supplementary Document	Uploaded 2013-09-09	Available
BeneFG-RecruitLetter_Medicaid.pdf	Supplementary Document	Uploaded 2013-09-09	Available
SupportingStatement-A_852013.pdf	Supporting Statement A	Uploaded 2013-09-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208628	MAPCP Demonstration: Focus Group Protocols	Form and Instruction	New

ICR Details

OMB Control No: 0938-1224	ICR Reference No: 201309-0938-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20498
Title: Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration: Focus Group Protocols
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: 02/26/2014
	Date Received in OIRA: 09/12/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved
Responses	384	0	0
Time Burden (Hours)	1,152	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,in-person focus groups with beneficiaries and their caregivers will be conducted. Six focus groups will be conducted in each of the eight participating states, spread across Medicare and Medicaid beneficiaries and caregivers of beneficiaries. Special populations ineach participating state (e.g., persons with chronic illnesses, mental illnesses, and disabilities; Medicare and Medicaid dual eligibles; and people living in rural or inner-city areas) will be represented.

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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:
	78 FR 25089	04/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 50057	08/16/2013
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
MAPCP Demonstration: Focus Group Protocols	CMS-10479, CMS-10479, CMS-10479, CMS-10479	Recruitment Script ,   Focus Group Guide for Beneficiaries ,   Focus Group Guide for Caregivers of Beneficiaries ,   Informed Consent to Participate in Research for Beneficiaries and Caregivers

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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	384	0	0	384	0	0
Annual Time Burden (Hours)	1,152	0	0	1,152	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: $359,677

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: 09/12/2013

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