Evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration: Provider Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10485 Evaluation of the Multi-payer Advanced Primary Care Practice Demonstration:	Form and Instruction	New	Available
Attachment C - 102714 clean.doc	Supplementary Document	Uploaded 2014-11-13	Available
Supporting Statement B_102714 clean.docx	Supporting Statement B	Uploaded 2014-11-13	Available
AttE-RevisionsMAPCP-ProvSurv.pdf	Supplementary Document	Uploaded 2014-02-03	Available
AttC-Recruit-comms123013final.pdf	Supplementary Document	Uploaded 2014-02-03	Available
Supporting Statement A_102714 clean.doc	Supporting Statement A	Uploaded 2014-11-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210263	Evaluation of the Multi-payer Advanced Primary Care Practice Demonstration:	Form and Instruction	New

ICR Details

OMB Control No: 0938-1256	ICR Reference No: 201402-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21396
Title: Evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration: Provider Survey
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 with change	Conclusion Date: 11/13/2014
	Date Received in OIRA: 02/03/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	6,602	0	0
Time Burden (Hours)	1,160	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, CMS proposes surveying 5,799 healthcare providers (e.g., medical doctors, doctors of osteopathy, nurse practitioners, and physician's assistants) who are participating in the MAPCP Demonstration and caring for patients insured through Medicaid and Medicare fee-for-service. This survey will allow evaluators to understand how participating practices' structures and functions vary, particularly with respect to their adoption of different components of the PCMH model of care.

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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 41931	07/12/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 4726	01/29/2014
Did the Agency receive public comments on this ICR? No

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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
Evaluation of the Multi-payer Advanced Primary Care Practice Demonstration:	CMS-10485, CMS-10485	MAPCP Provider Survey ,   MAPCP Practice Manager Survey

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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	6,602	0	0	6,602	0	0
Annual Time Burden (Hours)	1,160	0	0	1,160	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: CMS received feedback from six clinicians participating in the MAPCP Demonstration who pilot-tested our survey (a seventh clinician pilot-tested our survey but had no suggested revisions). In addition, staff from CMS and the firms it contracted with to develop this survey (RTI International and the Urban Institute) have suggested some minor refinements. As a result, minor revisions have been made throughout the survey in response to feedback from these parties. These revisions are documented in Attachment E. The estimated burden associated with completing this survey has also been increased from 15 minutes to 18 minutes, based on the length of time it took for pilot-testers to complete the survey.

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Annual Cost to Federal Government: $268,669

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 02/03/2014

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