Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410 (CMS-10422)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10422 Reimbursement Template - Physician Services (Increased Primary Care Service Payment 42 CFR 447.405, 447.210, 447.415)	Form	Modified	Available
Responses to Comments Received.docx	Supplementary Document	Uploaded 2014-11-18	Available
CMS-10422 - Supporting Statement part A [rev 11-18-2014 by OSORA PRA].doc	Supporting Statement A	Uploaded 2014-11-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202303	Primary Care Provider Payment Increases		Removed
202302	State Plan Requirements - Amending FFS Rate	Form	Modified	Reimbursement Template - Physician Services (Increased Primary Care Service Payment 42 CFR 447.405, 447.210, 447.415)
202301	Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality		Modified

ICR Details

OMB Control No: 0938-1170	ICR Reference No: 201411-0938-009
Status: Historical Inactive	Previous ICR Reference No: 201211-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410 (CMS-10422)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 12/18/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/19/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved	12/31/2014
Responses	126,059	0	126,059
Time Burden (Hours)	68,185	0	68,185
Cost Burden (Dollars)	0	0	0

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Abstract: States must submit information to document any expenditure eligible for 100 percent Federal matching funds. The collection of information required under this rule would conform to the new requirements in sections 1902(a)(13), 1902(jj), 1932(f), and 1905(dd) of the Social Security Act, as amended by the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148; the Affordable Care Act).

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Authorizing Statute(s): PL: Pub.L. 111 - 152 1905(dd) Name of Law: Health Care and Education Reconciliation
   PL: Pub.L. 111 - 152 1902(jj) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 152 1902(a)(13) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 152 1932(f) Name of Law: Health Care and Education Reconciliation Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 152 1932(f) Name of Law: Health Care and Education Reconciliation Act
PL: Pub.L. 111 - 152 1902(a)(13) and (jj) Name of Law: Health Care and Education Reconciliation Act
PL: Pub.L. 111 - 152 1905(dd) Name of Law: Health Care and Education Reconciliation Act

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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:
	79 FR 53069	09/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68450	11/17/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Primary Care Provider Payment Increases
Primary Care Services Furnished by Physicians with a Specified Specialty or Subspeciality
State Plan Requirements - Amending FFS Rate	CMS-10422	Reimbursement Template - Physician Services (Increased Primary Care Service Payment 42 CFR 447.405, 447.210, 447.415)

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: 438.804(a)(1) and (2) – Reduction in burden in CYs 2015 and 2016 Since the publication of the final rule, all states have submitted the required managed care methodologies and we assure that those methodologies will remain in use during CYs 2015 and 2016. Therefore, there is no burden associated with this requirement for the revised collection period. This is a reduction over the estimated burden for this provision for FY 2013 of 4,180 total annual hours at a total cost of $223,473. 447.410 – Reduction in burden in CYs 2015 and 2016 Since the publication of the final rule, all states have submitted SPAs providing for implementation of the regulatory requirements during CYs 2013 and 2014. Therefore, while states will need to submit an updated preprint to provide for continuation of the higher payments during CYs 2015 and 2016, the burden will be smaller. Specifically, the estimated burden for this provision for FY 2013 was 1,020 annual hours at a total cost of $38, 468. The estimated burden for CY 2015 is 255 hours at a total cost of $11,150.

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Annual Cost to Federal Government: $0

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]? Yes

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: 11/19/2014

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