Health Plan Monitoring System Level I and Level II Data Entry for the Program of all-Inclusive Care for the Elderly (CMS-10525)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10525 Level II Monitoring Data Entry	Form and Instruction	Removed	Available
Form CMS-10525 Level I Monitoring Data Entry	Form and Instruction	Modified	Available
CMS-10525 - Supporting Statement A [rev 9-23-2014 by OSORA PRA].docx	Supporting Statement A	Uploaded 2014-12-15	Available
Public Comment Responses final vs 9 11 2014 (3).xlsx	Supplementary Document	Uploaded 2014-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213218	Level II Monitoring Data Entry	Form and Instruction	Removed
213217	Level I Monitoring Data Entry	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1264	ICR Reference No: 201412-0938-004
Status: Historical Active	Previous ICR Reference No: 201409-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Health Plan Monitoring System Level I and Level II Data Entry for the Program of all-Inclusive Care for the Elderly (CMS-10525)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/16/2014
	Date Received in OIRA: 12/16/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved
Responses	24,000	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Quality improvement is a major initiative for the Centers for Medicare and Medicaid Services (CMS). With the passing of the Affordable Care Act in March 2010, there is an increased interest in providing quality healthcare for Medicare and Medicaid beneficiaries. Thus, it is imperative that CMS collect data for measuring and evaluating the quality of care provided to PACE participants and to establish PACE quality strategies and benchmarks for PACE organizations. This request is for requiring PACE organizations to enter Level I and Level II data into the CMS's Health Plan Monitoring System (HPMS) (an electronic data entry system) for purpose of analyzing quality of care. Once PACE organizations are entering Level I and Level II data into HPMS, CMS will be able to analyze results for each organization and the PACE program as a whole. We can then use that analysis to develop a quality improvement strategy for PACE.

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Authorizing Statute(s): US Code: 42 USC 1934(e)(3)(A) Name of Law: Social Security Act
   US Code: 42 USC 1894(b)(2)(A) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: US Code: 42 USC 1894(b)(2)(A) Name of Law: Social Security Act
US Code: 42 USC 1934(e)(3)(A) Name of Law: Social Security 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 29776	05/23/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 54725	09/12/2014
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
Level I Monitoring Data Entry	CMS-10525	Level I Monitoring Data Entry
Level II Monitoring Data Entry	CMS-10525, CMS-10525	Level Two Conference Call Worksheet ,   Level Two Incident Intake Summary

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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	24,000	0	40,000	0	-40,000	24,000
Annual Time Burden (Hours)	6,000	0	40,000	0	-40,000	6,000
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:

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Annual Cost to Federal Government: $19,623

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: 12/16/2014

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