Information Collection

External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364

IC 8551 under ICR 201504-0938-009 · OMB 0938-0786.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0786 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Introduction to Protocols 051712.pdf	Instruction
P1 - Compliance Review 05172012.pdf	Instruction
P1 Attachment A - Compliance Review Worksheet 122111edit (3).pdf	Instruction
P1 Attachment B - Compliance definitions 122111.pdf - Adobe Acrobat Pro.pdf	Instruction
P1 Attachment C - Sample Site Visit Agenda 122111.pdf	Instruction
P1Attach D_ Compliance_InterQ 05172012.pdf	Instruction
P2 - Validation of Measures 051112.pdf	Instruction
P2 Attachment A - PM Validation Worksheet 122111.pdf	Instruction
P3 - PIP Validation 051712.pdf	Instruction
P3 Attachment A - PIP worksheet 5-22-12.pdf	Instruction
P4 - Validate Enounter Data 05-17-2012.pdf	Instruction
P4 Attachment A - Encounter Data Tables 122111 (4).pdf	Instruction
P4 Attachment B - Medical Record Review Worksheet 122111.pdf	Instruction
P5 - Surveys 051712.pdf	Instruction
P5 Attachment A - Survey Validation Worksheet 050712.pdf	Instruction
P6- PM Validation 011212.pdf	Instruction
P6 Attachment A - PM Calculation Tables 122111 (2).pdf	Instruction
P7 - PIP Implementation 051012.pdf	Instruction
P8 - Focused Studies 011212.pdf	Instruction
Appendix I - Methodology 011212.pdf	Instruction
Appendix II - Sampling Approaches 122111.pdf	Instruction
Appendix III - Glossary 122111.pdf	Instruction
Appendix IV - Acronyms 122111.pdf	Instruction
Appendix V - IS Assessment 057712 formatted.pdf	Instruction
Appendix V Attachment A - ISCA tool 011212 (2).pdf	Instruction
Appendix V Attachment B - IS Review 011212.pdf	Instruction
5-11-12 Final Edits to EQR Draft Protocols based on Public Comments.docx Protocol Changes	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 438.362 42 CFR 438.364 42 CFR 438.360

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Introduction to Protocols 051712.pdf	Yes	Yes	Fillable Printable
Instruction	P1 - Compliance Review 05172012.pdf	Yes	Yes	Fillable Printable
Instruction	P1 Attachment A - Compliance Review Worksheet 122111edit (3).pdf	Yes	Yes	Fillable Printable
Instruction	P1 Attachment B - Compliance definitions 122111.pdf - Adobe Acrobat Pro.pdf	Yes	Yes	Fillable Printable
Instruction	P1 Attachment C - Sample Site Visit Agenda 122111.pdf	Yes	Yes	Fillable Printable
Instruction	P1Attach D_ Compliance_InterQ 05172012.pdf	Yes	Yes	Fillable Printable
Instruction	P2 - Validation of Measures 051112.pdf	Yes	Yes	Fillable Printable
Instruction	P2 Attachment A - PM Validation Worksheet 122111.pdf	Yes	Yes	Fillable Printable
Instruction	P3 - PIP Validation 051712.pdf	Yes	Yes	Fillable Printable
Instruction	P3 Attachment A - PIP worksheet 5-22-12.pdf	Yes	Yes	Fillable Printable
Instruction	P4 - Validate Enounter Data 05-17-2012.pdf	Yes	Yes	Fillable Printable
Instruction	P4 Attachment A - Encounter Data Tables 122111 (4).pdf	Yes	Yes	Fillable Printable
Instruction	P4 Attachment B - Medical Record Review Worksheet 122111.pdf	Yes	Yes	Fillable Printable
Instruction	P5 - Surveys 051712.pdf	Yes	Yes	Fillable Printable
Instruction	P5 Attachment A - Survey Validation Worksheet 050712.pdf	Yes	Yes	Fillable Printable
Instruction	P6- PM Validation 011212.pdf	Yes	Yes	Fillable Printable
Instruction	P6 Attachment A - PM Calculation Tables 122111 (2).pdf	Yes	Yes	Fillable Printable
Instruction	P7 - PIP Implementation 051012.pdf	Yes	Yes	Fillable Printable
Instruction	P8 - Focused Studies 011212.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix I - Methodology 011212.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix II - Sampling Approaches 122111.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix III - Glossary 122111.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix IV - Acronyms 122111.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix V - IS Assessment 057712 formatted.pdf	Yes	Yes	Fillable Printable
Instruction	Appendix V Attachment A - ISCA tool 011212 (2).pdf	Yes	Yes	Fillable Printable
Instruction	Appendix V Attachment B - IS Review 011212.pdf	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 43

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	76	6	70
Annual IC Time Burden (Hours)	451,288	35,645	415,643
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Protocol Changes	5-11-12 Final Edits to EQR Draft Protocols based on Public Comments.docx	06/13/2012

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