Collection of Encounter Data from Medicare Advantage Organizations (CMS-10340)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10340 Electronic Data Interchange (EDI) Agreement	Form and Instruction	Modified	Available
Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-08-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199936	Collection of Encounter Data from Medicare Advantage Organizations	Form and Instruction	Modified	Electronic Data Interchange (EDI) Agreement

ICR Details

OMB Control No: 0938-1152	ICR Reference No: 201508-0938-001
Status: Historical Active	Previous ICR Reference No: 201410-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Collection of Encounter Data from Medicare Advantage Organizations (CMS-10340)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/03/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	11/30/2017	11/30/2017
Responses	516,493,635	0	516,493,635
Time Burden (Hours)	34,433	0	34,433
Cost Burden (Dollars)	0	0	0

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Abstract: Given the increased importance of the accuracy of our Medicare Advantage risk adjustment methodology, we amended ? 422.310 in August of 2008 to announce that CMS would collect data from MA organizations regarding each item and service provided to an MA plan enrollee. This would allow CMS to incorporate the Medicare Advantage utilization in the development of risk adjustment models for the Medicare Advantage program.

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Authorizing Statute(s): US Code: 42 USC 1395w-23 Name of Law: Data Collection
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part D Payment
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
  

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:
	79 FR 31336	06/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 53067	09/05/2014
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
Collection of Encounter Data from Medicare Advantage Organizations	CMS-10340	Electronic Data Interchange (EDI) Agreement

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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	516,493,635	516,493,635	0	0	0	0
Annual Time Burden (Hours)	34,433	34,433	0	0	0	0
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: $25,010,000

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: 08/03/2015

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