Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10672 LAN Session Evaluation Form	Form and Instruction	New	Available
Form CMS-10671 LAN Summit Evaluation Form	Form and Instruction	New	Repair queued
Form CMS-10670 LAN Summit Registration Form	Form and Instruction	New	Repair queued
Form CMS-10620 Informational Questions	Form and Instruction	New	Available
Form CMS-10620 APM Survey	Form and Instruction	New	Available
Form CMS-10620 National Data Collection Metrics	Form and Instruction	New	Available
Form CMS-10660 Sessions Evaluations	Form and Instruction	New	Available
Form CMS-10659 Summit web portal evalations	Form and Instruction	New	Repair queued
Form CMS-10659 Overall Evaluations Summit 2017	Form and Instruction	New	Available
Form CMS-10655 GenIC#16 LAN Summit 2017 Registration Form	Form and Instruction	New	Available
Form CMS-10620 National Data Collection Metrics - Excel	Form and Instruction	New	Available
Form CMS-10620 National Data Collection Metric	Form and Instruction	New	Available
Form CMS-10648 LAN Forum Evaluation Form	Form and Instruction	New	Available
Form CMS-10644 LAN Forum Registration Form	Form and Instruction	New	Available
Form CMS-10640 MAC Participant Form	Form and Instruction	New	Available
Form CMS-10620 National Data Collection Metrics	Form and Instruction	New	Available
Form CMS-10618 Webinar Post-Session Evaluation - Learnings	Form and Instruction	New	Available
Form CMS-10616 Webinar Post-Session Evaluation Form - Lan Update	Form and Instruction	New	Available
Form CMS-10617 Webinar Post-Session Evaluation Form - Listening	Form and Instruction	New	Repair queued
Form CMS-10614 LAN Summit Evaluation Form	Form and Instruction	New	Available
Form CMS-10613 LAN Summit Session Evaluation Form	Form and Instruction	New	Available
Form CMS-10612 Webinar Registration - LAN Listening	Form and Instruction	New	Available
Form CMS-10607 Webinar Registration - LAN Learning	Form and Instruction	New	Available
Form CMS-10608 Webinar Registration - LAN update	Form and Instruction	New	Available
Form CMS-10606 Speaker Request Form	Form and Instruction	New	Available
Form CMS-10604 LAN Registration Form	Form and Instruction	New	Available
Form CMS-10603 LAN Summit Abstract Submission	Form and Instruction	New	Available
Form CMS-10602 LAN Summit Registration Form	Form and Instruction	New	Available
CMS-10575 Final SS - Part B - 1 21 16 clean.docx	Supporting Statement B	Uploaded 2016-01-28	Available
CMS-10575 Final SS - Part A - 1 21 16 clean.docx	Supporting Statement A	Uploaded 2016-01-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231525	LAN Documents (CMS-10670, CMS-10671, and CMS-10672)	Form and Instruction	New	LAN Session Evaluation Form
231525	LAN Documents (CMS-10670, CMS-10671, and CMS-10672)	Form and Instruction	New	LAN Summit Evaluation Form
231525	LAN Documents (CMS-10670, CMS-10671, and CMS-10672)	Form and Instruction	New	LAN Summit Registration Form
230265	Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction	New	Informational Questions
230265	Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction	New	APM Survey
230265	Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction	New	National Data Collection Metrics
228452	LAN Documents (CMS-10659 and CMS-10660)	Form and Instruction	New	Sessions Evaluations
228452	LAN Documents (CMS-10659 and CMS-10660)	Form and Instruction	New	Summit web portal evalations
228452	LAN Documents (CMS-10659 and CMS-10660)	Form and Instruction	New	Overall Evaluations Summit 2017
227625	LAN Document (CMS-10655)	Form and Instruction	New	GenIC#16 LAN Summit 2017 Registration Form
227104	Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction	New	National Data Collection Metrics - Excel
227104	Tracking the Adoption of Alternative Payment Models (CMS-10620)	Form and Instruction	New	National Data Collection Metric
226339	(CMS-10648) LAN Forum –Event Evaluations	Form and Instruction	New	LAN Forum Evaluation Form
226053	(CMS-10644) LAN Forum Registration Form	Form and Instruction	New	LAN Forum Registration Form
224394	CMS-10640 (MAC) Participant Form	Form and Instruction	New	MAC Participant Form
221558	(CMS-10620) Tracking the adoption of alternative payment models	Form and Instruction	New	National Data Collection Metrics
221098	LAN Documents (CMS-10616, CMS-10617 and CMS-10618)	Form and Instruction	New	Webinar Post-Session Evaluation - Learnings
221098	LAN Documents (CMS-10616, CMS-10617 and CMS-10618)	Form and Instruction	New	Webinar Post-Session Evaluation Form - Lan Update
221098	LAN Documents (CMS-10616, CMS-10617 and CMS-10618)	Form and Instruction	New	Webinar Post-Session Evaluation Form - Listening
220737	LAN Documents (CMS-10612, CMS-10613 and CMS-10614)	Form and Instruction	New	LAN Summit Evaluation Form
220737	LAN Documents (CMS-10612, CMS-10613 and CMS-10614)	Form and Instruction	New	LAN Summit Session Evaluation Form
220737	LAN Documents (CMS-10612, CMS-10613 and CMS-10614)	Form and Instruction	New	Webinar Registration - LAN Listening
220496	LAN Documents (CMS-10606, CMS-10607 and CMS-10608)	Form and Instruction	New	Webinar Registration - LAN Learning
220496	LAN Documents (CMS-10606, CMS-10607 and CMS-10608)	Form and Instruction	New	Webinar Registration - LAN update
220496	LAN Documents (CMS-10606, CMS-10607 and CMS-10608)	Form and Instruction	New	Speaker Request Form
220071	LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction	New	LAN Registration Form
220071	LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction	New	LAN Summit Abstract Submission
220071	LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	Form and Instruction	New	LAN Summit Registration Form

ICR Details

OMB Control No: 0938-1297	ICR Reference No: 201509-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Generic Clearance for the Heath Care Payment Learning and Action Network (CMS-10575)
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: 01/29/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/11/2015
Terms of Clearance: CMS must obtain OMB approval for each data collection instrument under this Generic ICR by submitting a mini-supporting statement describing the purpose and protocol of each collection. This generic includes four types of ICs. GenICs of the first two types (registration and participant opinions and priorities) may be submitted to OMB at any time. However, before submitting clearance requests to OMB for GenICs for tracking the adoption of alternative payment systems and for tracking the characteristics of alternative payment models adopted, CMS has committed to first conducting pilot tests with less than 10 LAN participants and then, once the approaches for full-scale data collection are finalized, posting the details of those methods for a public for a 30 day comment period through the LAN website, blog, newsletter, and other communication mediums if needed, such as webinars and listening sessions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved
Responses	48,440	0	0
Time Burden (Hours)	49,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: On January 26, 2015 Secretary Burwell announced the ambitious goal to have 30% of Medicare FFS payments tied to alternative payment models (such as Pioneer ACOs or bundled payment arrangements) by the end of 2016, and 50% of payments by the end of 2018. To more effectively partner with stakeholders across the health care system and accelerate transformation through the use of alternative payment models, CMS launched the Health Care Payment Learning and Action Network (LAN) through the CMS Alliance to Modernize Healthcare (CAMH) Federally Funded Research and Development Center, operated by The MITRE Corporation. Through CAMH, the LAN will seek to accelerate the transition to Medicare and non-Medicare alternative payment models by collaborating with a broad array of health care delivery stakeholders, identifying best practices in their implementation, and monitoring the adoption of value-based alternative payment models across the U.S. health care system-to include the percentage of Medicare, Medicaid, and non-Medicare payments tied to (and U.S. lives covered by) alternative payment models that reward the quality of care delivered.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3021 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3012 Name of Law: Affordable Care 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:
	80 FR 36812	06/26/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 53515	09/04/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Tracking the Adoption of Alternative Payment Models (CMS-10620)	CMS-10620, CMS-10620	National Data Collection Metric ,   National Data Collection Metrics - Excel
Tracking the Adoption of Alternative Payment Models (CMS-10620)	CMS-10620, CMS-10620, CMS-10620	National Data Collection Metrics ,   APM Survey ,   Informational Questions
(CMS-10620) Tracking the adoption of alternative payment models	CMS-10620	National Data Collection Metrics
(CMS-10644) LAN Forum Registration Form	CMS-10644	LAN Forum Registration Form
(CMS-10648) LAN Forum –Event Evaluations	CMS-10648	LAN Forum Evaluation Form
CMS-10640 (MAC) Participant Form	CMS-10640	MAC Participant Form
LAN Document (CMS-10655)	CMS-10655	GenIC#16 LAN Summit 2017 Registration Form
LAN Documents (CMS-10602, CMS-10603 and CMS-10604)	CMS-10603, CMS-10604, CMS-10602	LAN Summit Abstract Submission ,   LAN Registration Form ,   LAN Summit Registration Form
LAN Documents (CMS-10606, CMS-10607 and CMS-10608)	CMS-10608, CMS-10606, CMS-10607	Speaker Request Form ,   Webinar Registration - LAN update ,   Webinar Registration - LAN Learning
LAN Documents (CMS-10612, CMS-10613 and CMS-10614)	CMS-10613, CMS-10614, CMS-10612	Webinar Registration - LAN Listening ,   LAN Summit Session Evaluation Form ,   LAN Summit Evaluation Form
LAN Documents (CMS-10616, CMS-10617 and CMS-10618)	CMS-10617, CMS-10616, CMS-10618	Webinar Post-Session Evaluation Form - Lan Update ,   Webinar Post-Session Evaluation Form - Listening ,   Webinar Post-Session Evaluation - Learnings
LAN Documents (CMS-10659 and CMS-10660)	CMS-10659, CMS-10659, CMS-10660	Overall Evaluations Summit 2017 ,   Summit web portal evalations ,   Sessions Evaluations
LAN Documents (CMS-10670, CMS-10671, and CMS-10672)	CMS-10671, CMS-10672, CMS-10670	LAN Summit Registration Form ,   LAN Summit Evaluation Form ,   LAN Session Evaluation Form

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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	48,440	0	0	48,440	0	0
Annual Time Burden (Hours)	49,400	0	0	49,400	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: This is a new Generic information collection.

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Annual Cost to Federal Government: $500,000

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]? 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: 09/11/2015

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