State Review of Accreditation Status, Medicaid Managed Care Quality Rating System, and Quality Strategy (QS) and Supporting Regulations in 438.310, 438.330, 438.332, 438.334, and 438.340 (CMS-10553)

Forms and Documents

Document Name	Status
CMS-10553 Supporting Statement rev 09-21-16 -- CLEAN.docx Supporting Statement A	2016-09-21
CMS-10553 Crosswalk for CFR Redesignations 06-29-2016.docx Supplementary Document	2016-06-29
Response to Public Comments.docx Supplementary Document	2016-06-29

IC Document Collections

IC ID	Document Title	Status
222247	Private Sector	New
216793	State Governments	Modified

ICR Details

OMB Control No: 0938-1281	ICR Reference No: 201606-0938-010
Status: Historical Active	Previous ICR Reference No: 201505-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Review of Accreditation Status, Medicaid Managed Care Quality Rating System, and Quality Strategy (QS) and Supporting Regulations in 438.310, 438.330, 438.332, 438.334, and 438.340 (CMS-10553)
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: 09/27/2016
	Date Received in OIRA: 06/30/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved
Responses	6,441	0	0
Time Burden (Hours)	52,343	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The May 6, 2016, final rule (RIN 0938-AS25, CMS-2390-F) contains new and revised quality and quality strategy requirements that apply to states that contract with MCOs, PIHPs, PAHPs and certain PCCM entities to deliver Medicaid services. The burden for elements previously captured in the CMS-10108 package (0938-0920), related to quality strategy and quality assessment and performance improvement (QAPI) programs have been moved into this PRA package, as the final rule has re-codified non-EQR portions of the quality regulations from Section 438 Subpart D into Subpart E. This PRA package now includes the Medicaid Quality Assessment and Performance Improvement Programs, State Review of Accreditation Status, Medicaid Managed Care Quality Rating System, and Quality Strategy (QS).

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Authorizing Statute(s): PL: Pub.L. 105 - 33 4507 Name of Law: BBA of 1997
  

Citations for New Statutory Requirements: PL: Pub.L. 105 - 33 4705 Name of Law: BBA of 1997

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS25	Final or interim final rulemaking	81 FR 27498	05/06/2016

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 31098	06/01/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 27498	05/06/2016
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Private Sector
State Governments

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ICR Summary 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	6,441	0	0	6,441	0	0
Annual Time Burden (Hours)	52,343	0	0	52,343	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden is due to new regulations, which are being issued at the agency’s discretion. The burden includes both one-time costs and ongoing costs, which are presented as an annualized figure. New and revised quality and quality strategy requirements apply to states that contract with MCOs, PIHPs, PAHPs and certain PCCM entities to deliver Medicaid services. The burden for elements previously captured in the CMS-10108 package, related to quality strategy and quality assessment and performance improvement (QAPI) programs have been moved into this PRA package, as the final rule has re-codified non-EQR portions of the quality regulations from Section 438 Subpart D into Subpart E. The final rule includes revisions to apply certain QAPI and quality strategy requirements to states whose contracts with PCCM entities include shared savings, incentive payments, or other financial rewards. The revised QAPI regulations require performance measurement for each MCO, PIHP, PAHP and PCCM entity, including two LTSS-specific categories as well as assessment of efforts to support state goals to promote community integration in LTSS. A new section, §438.332 requires states to review the accreditation status of each MCO, PIHP and PAHP and post this status on the state’s website at least annually. The final rule establishes authority for a Medicaid and CHIP Quality Rating System and requires states to implement a quality rating system for Medicaid managed care and CHIP plans within 3 years of the date of a final notice that CMS will publish in the Federal Register. The regulation establishes an option for states to develop and use their own alternative QRS with CMS approval. The quality ratings of managed care plans generated by the QRS will be published by states to assist their quality improvement efforts and to assist beneficiaries to make informed plan choices. The final rule extends the Medicaid managed care quality strategy requirements to PAHPs and certain PCCM entities, adds elements to the quality strategy and adds an effectiveness evaluation of the quality strategy, adds transparency requirements for web posting.

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Annual Cost to Federal Government: $1,774,231

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: 06/30/2016

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