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)
ICR 201606-0938-010 · OMB 0938-1281 · Historical Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1281 can be found here:
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)
New collection (Request for a new OMB Control Number)
No
Regular
Approved with change
09/27/2016
06/30/2016
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
09/30/2019
36 Months From Approved
6,441
0
0
52,343
0
0
0
0
0
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).
The increase in burden is due to new regulations, which are being issued at the agencyâs 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 stateâs 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.
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:
(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;
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.
CMS-10553 Supporting Statement rev 09-21-16 -- CLEAN.docx
Private Sector