Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10316 Medicare Disenrollee Survey - MA	Form	Modified	Available
Form CMS-10316 Medicare Disenrollee Survey - MA-PD	Form	Modified	Available
Form CMS-10316 Medicare Disenrollment Survey - Stand Alone PDP Version	Form	Modified	Available
PDP Crosswalk 508.pdf	Supplementary Document	Uploaded 2017-04-21	Available
MAPD Crosswalk 508 revised.pdf	Supplementary Document	Uploaded 2017-04-21	Available
MA Only Crosswalk 508 revised.pdf	Supplementary Document	Uploaded 2017-04-21	Available
Responses to public comment.docx	Supplementary Document	Uploaded 2016-07-13	Available
CMS-10316 - Supporting Statement A passback3 OMB _04 25_2017 CLEAN.docx	Supporting Statement A	Uploaded 2017-04-26	Repair queued
supporting statement B_disenrollment reasons survey 3_22_2016 (002).pdf	Supporting Statement B	Uploaded 2016-07-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207675	Medicare Disenrollee Survey - MA	Form	Modified
194738	Medicare Disenrollee Survey - MA-PD	Form	Modified
194737	Medicare Disenrollment Survey - Stand Alone PDP Version	Form	Modified

ICR Details

OMB Control No: 0938-1113	ICR Reference No: 201607-0938-007
Status: Historical Active	Previous ICR Reference No: 201307-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey (CMS-10316)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/08/2017
	Date Received in OIRA: 07/14/2016
Terms of Clearance: When four years of data are available, CMS will evaluate the within-plan temporal variability in quality scores available to consumers and adjust the frequency of the data collection accordingly. If there is very little change in the quality scores across time, CMS will consider collecting the information less frequently.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	56,972	0	88,492
Time Burden (Hours)	12,754	0	22,887
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection will survey disenrollees from Medicare Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MA-PDs). The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides a requirement to collect and report performance data for Part D prescription drug plans. Specifically, the MMA under Sec. 1860D-4 (Beneficiary Protections for Qualified Prescription Drug Coverage) requires CMS to conduct consumer satisfaction surveys regarding PDPs and MA-PDs - pursuant to section 1860D-4(d). This data collection complements the satisfaction data collected through the Medicare CAHPS Survey by providing dissatisfaction data in the form of reasons for disenrollment from PDPs and MA-PDs.

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Authorizing Statute(s): Statute at Large: 1 Stat. 1860 Name of Statute: null
  

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:
	81 FR 16184	03/25/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 42711	06/30/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Disenrollment Survey - Stand Alone PDP Version	CMS-10316	Medicare Disenrollee Survey: Prescription Drug Plan
Medicare Disenrollee Survey - MA-PD	CMS-10316	Medicare Disenrollee Survey - MA PD
Medicare Disenrollee Survey - MA	CMS-10316	Medicare Disenrollee Survey - MA

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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	56,972	88,492	0	-31,520	0	0
Annual Time Burden (Hours)	12,754	22,887	0	-10,133	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This request seeks approval of an estimated 12,754 hours of respondent burden per year to assess reasons for disenrollment from MA and PDP contracts. The actual respondent burden is subject to change between years depending on shifts in number of PDP and MA contracts and/or changes in response rates from year-to-year. It is important to maintain flexibility and consider larger sample sizes that will preserve adequate contract-level reporting reliabilities in the event of increases in the number of PDP and MA contracts and/or declines in response rates. Proposed changes to the 2016 disenrollment surveys are detailed in the attached crosswalks. A handful of items have been deleted due to low rates of endorsement, or because the information is available through administrative sources and thus not necessary to include in the “about you” section of the survey. One item on the effect of Star ratings on disenrollment decisions has been added. In general, revisions have been made to make items easier to for respondents to understand. However, these revisions do not change our estimated completion time per survey. On an annualized basis, the estimate of respondent burden is reduced from the estimate provided in our 2013 OMB application due to -- (1) a reduction in response rates from 50% (2013 OMB application assumption) to 40% (based on observed response rates for the survey in years 2014 and 2015) and (2) reduction in the number of items on the current survey instruments compared with 2013 instruments.

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Annual Cost to Federal Government: $1,649,028

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 07/14/2016

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