CMS' regulatory authority to establish
reporting requirements for Part C Medicare Advantage (MA)
organizations is described in 42CFR ?422.516 (a). It is noted that
each MA organization must have an effective procedure to develop,
compile, evaluate, and report to CMS, to its enrollees, and to the
general public, at the times and in the manner that CMS requires,
and while safeguarding the confidentiality of the doctor-patient
relationship, statistics and other information with respect to the
following: (1) The cost of its operations. (2) The patterns of
utilization of its services. (3) The availability, accessibility,
and acceptability of its services. (4) To the extent practical,
developments in the health status of its enrollees. (5) Other
matters that CMS may require. With both growth in the number of
participating organizations and the types of plan "packages"
available to Medicare beneficiaries, the need for more extensive,
in depth, and effective monitoring has increased. Therefore, CMS is
requesting a 3 year OMB approval of additional Part C data
reporting.
We estimated the number of
contracts reporting in 2016, based on the number of contracts
reporting in CY 2014 (n=544). The currently approved figure
estimates 562 contracts. Organization
Determinations/Reconsiderations This ICR now lists just four new
data elements to the reporting section: Organization Determinations
and Reconsiderations. These new data elements are needed to obtain
more information about case reopenings. Increasing the number of
data elements from 31 to 35 increased the estimated annual
reporting burden for ODR by 9,604 hours. Per contract, the hourly
burden increase for ODR was from 137 hours to 155 hours. Payments
to Providers Adding Payments to Providers as a new reporting
section increased hours by 11,312. Per contract, this resulted in
an average increase of 20.8 hours. Enrollment/Disenrollment For the
Enrollment/Disenrollment reporting section, the decrease in hours
was 9.1 percent based on the percentage decrease in data elements
from 22 to 20. This translated into a decrease of hour’s burden
from 768 hours to 698 annual hours (a change of -70 hr). Former
data elements 1-M and 1-N need to be removed since they no longer
apply. This would decrease the reporting burden slightly. The data
elements were: Of the number reported in A, the number of
enrollment transactions submitted using the SEP Election Period
code "S" related to SPAP. Of the number reported in A, the number
of enrollment transactions submitted using the SEP Election Period
code “S” related to SPAP. Sponsor Oversight of Agents Sponsor
Oversight of Agents is being suspended. This 2017 suspension is
still planned and would have a significant impact by lowering the
resource utilization. The average decrease in hours is 62 per
contract.
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-10261 - Supporting Statement_ICR_2017_2018_Part_C_RR_080816 [rev 09-16-2016 by OSORA PRA].docx
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a)