As discussed with CMS, any collection of information by CMS with regard to the effort to collect coverage determinations and appeals information for each of the 201 sponsoring organizations in the MA and Part D programs prior to the approval of this package is in violation of the Paperwork Reduction Act and will be noted in the Information Collection Budget.
Inventory as of this Action
Requested
Previously Approved
04/30/2020
36 Months From Approved
04/30/2017
241
0
195
52,261
0
23,595
0
0
0
42 CFR 422.502 describes CMS' regulatory authority to evaluate, through inspection or other means, Medicare Advantage Part C organizations. These records include books, contracts, medical records, patient care documentation and other records that pertain to any aspect of services performed, reconciliation of benefit liabilities, and determination of amounts payable. 42 CFR 423.503 states that CMS must oversee a Part D plan sponsor's continued compliance with the requirements for a Part D plan sponsor. 423.514 states that the Part D plan sponsor 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, statistics regarding areas such as cost of operations, patterns of utilization availability, accessibility, and acceptability of services. CMS developed a strategy to address our oversight and audit responsibilities within the context of limited audit/oversight resources. We intend to combine all Part C and Part D guides into one universal guide as it will promote efficiency and effectiveness and reduce financial and time burdens for both CMS and Medicare-contracting entities.
Under Routine Audits, the total hour burden has been adjusted from 121 hours to 701 hours to more accurately reflect the entirety of the audit process. Additionally, PACE organizations have been removed from this collection request and will be submitted under a different PRA package, as the collection instruments and burden estimates for this collection and a PACE audit differ greatly. Additionally, ad hoc audits have been removed from the burden estimate because ad hoc audits have not exceeded 3 per year in the last 5 years and routine audits have not exceeded 30 in the last 3 years. Therefore, we believe the total number of 40 routine audits more accurately reflects the burden associated with this collection. Consequently, the total burden has been adjusted from 23,595 hours to 28,040 hours.
Additionally, we increased the number of respondents who will submit coverage determinations, organization determinations and appeals universes, as we will be conducting industry-wide monitoring of timeliness to be used for Star Rating purposes. The changes to the burden are reflected and discussed in this document.
We have also prepared a detailed crosswalk of all the changes to the burden, as well as crosswalks detailing all changes to documents from the 60-day to the 30-day comment period. Please see the crosswalks for changes.
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.
Form CMS-10191 Medicare Parts C and D Program Audit Protocols and Data Requests
2017_30_day_Comment_Response_Document_Passback1_032817 CLEAN.pdf
CMS-10191 - Supporting Statement A - Passback3 (002)_MOEG edits CLEAN.docx
Medicare Parts C and D Program Audit Protocols and Data Requests