CMS uses the risk adjustment data to develop individual risk scores for risk adjusted payment under Part C. As required by law, CMS also establishes the risk adjustment methodology and annually publishes the risk adjustment factors for MA organizations and other interested entities in the Advance Notice of Methodological Changes for MA Payment Rates (every February) and the Announcement of Medicare Advantage Payment Rates (every April). Risk adjustment data in particular is used to calibrate the CMS-HCC risk adjustment models using MA patterns of diagnoses, utilization, and expenditures.
While establishing a risk adjustment model appropriate for the MA program is the paramount reason for collecting MA risk adjustment, there are other important uses of the data that will improve other key functions undertaken by CMS. Data is used for the calculation of Medicare Disproportionate Share Hospital (DSH) payments. CMS collects inpatient stay information for the Medicare managed care enrollees. In particular, we collect the admission date, discharge date, Health Insurance Claim Number (HICN), and Medicare hospital number/CCN. Further, we also use the data for quality review and improvement activities. For example, MA risk adjustment data may be used in the development and calculation of quality measures for MA organizations. Other uses for the data include geographical acuity studies, utilization trends and detection of abuse as defined in the False Claim Act. Additional uses for the data include verifying the accuracy and validity of the reasonable costs claimed on Cost Reports submitted by section 1876 Cost HMOs/CMPs and section 1833 HCPPs. Finally, as stated in the regulation, we use the data for Medicare coverage purposes. For example, we can use risk adjustment data for the determination of whether day limits have been exhausted and, if not, how many such days are left.
The currently approved title for this information collection request is, âCollection of Encounter Data from Medicare Advantage Organizations.â This iteration proposes to revise the title to read, âCollection of Risk Adjustment Data from MA Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 HCPPS, MMPS), and PACE Organizations.â
We have revised the CSSC Operations Submitter Application Instruction and CSSC Operations Submitter Authorization Forms (see the attached Crosswalk). Our currently approved burden estimates have not been revised as a result of these changes.
While the number of respondents has been adjusted by +8 (from 683 (currently approved) to 691 (proposed), our total time estimate has decreased by -28,136 hours (664 hr -28,800 hr). This net reduction includes -28,800 hours under the Risk Adjustment Data Submission ICR along with +664 hours for the remaining ICRs.
Institutional, Professional, and DME companion guides have been added to this package since the system processes all institutional, professional, and DME claims. The burden for these claims is built into the cost of effort for a plan per year that is calculated in section 12 of this Supporting Statement, listed as $840,810. DME claims for risk adjustment data is a smaller portion of Part B claims and therefore the process to create the data in the same format is reduced.
We are also requiring that accountable MA management approve their contract jurisdiction before any pharmacy reconciliation reports are submitted to them by completing a PRS Contract and Contact Verification Form. We have clarified the submission timeframes in section 6 of this Supporting Statement based on the release of the reconciliation reports. This information collection effort includes a data collection instrument that is updated annually to validate accountable MA management (i.e. Survey or form).
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-10340 Submitter Authorization Form
CMS-10340 - Supporting Statement A rev 01-03-2017 - Passback2_04052018 [rev 04-13-2018 by OSORA PRA].docx
Crosswalk - Submitter Application 12_2_2 and Submitter Authorization 12_2_3 (rev OSORA PRA).xlsx
SSN Justification.pdf
PRS Contract and Contact Verification Form