Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

Forms and Documents

Document Name	Status
Form FORM B Bidding Form (Form B) Form and Instruction	Modified
Form FORM A Application for DMEPOS Competitve Bidding Program (Form A) Form and Instruction	Modified
Form CMS-10169 Change of Ownership (CHOW) - Purchaser Form Form and Instruction	Removed
Form CMS-10169 Change of Ownership (CHOW) Forms-60-day & 30-day notices Form and Instruction	Modified
Form CMS-10169 Subcontracting Disclosure Form and Instruction	Modified
Form FORM D Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Form and Instruction	Modified
Form FORM C Form C-Semi Annual Report Screen Shot Form and Instruction	Modified
Crosswalk_Form_A_- 508.xlsx Supplementary Document	2017-02-08
CMS-10169 - Revised Supporting Statement part A PRA.docx Supporting Statement A	2017-02-08

IC Document Collections

IC ID	Document Title	Status
212257	Bidding Form (Form B) Form and Instruction	Modified
212256	Application for DMEPOS Competitve Bidding Program (Form A) Form and Instruction	Modified
206873	Change of Ownership (CHOW) - Purchaser Form Form and Instruction	Removed
206872	Change of Ownership (CHOW) Forms-60-day & 30-day notices Form and Instruction	Modified
203541	Subcontracting Disclosure Form and Instruction	Modified
203540	Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D) Form and Instruction	Modified
203539	Form C-Semi Annual Report Screen Shot Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1016	ICR Reference No: 201701-0938-004
Status: Historical Inactive	Previous ICR Reference No: 201508-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10169
Title: Requests for Bids (RFB) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 02/09/2017
	Date Received in OIRA: 02/08/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2017	36 Months From Approved	05/07/2018
Responses	36,997	0	36,997
Time Burden (Hours)	234,194	0	234,194
Cost Burden (Dollars)	0	0	0

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Abstract: The Medicare DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("Medicare Modernization Act" or "MMA"). Section 302 of the MMA amended Section 1847 of the Social Security Act to establish the competitive acquisition program and define program requirements. The most recent approval for this information collection request (ICR) was issued by OMB on June 10, 2013. That ICR included the estimated burden to collect the information in bidding Forms A and B for the Round 1 Recompete. We are now seeking approval to collect the information in Forms A and B for competitions that will occur before 2017.

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Authorizing Statute(s): PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
   PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program

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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 71100	10/14/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 5578	01/18/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Change of Ownership (CHOW) Forms-60-day & 30-day notices	CMS-10169, CMS-10169	CHOW 30-day Notice(Change of Ownership Form) ,   CHOW 60-day Notice(Change of Ownership Form)
Application for DMEPOS Competitve Bidding Program (Form A)	FORM A, FORM A, FORM A, FORM A	Multi Location Bidder ,   Network Bidder ,   Single Location Bidder ,   Round 1 -2019
Bidding Form (Form B)	FORM B	Bidding Form
Form C-Semi Annual Report Screen Shot	FORM C	Semi Annual Report
Change of Ownership (CHOW) - Purchaser Form	CMS-10169	Change of Ownership - Purchaser Form - 30-day notice
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)	FORM D, FORM D	Beneficiary Survey-English Version ,   Beneficiary Survey-Spanish Version
Subcontracting Disclosure	CMS-10169	Subcontracting Disclosure

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We have made no changes to Form D however, the estimated number of respondents and per response burden has been adjusted to reflect program changes. During Round 2 Recompete we eliminated multi-state CBAs so that each CBA would exist within a single state. This was added as a program improvement for suppliers in meeting State licensure requirements. This change increased the number of CBAs from 9 to 13 in the Round 1 areas and from 100 to 117 in the Round 2 areas for a total of 140 CBAs for Round 2019. We note that we have made an adjustment to the burden estimates for the national mail-order recompete from the previous ICR. Since the beneficiary population for the competition is nationwide, a larger sample size is indicated to produce a more representative sample for this competition. Given these changes, the annual burden for Form D has increased and is projected to be 21,200 responses and 10,600 hours. We have made no changes to the contract supplier’s disclosure of subcontractors form however, the estimated number of respondents and per response burden has been adjusted to account for Round 2019. The annual burden for the Subcontractor Disclosure Form for all rounds of competition is 516 responses and 165 hours. We have made no changes to the CHOW forms; however, the estimated number of respondents and per response burden has been adjusted to account for Round 2019. The annual burden for the CHOW Forms for all rounds of competition is 92 responses and 169 hours.

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Annual Cost to Federal Government: $2,798,264

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? Yes

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: 02/08/2017

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