Evaluation of the Certified Community Behavioral Health Clinic Demonstration

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
30-day Federal Register, Volume 82 Issue 140 (Monday, July 24, 2017).htm	Supplementary Document	Uploaded 2017-07-25	Available
60-day Federal Register, Volume 82 Issue 81 (Friday, April 28, 2017).htm	Supplementary Document	Uploaded 2017-07-25	Available
SSB_CCBHC Evaluation_final.docx	Supporting Statement B	Uploaded 2017-07-25	Available
SSA_CCBHC Evaluation_final _OMB.docx	Supporting Statement A	Uploaded 2017-11-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227611	CCBHC site leadership staff-completion of report	Other-report	New
227609	State consumer/family representative-telephone interview	Other-interview	New
227606	State mental health official-telephone interview	Other-survey	New
227605	State Medicaid official-telephone interview	Other-evaluation	New
227604	CCBHC administrative/finance staff-site interview	Other-interview	New
227603	CCBHC care managers-site interview	Other-interview	New
227592	CCBHC frontline providers-site interview	Other-front line interview	New
227582	CBHC Site Leadership Staff-site interview	Other-survey	New

ICR Details

OMB Control No: 0990-0461	ICR Reference No: 201707-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of the Certified Community Behavioral Health Clinic Demonstration
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/29/2017
	Date Received in OIRA: 07/26/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved
Responses	328	0	0
Time Burden (Hours)	792	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To support the evaluation of the Certified Community Behavioral Health Clinic (CCBHC) demonstration program. The quantitative data collection activities with their respective OMB approval numbers are described further in the final paragraph of this section. In April 2014, Section 223 of the Protecting Access to Medicare Act (PAMA) mandated the CCBHC demonstration to address some of the challenges of access, coordination, financing, and quality facing community mental health centers (CMHCs) across the country. The CCBHC demonstration is intended to improve the availability, quality and outcomes of CMHC ambulatory care by establishing a standard definition and criteria for CCBHCs, and developing a new payment system that accounts for the total cost of providing comprehensive services to all individuals who seek care. The demonstration also aims to more fully integrate primary and behavioral health care services; ensure more consistent use of evidence-based practices; and, through enhanced standardized reporting requirements, offer an opportunity to assess the quality of care provided by CCBHCs.

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Authorizing Statute(s): PL: Pub.L. 113 - 95 101 Name of Law: In April 2014, Section 223 of the Protecting Access to Medicare Act (PAMA)
  

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:
	82 FR 20898	05/04/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 34312	07/24/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
CCBHC frontline providers-site interview
CBHC Site Leadership Staff-site interview
CCBHC care managers-site interview
CCBHC administrative/finance staff-site interview
State Medicaid official-telephone interview
State mental health official-telephone interview
State consumer/family representative-telephone interview
CCBHC site leadership staff-completion of report

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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	328	0	0	328	0	0
Annual Time Burden (Hours)	792	0	0	792	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: No

Burden Reduction Due to:

Short Statement: New Collection

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Annual Cost to Federal Government: $441,730

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 07/26/2017

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