Medicaid and CHIP Program (MACPro) (CMS-10434)

Forms and Documents

Document	Type	Status	Availability
Form CMS-10434 #45 GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality	Form	New	Repair queued
Form CMS-10434 #26 GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures	Form	New	Available
Form 1 GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction	New	Repair queued
Form HHQM14 GenIC #47 - Health Home Core Sets	Form	New	Repair queued
Form CMS-10434 #22 GenIC #22 - Health Home State Plan Amendment (SPA)	Form	New	Repair queued
Form CMS-10434 (#3) GenIC #3 - Alternative Benefit Plans (ABPs)	Form	Unchanged	Repair queued
Form CMS-10434 (#2) GenIC #2 - CHIP State Plan Eligibility	Form	Unchanged	Repair queued
Form CMS-10434 (#1) GenIC #1 - Initial Application	Form	Modified	Repair queued
Justification for Nonsubstantive Change.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-08-03	Repair queued
CMS-10434 - Supporting Statement A [rev 03-28-2016 by OSORA PRA].docx	Supporting Statement A	Uploaded 2016-03-30	Available
MACPro PRA Hours Used and Upcoming Packages 03-22-16.xlsx	Supplementary Document	Uploaded 2016-03-30	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
236830	GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality	Form	New
236825	GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures	Form	New
236741	GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	Form and Instruction	New
235671	GenIC #47 - Health Home Core Sets	Form	New
235263	GenIC #22 - Health Home State Plan Amendment (SPA)	Form	New
220810	GenIC #3 - Alternative Benefit Plans (ABPs)	Form	Unchanged
220809	GenIC #2 - CHIP State Plan Eligibility	Form	Unchanged
220807	GenIC #1 - Initial Application	Form	Modified

ICR Details

OMB Control No: 0938-1188	ICR Reference No: 201708-0938-004
Status: Historical Active	Previous ICR Reference No: 201603-0938-022
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Medicaid and CHIP Program (MACPro) (CMS-10434)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/07/2017
	Date Received in OIRA: 08/03/2017
Terms of Clearance: Approved with the understanding that some of the burden hours are also captured under 0938-1148. in order to avoid double-counting, the burden hours associated with 0938-1148 should be reassessed periodically and eliminated as they are accounted for under this ICR.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	08/31/2019	08/31/2019
Responses	280	0	280
Time Burden (Hours)	96,844	0	2,772
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is in the process of evaluating Medicaid systems currently operating, in order to build an enterprise architecture platform and data repository. Ideally, CMS would allow for a single point of entry to access various program and operational data applications. This effort will be implemented in phases over several years. Phase 1 will provide for a Medicaid and CHIP Program data system (MACPro) accessed through a web portal/portlet that will automate the input and retrieval of data from the states related to CHIP eligibility and Alternative Benchmark Plans (ABP). This system will also support an efficient workflow for the review and approval of the CHIP and ABP process. States will access this system and submit program information into structured data templates. CMS staff will review the templates for compliance with federal statute, regulation and policy, provide feedback to the states and track/monitor the review and approval process. Future project phasing will provide for the design, delivery and implementation of financial management programs and performance and quality metrics. CMS must meet a hard deadline for the implementation of the Affordable Care Act. This system will be operational in phases with the CHIP eligibility and benchmark plans portions/modules to be implemented in January 2013.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act

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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:
	80 FR 69227	11/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 17167	03/28/2016
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
GenIC #2 - CHIP State Plan Eligibility	CMS-10434 (#2), CMS-10434 (#2)	CHIP Admin ,   CHIP Eligibility
GenIC #47 - Health Home Core Sets	HHQM1, HHQM11, HHQM13, HHQM19, HHQM4, HHQM15, HHQM3, HHQM7, HHQM10, HHQM12, HHQM16, HHQM18, HHQM20, HHQM2, HHQM5, HHQM6, HHQM17, HHQM8, HHQM9, HHQM14, HHQM21	HHQM-NFU ,   Admin-Data-Source ,   Admin-Hybrid-Data-Source ,   Admin-Questions ,   Admin-Screen ,   Admin-Combined-Rates ,   HHQM-ABA ,   HHQM-AMB ,   HHQM-CBP ,   HHQM-CDF ,   HHQM-CTR ,   HHQM-FUH ,   HHQM-IET ,   HHQM-IU ,   HHQM-PCR ,   HHQM-PQI92 ,   HHQM-SSGM ,   Hybrid-Data-Source ,   Hybrid-or-EHR ,   If-Data-Not-Reported ,   Technical-Assistance
GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, CMS-10434 #15, 1, 1, 1, 1, 1, CMS-10434 #15, CMS-10434 #15, CMS-10434 #15, 1, 1, 1, 1	Tribal Input ,   AFDC Income Standards ,   Income Standards – Poverty Level – Territories ,   Income Standards - AFDC-related – Territories ,   Presumptive Eligibility for Children under Age 19 ,   Qualified Entities ,   Financial Eligibility Requirements for Non-MAGI Groups ,   Presumptive Eligibility by Hospitals ,   Other Comment ,   MAGI Based Methodologies ,   MAGI Based Methodologies – Territories ,   Reasonable Classification of Children All ,   Reasonable Classification of Children Limit ,   Income Standard ,   Parents and Other Caretaker Relatives ,   Presumptive Eligibility for Parents and Other Caretaker Relatives ,   Designation and Authority ,   Intergovernmental Cooperation Act Waivers ,   Eligibility Determinations and Fair Hearings ,   Organization and Administration ,   Single State Agency Assurances ,   Submission Summary ,   Medicaid State Plan ,   Public Comment ,   Pregnant Women ,   Presumptive Eligibility for Pregnant Women ,   Presumptive Eligibility for Pregnant Women ,   Financial Eligibility Requirements for Non-MAGI Groups – Territories ,   Optional Eligibility Groups ,   Infants and Children under Age 19 ,   Infants and Children under Age 19 – Territories ,   Adult Group ,   Adult Group - Presumptive Eligibility ,   Adult Group - Presumptive Eligibility – Territories ,   Former Foster Care Children ,   Former Foster Care Children – Presumptive Eligibility ,   De-selected ,   Mandatory Eligibility Groups ,   Individuals above 133% FPL under Age 65 ,   Individuals above 133% FPL under Age 65 - Presumptive Eligibility ,   Optional Coverage of Parents and Other Caretaker Relatives ,   Reasonable Classification of Individuals under Age 21 ,   Children with Non IV-E Adoption Assistance ,   Optional Targeted Low Income Children ,   Individuals with Tuberculosis ,   Independent Foster Care Adolescents ,   Individuals Eligible for Family Planning Services ,   Individuals Eligible for Family Planning Services - Presumptive Eligibility ,   State Residency ,   Citizenship and Non-Citizenship ,   Eligibility Process ,   Application
GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures	CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26, CMS-10434 #26	AQM2017-ABA ,   AQM2017-AdminScreen ,   AQM2017-AMM ,   AQM2017-BCS ,   AQM2017-CBP ,   AQM2017-CCP ,   AQM2017-CCS ,   AQM2017-CDF ,   AQM2017-CHL ,   AQM2017-CPA ,   AQM2017-FUA ,   AQM2017-FUH ,   AQM2017-FVA ,   AQM2017-HA1C ,   AQM2017-HPC ,   AQM2017-HPCMI ,   AQM2017-HVL ,   AQM2017-IET ,   AQM2017-MPM ,   AQM2017-MSC ,   AQM2017-OHD ,   AQM2017-PCO1 ,   AQM2017-PC03 ,   AQM2017-PCR ,   AQM2017-PPC ,   AQM2017-PQI01 ,   AQM2017-PQI05 ,   AQM2017-PQI08 ,   AQM2017-PQI15 ,   AQM2017-SAA ,   AQM2017-SSD ,   AQM2018-ABA ,   AQM2018-AdminScreen ,   AQM2018-AMM ,   AQM2018-AMR ,   AQM2018-HPC ,   AQM2018-HPCMI ,   AQM2018-HVL ,   AQM2018-IET ,   AQM2018-MPM AD ,   AQM2018-MSC ,   AQM2018-OHD ,   AQM2018-PC01 AD ,   AQM2018-PC03 AD ,   AQM2018-PCR AD ,   AQM2018-PPC AD ,   AQM2018-PQI01 ,   AQM2018-PQI05 ,   AQM2018-BCS ,   AQM2018-CBP ,   AQM2018-CCP ,   AQM2018-CCS ,   AQM2018-CCW ,   AQM2018-CHL ,   AQM2018-COB ,   AQM2018-CPA ,   AQM2018-FUA FUM ,   AQM2018-FUH ,   AQM2018-FVA ,   AQM2018-HA1C ,   CQM2017-AUD ,   CQM2017-AWC ,   CQM2017-BHRA ,   CQM2017-CAP ,   CQM2017-CHL ,   CQM2017-CIS ,   CQM2017-CLABSI ,   CQM2017-CPC ,   CQM2017-DEV ,   CQM2017-FPC ,   CQM2017-FUH ,   CQM2017-IMA ,   CQM2017-LBW ,   CQM2017-MMA ,   CQM2017-PC02 ,   CQM2017-PDENT ,   CQM2017-PPC ,   CQM2017-SEAL ,   CQM2017-SRA ,   CQM2017-StateSpecific ,   CQM2017-W15 ,   CQM2017-W34 ,   CQM2017-WCC ,   CQM2018-ADD-CH ,   CQM2018-AdminScreen ,   CQM2018-AMB-CH ,   CQM2018-AMR-CH ,   CQM2018-APC-CH ,   CQM2018-APP-CH ,   CQM2018-AUD-CH ,   CQM2018-AWC-CH ,   CQM2018-CAP-CH ,   CQM2018-CCP-CH ,   CQM2018-CCW-CH ,   CQM2018-CDF-CH ,   CQM2018-CHL-CH ,   CQM2018-CIS-CH ,   CQM2018-CLABSI-CH ,   CQM2018-CPC-CH ,   CQM2018-DEV-CH ,   CQM2018-FUH-CH ,   CQM2018-IMA-CH ,   CQM2018-LBW-CH ,   CQM2018-PC02-CH ,   CQM2018-PDENT-CH ,   CQM2018-PPC-CH ,   CQM2018-SEAL-CH ,   CQM2018-W15-CH ,   CQM2018-W34-CH ,   CQM2018-WCC-CH ,   AQM2018-PQI08 ,   AQM2018-PQI15 ,   AQM2018-SSA AD ,   AQM2018-SSD AD ,   CQM2017-ADD ,   CQM2017-AdminScreen ,   CQM2017-AMB ,   CQM2017-APC ,   CQM2017-APP
GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality	CMS-10434 #45, CMS-10434 #45	MIHQM2017-AdminScreen ,   MIHQM2017-CCW
GenIC #22 - Health Home State Plan Amendment (SPA)	CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22, CMS-10398 #22, CMS-10434 #22, CMS-10434 #22, CMS-10434 #22	Health Homes Intro Screenshots ,   Population and Enrollment Screenshots ,   Geographic Limitations Screenshots ,   Health Homes Services Screenshots ,   Health Homes Providers Screenshots ,   Health Homes Service Delivery Systems – Screenshots ,   Health Homes Payment Methodologies – Screenshots ,   Health Homes Monitoring, Quality Measurement and Evaluation – Screenshots ,   Health Homes Program Termination – Screenshots ,   Submission Summary – Screenshots ,   Medicaid State Plan – Screenshots ,   Public Comment – Screenshots ,   Tribal Input – Screenshots ,   Other Comment – Screenshots
GenIC #3 - Alternative Benefit Plans (ABPs)	CMS-10434 (#3)	GenIC #3 - Screen Shots (Alternative Benefit Plans)
GenIC #1 - Initial Application	CMS-10434 (#1), CMS-10434 (#1), CMS-10434 (#1)	Initial Application ,   Initial Application (SPA Administration) ,   MACPro Homepage

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ICR Summary 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	280	280	0	0	0	0
Annual Time Burden (Hours)	96,844	2,772	0	0	94,072	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: The previous approval inadvertently did not account for the full bank of burden hours requested in the supporting statement.

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Annual Cost to Federal Government: $17,800,000

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: 08/03/2017

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