Quality Bonus Payment Appeals

Forms and Documents

Document Name	Status
Form CMS-10346 Appeals of Quality Bonus Payment Determinations Form and Instruction	Modified
Response to Comments to OMB.doc Supplementary Document	2017-10-18
Crosswalk revised.xlsx Supplementary Document	2017-10-18
CMS-10346 - Supporting_Statement_A - Passback2 CLEAN.doc Supporting Statement A	2018-04-30

IC Document Collections

IC ID	Document Title	Status
195883	Appeals of Quality Bonus Payment Determinations Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1129	ICR Reference No: 201710-0938-008
Status: Active	Previous ICR Reference No: 201403-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Quality Bonus Payment Appeals
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/30/2018
	Date Received in OIRA: 10/19/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved
Responses	20	0	0
Time Burden (Hours)	160	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1853(o) of the Social Security Act requires us to make Quality Bonus Payments (QBPs) to Medicare Advantage (MA) organizations that achieve performance rating scores of at least 4 stars under a five star rating system. Beginning in 2012, the star ratings we assign for purposes of QBPs under section 1858(o) of the Act will directly affect the monthly payment amount MA organizations receive from us under their contracts. In effect, this information collection request addresses a review process through which MA organizations may seek review of determinations governing their star rating ("QBP status") when the MA organization's rating is less than 4 stars. Regarding the appeals process, MA organizations have 5 calendar days from the date of CMS' release of its QBP determinations to request a technical report from CMS explaining the development of their QBP status. The technical report will be provided in writing by electronic mail to the MA organization and CMS within 30 days of CMS' receipt of the organization's request for the report by the technical report contractor. If, after reviewing the technical report, the MA organization believes that CMS was incorrect in its QBP determination, within 7 calendar days, the MA organization may request an appeal to be conducted by a hearing officer designated by CMS. The hearing officer's decision would be final and binding on both the MA organization and CMS. The hearing officer will be required to issue his/her decision on or before May 15 of the year preceding the year in which the plans for which the QBP is to be applied will be offered.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1853 Name of Statute: null
   Statute at Large: 18 Stat. 1856 Name of Statute: null
   PL: Pub.L. 111 - 152 1102 Name of Law: Medicare Advantage Payments
  

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 26804	06/09/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 41965	09/05/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Appeals of Quality Bonus Payment Determinations	CMS-10346	Request for Reconsideration

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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	20	0	0	0	-5	25
Annual Time Burden (Hours)	160	0	0	0	-40	200
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: We have reduced the number of measures on the form from 36 to 34 (Part C) and from 15 to 14 (Part D) based on stakeholder feedback about the Star Ratings measures. On the Part C form, we have removed measures C35 and C36. On the Part D form, we have removed measure D15. The changes have no impact on our currently approved 8 hour per response burden estimate. We have also updated the path to reach the form in HPMS. We are adjusting our currently approved 200 hour burden estimate (8 hours x 25 contracts) to 160 hours (8 hours x 20 contracts). We are reducing our total burden estimate based on a lower number of contracts appealing in the past few years.

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Annual Cost to Federal Government: $6,489

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]? 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: 10/19/2017

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