CMS' regulatory authority to establish reporting requirements for Part C Medicare Advantage (MA) organizations is described in 42CFR ?422.516 (a). It is noted that each MA organization must have an effective procedure to develop, compile, evaluate, and report to CMS, to its enrollees, and to the general public, at the times and in the manner that CMS requires, and while safeguarding the confidentiality of the doctor-patient relationship, statistics and other information with respect to the following:
(1) The cost of its operations.
(2) The patterns of utilization of its services.
(3) The availability, accessibility, and acceptability of its services.
(4) To the extent practical, developments in the health status of its enrollees.
(5) Other matters that CMS may require.
With both growth in the number of participating organizations and the types of plan "packages" available to Medicare beneficiaries, the need for more extensive, in depth, and effective monitoring has increased. Therefore, CMS is requesting a 3 year OMB approval of additional Part C data reporting.
Changes for the 2019 Reporting Requirements would include additional data elements where more information is needed to enhance CMS oversight of Medicare Part C plans, and the elimination of requirements either no longer applicable or needed.
We updated the average hour estimates per contract and reporting. Using the revised contract data, we adjusted these estimates based on: (1) the percentage increase in the number of data elements for Organization Determinations and Reconsiderations (ODR), (2) the reduction in the number of data elements for grievance reporting, and (3) the burden decreases due to the suspension of the reporting elements for the Private Fee for Service Provider Payment Dispute Resolution Process and Mid-Year Network Changes reporting section.
Using recent contract data, this iteration increases the number of contracts from 544 to 566 (an increase of 22 contracts). Similarly, we propose to increase or response estimate by 454 responses (from 3,508 to 3,962 responses).
Please note that respondents usually have more than one response per respondent because each reporting section is counted as one response and respondents (plans) generally report on multiple reporting sections. If, for example, a plan reports on seven sections annually, that would be seven responses for that particular plan.
Despite the increase in the number of contracts, the removal of the two reporting sections and the deletion of the many of the grievance elements resulted in an overall decrease in burden despite the additional elements for ODR Reporting. Overall, we estimate a decrease of 2,253 hours (from 169,077 to 166,824 hours).
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.
CMS-10261 - Supporting Statement A (rev 07-19-2018).docx
Part_C - Crosswalk.pdf
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a)