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plans, and the elimination of requirements either no longer
applicable or needed.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)