Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10169 Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction	Modified	Available
Form CMS-10169 Bidding Form (Form B)	Form and Instruction	Modified	Available
Form CMS-10169 Application for DMEPOS Competitve Bidding Program (Form A)	Form and Instruction	Removed	Repair queued
Form CMS-10169 Change of Ownership (CHOW) - Purchaser Form	Form and Instruction	Removed	Available
Form CMS-10169 Change of Ownership (CHOW) Contract Supplier Notification Form	Form and Instruction	Removed	Available
Form CMS-10169 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure	Form and Instruction	Removed	Available
Form CMS-10169 Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)	Form and Instruction	Removed	Repair queued
Form CMS-10169 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)	Form and Instruction	Removed	Available
CMS-10169_Supporting_Statement_Part_A - final.docx	Supporting Statement A	Uploaded 2018-12-06	Available
CMS-10169_Next_Round_Crosswalk_Form_B.pdf	Supplementary Document	Uploaded 2018-07-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
232396	Form A: Application for DMEPOS Competitve Bidding Program	Form and Instruction	Modified
212257	Bidding Form (Form B)	Form and Instruction	Modified
212256	Application for DMEPOS Competitve Bidding Program (Form A)	Form and Instruction	Removed
206873	Change of Ownership (CHOW) - Purchaser Form	Form and Instruction	Removed
206872	Change of Ownership (CHOW) Contract Supplier Notification Form	Form and Instruction	Removed
203541	Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure	Form and Instruction	Removed
203540	Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)	Form and Instruction	Removed
203539	Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)	Form and Instruction	Removed

ICR Details

OMB Control No: 0938-1016	ICR Reference No: 201812-0938-004
Status: Active	Previous ICR Reference No: 201807-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS/CM
Title: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
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 without change	Conclusion Date: 12/07/2018
	Date Received in OIRA: 12/06/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	05/07/2018
Responses	18,000	0	19,053
Time Burden (Hours)	56,675	0	18,870
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is seeking approval to reinstate the Information Collection Request (ICR) and to update our burden estimates to Forms A and B in preparation for the next round. CMS will publish a slightly modified version of Form A so that bidders will be better able to identify and understand the new requirement related to bid surety bonds (Section 1847(a)(1)(G) of the Act, added by section 522(a) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA). We have made changes to Form B to remove the expansion plan section and to include the bidding methodology proposed in CMS-1691-P (83 FR 34304).

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Authorizing Statute(s): PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
   PL: Pub.L. 111 - 148 6410 Name of Law: Adjustments to the Medicare DMEPOS competitive acquisition program
   PL: Pub.L. 114 - 10 522 Name of Law: Requiring bid surety bonds for bidding entities
   PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 275 154 Name of Law: Delay in and Reform of Medicare DMEPOS Competitive Acquisition Program
PL: Pub.L. 108 - 173 302(b)(1) Name of Law: Payment for durable medical equipment; competitive acquisition of certain items and services
PL: Pub.L. 111 - 148 6410 Name of Law: Adjustments to the Medicare DMEPOS competitive acquisition program
PL: Pub.L. 114 - 10 522 Name of Law: Requiring bid surety bonds for bidding entities

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT28	Final or interim final rulemaking	83 FR 56922	11/14/2018

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Form A: Application for DMEPOS Competitve Bidding Program	CMS-10169	Form A: Application for DMEPOS Competitve Bidding Program
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Subcontracting Disclosure	CMS-10169	Contract Suppliers Disclosure of Subcontractors
Round 1 Re-Compete for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Beneficiary Survey (Form D)	CMS-10169, CMS-10169	Beneficiary Survey (English Language Version) ,   Beneficiary Survey (Spanish Language Version)
Bidding Form (Form B)	CMS-10169	Form B _ Bidding Form
Change of Ownership (CHOW) - Purchaser Form	CMS-10169	Change of Ownership - Purchaser Form - 30-day notice
Application for DMEPOS Competitve Bidding Program (Form A)	CMS-10169	Form A
Change of Ownership (CHOW) Contract Supplier Notification Form	CMS-10169	Change of Ownership - Contract Supplier Notificaiton Form - 60-day Notice
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Quarterly Reporting Form (Form C)	CMS-10169	Quarterly 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	18,000	19,053	0	-1,053	0	0
Annual Time Burden (Hours)	56,675	18,870	0	37,805	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: While the total number of annual responses has slightly decreased, the overall burden has increased. Round consolidation (multiple rounds to single round), more accurate estimates based on our experience from prior rounds of competition, more bidders who are experienced with the Program, information technology efficiencies in the bidding process (DBidS), the bidding methodology finalized in CMS-1691-F, and the exclusion of other forms for the Program that will be included in a subsequent PRA information collection request are the reasons for the changes in burden.

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Annual Cost to Federal Government: $1,500,000

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: 12/06/2018

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