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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form I5A 1945A Other Comment	Form	New	Repair queued
Form I4A 1945A Tribal Input	Form	New	Repair queued
Form I3aA 1945A Public Notice-Process	Form	New	Repair queued
Form I3A 1945A Public Comment	Form	New	Repair queued
Form I2A 1945A Submission Summary	Form	New	Repair queued
Form HH9A 1945A Health Homes Program Termination	Form	New	Repair queued
Form HH8A 1945A Health Homes Monitoring, Quality Measurement, and Evaluation	Form	New	Repair queued
Form HH7A 1945A Health Homes Payment Methodologies	Form	New	Repair queued
Form HH6A 1945A Health Homes Delivery Systems	Form	New	Repair queued
Form HH5A 1945A Health Homes Providers	Form	New	Repair queued
Form HH4A 1945A Health Homes Services	Form	New	Repair queued
Form HH3A 1945A Geographic Limitations	Form	New	Repair queued
Form HH2A 1945A Population and Enrollment	Form	New	Repair queued
Form HH1A 1945A Health Homes Introduction	Form	New	Repair queued
Form A1 - A5, HH1 - HH9 1945 Health Home SPA Templates	Form	New	Repair queued
Form CMS-10434 #77 Home Page and Initial Application Forms	Form and Instruction	New	Repair queued
Form CMS-10434 #77 Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage (reviewable unit screenshots)	Form and Instruction	New	Repair queued
Form CMS-10434 #77 Continuous Eligibility for Children (reviewable unit screenshots)	Form and Instruction	New	Repair queued
Form CMS-10434 #45 Maternal and Infant Health	Form	New	Available
Form 245-QSSI-MACPro-PR AQM, CQM & MIH - Additional Notes PRA document	Form and Instruction	New	Available
Form 429-AQM 2018 ABA-A AQM 2018 – Adult Body Mass Index Assessment (ABA) Core Measure PRA document	Form and Instruction	New	Available
Form 385-CQM 2018-ADD-C CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document	Form and Instruction	New	Available
Form 385-CQM 2018-ADD-C CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document	Form and Instruction	New	Available
Form 390-CQM 2018-CCW-C Contraceptive Care – All Women Ages 15-20 (CCW-CH)	Form and Instruction	New	Available
Form CMS-10434 #15 Medicaid State Plan Eligibility	Form	New	Available
Form CMS-10434 #47 Health Home Core Set	Form	New	Available
Form CMS-10434 #22 Health Homes	Form	New	Available
Form CMS-10434 #3 ABP	Form	New	Available
Form CMS-10434 #2 CHIP State Plan Eligibility	Form	New	Available
Form CMS-10434 #1 Initial Application	Form	New	Available
Form CMS-10434 #1 Initial Application SPA Admin	Form	New	Available
Form CMS-10434 #1 Initial Application Combined	Form	New	Available
MACPro PRA Upcoming Inventory 08-29-19.pdf	Supplementary Document	Uploaded 2019-08-30	Available
MACPro PRA Hours Used 08-29-19.pdf	Supplementary Document	Uploaded 2019-08-30	Available
CMS-10434 - Supporting Statement A 082919.docx	Supporting Statement A	Uploaded 2019-08-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Other Comment
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Tribal Input
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Public Notice-Process
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Public Comment
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Submission Summary
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Program Termination
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Monitoring, Quality Measurement, and Evaluation
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Payment Methodologies
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Delivery Systems
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Providers
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Services
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Geographic Limitations
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Population and Enrollment
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945A Health Homes Introduction
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form	New	1945 Health Home SPA Templates
254721	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Instruction	New
251124	GenIC #77 (New): Medicaid Extended Postpartum Coverage and Continuous Eligibility for Children	Form and Instruction	New	Home Page and Initial Application Forms
251124	GenIC #77 (New): Medicaid Extended Postpartum Coverage and Continuous Eligibility for Children	Form and Instruction	New	Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage (reviewable unit screenshots)
251124	GenIC #77 (New): Medicaid Extended Postpartum Coverage and Continuous Eligibility for Children	Form and Instruction	New	Continuous Eligibility for Children (reviewable unit screenshots)
237605	GenIC # 45 (Extension) - Maternal and Infant Health Quality	Form	New	Maternal and Infant Health
237605	GenIC # 45 (Extension) - Maternal and Infant Health Quality	Other-PRA Disclosure Statement	New
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Form and Instruction	New	AQM, CQM & MIH - Additional Notes PRA document
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Form and Instruction	New	AQM 2018 – Adult Body Mass Index Assessment (ABA) Core Measure PRA document
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Form and Instruction	New	CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Form and Instruction	New	CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Form and Instruction	New	Contraceptive Care – All Women Ages 15-20 (CCW-CH)
237603	GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	Other-PRA Disclosure Statement	New
237601	GenIC #15 (Extension) - Medicaid State Plan Eligibility	Form	New	Medicaid State Plan Eligibility
237601	GenIC #15 (Extension) - Medicaid State Plan Eligibility	Other-PRA Disclosure Statement	New
237600	GenIC #47 (Extension) - Health Home Core Sets	Form	New	Health Home Core Set
237600	GenIC #47 (Extension) - Health Home Core Sets	Other-PRA Disclosure Statement	New
237599	GenIC #22 (Extension) - Health Home State Plan Amendment (SPA)	Form	New	Health Homes
237599	GenIC #22 (Extension) - Health Home State Plan Amendment (SPA)	Other-PRA Disclosure Statement	New
237598	GenIC #3 (Extension) - Alternative Benefit Plans (ABPs)	Form	New	ABP
237598	GenIC #3 (Extension) - Alternative Benefit Plans (ABPs)	Other-PRA Disclosure Statement	New
237597	GenIC #2 (Extension) - CHIP State Plan Eligibility	Form	New	CHIP State Plan Eligibility
237597	GenIC #2 (Extension) - CHIP State Plan Eligibility	Other-PRA Disclosure Statement	New
237596	GenIC #1 (Extension) - Initial Application	Form	New	Initial Application
237596	GenIC #1 (Extension) - Initial Application	Form	New	Initial Application SPA Admin
237596	GenIC #1 (Extension) - Initial Application	Form	New	Initial Application Combined
237596	GenIC #1 (Extension) - Initial Application	Other-PRA Disclosure Statement	New

ICR Details

OMB Control No: 0938-1188	ICR Reference No: 201908-0938-015
Status: Historical Active	Previous ICR Reference No: 201708-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Medicaid and CHIP Program (MACPro) (CMS-10434)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/14/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	07/31/2020
Responses	280	0	280
Time Burden (Hours)	96,844	0	96,844
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:
	84 FR 27636	06/13/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 41722	08/15/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
GenIC # 45 (Extension) - Maternal and Infant Health Quality	CMS-10434 #45	Maternal and Infant Health
GenIC #1 (Extension) - Initial Application	CMS-10434 #1, CMS-10434 #1, CMS-10434 #1	Initial Application Combined ,   Initial Application SPA Admin ,   Initial Application
GenIC #15 (Extension) - Medicaid State Plan Eligibility	CMS-10434 #15	Medicaid State Plan Eligibility
GenIC #2 (Extension) - CHIP State Plan Eligibility	CMS-10434 #2	CHIP State Plan Eligibility
GenIC #22 (Extension) - Health Home State Plan Amendment (SPA)	CMS-10434 #22	Health Homes
GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures	390-CQM 2018-CCW-CH-PRA-D, 385-CQM 2018-ADD-CH-PRA-D, 245-QSSI-MACPro-PRA-AdditionalNotes-D, 385-CQM 2018-ADD-CH-PRA-D, 429-AQM 2018 ABA-AD PRA-D	Contraceptive Care – All Women Ages 15-20 (CCW-CH) ,   CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document ,   CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document ,   AQM 2018 – Adult Body Mass Index Assessment (ABA) Core Measure PRA document ,   AQM, CQM & MIH - Additional Notes PRA document
GenIC #3 (Extension) - Alternative Benefit Plans (ABPs)	CMS-10434 #3	ABP
GenIC #47 (Extension) - Health Home Core Sets	CMS-10434 #47	Health Home Core Set
GenIC #77 (New): Medicaid Extended Postpartum Coverage and Continuous Eligibility for Children	CMS-10434 #77, CMS-10434 #77, CMS-10434 #77	Continuous Eligibility for Children (reviewable unit screenshots) ,   Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage (reviewable unit screenshots) ,   Home Page and Initial Application Forms
GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	HH4A, HH1A, HH2A, HH3A, HH5A, HH6A, HH7A, HH8A, HH9A, I3aA, I4A, I5A, I2A, I3A, A1 - A5, HH1 - HH9, I1 - I5, and S (misc.)	1945 Health Home SPA Templates ,   1945A Health Homes Introduction ,   1945A Population and Enrollment ,   1945A Geographic Limitations ,   1945A Health Homes Services ,   1945A Health Homes Providers ,   1945A Health Homes Delivery Systems ,   1945A Health Homes Payment Methodologies ,   1945A Health Homes Monitoring, Quality Measurement, and Evaluation ,   1945A Health Homes Program Termination ,   1945A Submission Summary ,   1945A Public Comment ,   1945A Public Notice-Process ,   1945A Tribal Input ,   1945A Other Comment

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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	280	280	0	0	0	0
Annual Time Burden (Hours)	96,844	96,844	0	0	0	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:

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Annual Cost to Federal Government: $10,433,876

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? No

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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: 08/31/2019

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