Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-R-282 - Supporting Statement A - 30-day_v508.docx	Supporting Statement A	Uploaded 2019-11-22	Available
CMS-R-0282 Crosswalk-508.pdf	Supplementary Document	Uploaded 2019-11-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8532	Collecting Appeals and Grievance Data	Instruction	Modified
46763	Reporting Appeals and Grievance Data	Other-Sample Report	Modified

ICR Details

OMB Control No: 0938-0778	ICR Reference No: 201910-0938-007
Status: Active	Previous ICR Reference No: 201607-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282)
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: 07/07/2020
	Date Received in OIRA: 11/25/2019
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	59,133	0	56,782
Time Burden (Hours)	5,405	0	5,906
Cost Burden (Dollars)	0	0	0

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Abstract: Medicare Advantage organizations (including MA plans and demonstrations) will collect information on appeals and grievance timeliness measures as well as dispositions. MA organizations will provide appeals and grievance information to individuals eligible to elect an MA organization, when requested, to help them make informed decisions about health plan performance.

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Authorizing Statute(s): US Code: 42 USC 1395w-22 Name of Law: BENEFITS AND BENEFICIARY PROTECTIONS
   PL: Pub.L. 105 - 33 4001 Name of Law: Balanced Budget Act of 1997
   Statute at Large: 1 Stat. 1852 Name of Statute: BENEFITS AND BENEFICIARY PROTECTIONS
  

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:
	84 FR 41723	08/15/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 63657	11/18/2019
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
Collecting Appeals and Grievance Data
Reporting Appeals and Grievance Data

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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	59,133	56,782	0	2,351	0	0
Annual Time Burden (Hours)	5,405	5,906	0	-501	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: Miscellaneous Actions

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

Burden Reduction Due to: Cutting Redundancy

Short Statement: Burden reduction has occurred due to a change in the collection and reporting periods to align with the Part C Reporting Requirements (OMB 0938-1054). There was also a change in the number of items reported (reduced from nineteen to six). Lastly, we removed the data related to expedited appeals, IRE (level 2 appeals), and withdrawals. This reduces the total number of pages of the form by 50% (previously six pages and is now three pages).

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Annual Cost to Federal Government: $0

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]? No

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: 11/25/2019

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