Medicaid Managed Care and Supporting Regulations (CMS-10108)

ICR 201912-0938-010

OMB: 0938-0920

Federal Form Document

Forms and Documents
Supporting Statement A
ICR Details
0938-0920 201912-0938-010
Active 201605-0938-016
Medicaid Managed Care and Supporting Regulations (CMS-10108)
Extension without change of a currently approved collection   No
Approved without change 02/19/2020
Retrieve Notice of Action (NOA) 12/19/2019
Prior to collecting any information under the authority at 42 CFR 438.7(d) from 10 or more persons in a 12 month period, CMS shall separately complete the process delineated at 5 CFR 1320.8 for that collection.
  Inventory as of this Action Requested Previously Approved
02/28/2023 36 Months From Approved 02/29/2020
23,288,061 0 22,564,877
1,570,817 0 1,371,968
0 0 0

These information collections requirements implement regulations that allow states greater flexibility to implement mandatory managed care programs, implement new beneficiary protections, and eliminate certain requirements viewed by state agencies as impediments to the growth of managed care programs. Information collected includes information about managed care programs, grievances and appeals, enrollment broker contracts, and managed care organizations capacity to provide health care services.

US Code: 42 USC 438.50 Name of Law: State Plan Requirements
   US Code: 42 USC 438.56 Name of Law: Disenrollment: Requirements and limitations
   US Code: 42 USC 438.102 Name of Law: Provider-enrollee communications
   US Code: 42 USC 438.114 Name of Law: Emergency and post-stabilization services
   US Code: 42 USC 438.202 Name of Law: State responsibilities
   US Code: 42 USC 438.204 Name of Law: Elements of State quality strategies
   US Code: 42 USC 438.8 Name of Law: Provisions that apply to PIHPs and PAHPs
   US Code: 42 USC 438.206 Name of Law: Availablity of services
   US Code: 42 USC 438.207 Name of Law: Assurances of adequate capacity and services
   US Code: 42 USC 438.242 Name of Law: Health information systems
   US Code: 42 USC 438.402 Name of Law: General requirements
   US Code: 42 USC 438.240 Name of Law: Quality assessment and performance improvement program
   US Code: 42 USC 438.404 Name of Law: Notice of Action
   US Code: 42 USC 438.406 Name of Law: Handling of grievances and appeals
   US Code: 42 USC 438.410 Name of Law: Expedited resolution of appeals
   US Code: 42 USC 438.414 Name of Law: Information about the grievance system to providers
   US Code: 42 USC 438.416 Name of Law: Record keeping and reporting requirements
   US Code: 42 USC 438.604 Name of Law: Data that must be certified
   US Code: 42 USC 438.710 Name of Law: Due process: Notice of sanction and pre-determination hearing
   US Code: 42 USC 438.408 Name of Law: Resolution and notification: Grievances and appeals
   US Code: 42 USC 438.722 Name of Law: Disenrollment during termination hearing process
   US Code: 42 USC 438.724 Name of Law: Notice to CMS
   US Code: 42 USC 438.810 Name of Law: Expenditures for enrollment broker services
   US Code: 42 USC 438.10 Name of Law: Information Requirements
   US Code: 42 USC 438.6 Name of Law: Contract Requirements
   US Code: 42 USC 438.12 Name of Law: Provider Discrimination prohibited

Not associated with rulemaking

  83 FR 57264 11/14/2018
84 FR 69380 12/18/2019

  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 23,288,061 22,564,877 0 723,184 0 0
Annual Time Burden (Hours) 1,570,817 1,371,968 0 198,849 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Changing Regulations
Changing Regulations
Adds/decreases the number of responses and hours for several of our currently approved requirements. Overall, the burden has increased by 723,184 responses and 198,849 hours. For States, we estimate a decrease of 95 responses and 1,757 hours. For the private sector we estimate an increase of 723,184 responses and 198,849 hours.

Mitch Bryman 410 786-5258 [email protected]


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.

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