Initial and Renewal Model of Care Submissions, and Off-cycle Submission of Summaries of Model of Care Changes (CMS-10565)

Forms and Documents

Document Name	Status
Form CMS-10565 Off-cycle Submission of Summaries (MOC Changes) Form	Modified
Form CMS-10565 Initial and renewal MOC Submissions Form	Modified
CMS-10565 - Supporting Statement A (2020 CMS-4190-P version 4).docx Supporting Statement A	2020-03-06

IC Document Collections

IC ID	Document Title	Status
240493	Tracking Face-to Face Encounters	New
218542	Off-cycle Submission of Summaries (MOC Changes) Form	Modified
218541	Initial and renewal MOC Submissions Form	Modified

ICR Details

OMB Control No: 0938-1296	ICR Reference No: 202001-0938-008
Status: Historical Inactive	Previous ICR Reference No: 201905-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Initial and Renewal Model of Care Submissions, and Off-cycle Submission of Summaries of Model of Care Changes (CMS-10565)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 01/05/2021
	Date Received in OIRA: 03/06/2020
Terms of Clearance: Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2022
Responses	323	0	323
Time Burden (Hours)	1,732	0	1,732
Cost Burden (Dollars)	0	0	0

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Abstract: Medicare Advantage (MA) Special Needs Plans (SNPs) are required to submit Models of Care (MOCs) as a component of the MA application process. The Affordable Care Act (ACA) requires that all SNPs be approved by the National Committee for Quality Assurance (NCQA). This approval is based on NCQA’s evaluation of SNPs using MOC scoring guidelines developed by CMS and NCQA for the Secretary of the Department of Health and Human Services (DHHS). The MOC elements cover the following areas: MOC 1- Description of the SNP Population; MOC 2 - Care Coordination; MOC 3 - Provider Network; and MOC 4 - Quality Measurement & Performance Improvement. SNPs submit a MOC at time of their initial application and based on their scores, SNPs receive an approval for a period of 1, 2 or 3 years. After the approval period expires, SNPs are required to submit an updated MOC for review for their renewal process. CMS is also developing a MOC off-cycle revision process so that SNPs can revise the MOC to modify its processes and strategies for providing care during their MOC approval period. CMS will require that SNPs submit summaries of their MOC revisions to CMS for NCQA evaluation when a SNP makes significant changes to its MOC during the approval period. NCQA will review the summary of changes to verify that the revisions are consistent with the acceptable, high quality standards as included in the original approved MOC. CMS will begin collecting MOCs mid-January 2016 to coincide with the MA Application collection.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3205(e) Name of Law: The Patient Protection and Affordable Care Act (ACA)
   PL: Pub.L. 111 - 148 1859(b)(6)(B)(iii) Name of Law: The Bipartisan Budget Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3205(e) Name of Law: The Patient Protection and Affordable Care Act (ACA)
PL: Pub.L. 111 - 148 1859(b)(6)(B)(iii) Name of Law: The Bipartisan Budget Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT97	Proposed rulemaking	85 FR 9002	02/18/2020

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 9002	02/18/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Tracking Face-to Face Encounters
Initial and renewal MOC Submissions	CMS-10565	Model of Care Matrix Upload Document for Initial Application and Renewal
Off-cycle Submission of Summaries (MOC Changes)	CMS-10565	Revised Model of Care Matrix Upload Document

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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: With respect to the following proposed changes, we project an overall burden increase of +2,928 hrs (4,660 hrs – 1,732 hrs currently approved) and an increase of +$215,829 to SNPs. This accounts for all existing MOC requirements as well as proposed requirements in CMS-4190-P. In response to changes legislated by the BBA of 2018 to section 1859(f) of the Act for C-SNPs and the application to all SNP types, we proposed to revise an number of MOC requirements in our Contract Year 2021 and 2022 Medicare Advantage and Part D proposed rule (CMS-4190-P). We also provided more definition and examples around what constitutes a substantive change regarding off-cycle MOC submission. We have also modified our burden estimates due to the new MOC care management requirements. To account for the additional care management requirements, including the face-to-face encounter and MOC resubmissions for those SNPs that do not meet the minimum thresholds, we have increased the estimate in both burden hours and overall costs for SNPs. Finally, we adjusted the number of initial and renewal MOC submissions from 220 to 273. We adjusted the number of Off-Cycle MOC submissions as well from 103 to 11 because the volume of submissions has significantly decreased due to the annual C-SNP MOC submission requirement.

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Annual Cost to Federal Government: $731,331

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: 03/06/2020

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