(CMS-10529) Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-64 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)	Form	Modified	Available
Form CMS-37 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37)	Form	Unchanged	Available
Form CMS-21 Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B)	Form and Instruction	Unchanged	Available
CMS-10529 - Supporting Statement A (CMS-2482-P version 4b).docx	Supporting Statement A	Uploaded 2020-06-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213568	Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)	Form	Modified
213567	Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37)	Form	Unchanged
213566	Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0938-1265	ICR Reference No: 202006-0938-014
Status: Historical Inactive	Previous ICR Reference No: 201901-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: (CMS-10529) Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64)
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: 11/02/2020
	Date Received in OIRA: 06/24/2020
Terms of Clearance: CMS shall ensure that this collection includes all of the information required by 5 CFR 1320.8(b)(3).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2021
Responses	672	0	672
Time Burden (Hours)	17,920	0	17,920
Cost Burden (Dollars)	0	0	0

---

Abstract: MBES/CBES is a financial reporting system that produces Budget and expenditures for Medical Assistance and Children's Health Insurance Program. All forms (CMS-21, -21B, -37, and -64) are to be filed on a quarterly basis and need to be certified by the States to the CMS.

---

Authorizing Statute(s): PL: Pub.L. 116 - 16 7 Name of Law: Medicaid Services Investment and Accountability Act of 2019
   PL: Pub.L. 115 - 123 53102 Name of Law: Bipartisan Budget Act of 2018
   PL: Pub.L. 111 - 148 2301, 2501, and 2703 Name of Law: Affordable Care Act of 2009 (ACA)
   PL: Pub.L. 111 - 152 4701 and 5001 Name of Law: Affordable Care Act of 2009 (ACA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT82	Proposed rulemaking	85 FR 37286	06/19/2020

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 37286	06/19/2020
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)	CMS-64, CMS-64	Medical Assistance Expenditures by Type of Service For the Medical Assistance Program ,   Unfilled Form
Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B)	CMS-21, CMS-21B	Quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI ,   Children's Health Insurance Program Budget Report for the Title XXI
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37)	CMS-37	Medicaid Program Budget Report

---

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: No

Burden Reduction Due to:

Short Statement: This 2020 information collection request is associated with our June 19, 2020, proposed rule (CMS-2482-P, RIN 0938-AT82). The rule proposes to implement provisions of Bipartisan Budget Act of 2018 (BBA 2018) which includes several provisions that modify COB and TPL in both statute and regulation related to special treatment of certain types of care and payment in Medicaid and Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Our changes are related only to the method states are required to use when reviewing and adjudicating claims for specific services. The BBA changes for which we are updating our regulation would require that states cost avoid claims when a liable third party is identified for a specific service that states were previously allowed to pay and chase. Since CMS-64 does not require expenditures to be reported by service type, the CMS-64 form does not require any such revisions. We estimate it would take 1 hour for a data entry/information processing worker to collect information on TPL and report that information to CMS on CMS-64 on a quarterly basis. In aggregate we estimate an added annual burden of 224 hours (1 hr/response x 4 responses/year x 56 respondents).

---

Annual Cost to Federal Government: $3,466,183

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

---

Common Form ICR:  No

---

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: 06/24/2020

---