HEDIS Data Collection for Medicare Advantage (CMS-10219)

Forms and Documents

Document	Type	Status	Availability
CMS-10219 - HEDIS Supporting Statement A 712020.docx	Supporting Statement A	Uploaded 2020-07-01	Repair queued
HEDIS Crosswalk OMB Number 0938-1028 March 6 2020_508.pdf	Supplementary Document	Uploaded 2020-06-25	Repair queued
CMS-10219 - HEDIS Supporting Statement B.docx	Supporting Statement B	Uploaded 2020-06-25	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
181326	HEDIS Information Collection Request	Other-HEDIS® 2020 Measures and Descriptions for Medicare	Modified

ICR Details

OMB Control No: 0938-1028	ICR Reference No: 202006-0938-017
Status: Received in OIRA	Previous ICR Reference No: 201702-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: HEDIS Data Collection for Medicare Advantage (CMS-10219)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/01/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	677	515
Time Burden (Hours)	216,640	164,800
Cost Burden (Dollars)	0	0

---

Abstract: CMS has a responsibility to its Medicare beneficiaries to ensure that care provided by Medicare Advantage (MA) contracts to CMS is of high quality and conforms to currently acceptable standards of medical care. CMS accomplishes this through the collection, analysis and dissemination of HEDIS data, the most widely used standardized clinical performance measurement set in managed care. Since January 1997, Medicare managed care contracts have been required to annually report quality of care performance measures from HEDIS. In April 1997, CMS began working with NCQA to implement HEDIS data collection directly into the Medicare managed care program. It is critical to the agency's mission that CMS continues to collect and disseminate information that will help beneficiaries choose among health plans; information that contributes to better health care through the identification of quality improvement opportunities; and provides for proper oversight and management of the Medicare program. These data are used in external CMS information products issued to beneficiaries, and are published on the CMS public website. These data are also made publicly available through public use files (PUFs) posted on the CMS website. CMS relies heavily on HEDIS data for contractor surveillance and assessment activities. It is critical to the agency's mission that CMS continues to collect and disseminate information that will help beneficiaries choose among health plans; information that contributes to better health care through the identification of quality improvement opportunities; and provides for proper oversight and management of the Medicare program.

---

Authorizing Statute(s): US Code: 42 USC Sec. 1395w-22(e)(3)(A) Name of Law: Benefits and beneficiary protections
   Statute at Large: 18 Stat. 1852 Name of Statute: null
   PL: Pub.L. 108 - 173 722 (a)(3)(A)(i) Name of Law: MMA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 21010	04/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 39570	07/01/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
HEDIS Information Collection Request

---

ICR Summary of Burden

	Total Request	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	677	515	0	0	162	0
Annual Time Burden (Hours)	216,640	164,800	0	0	51,840	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: There have been very minor changes in the measurement set for HEDIS. Six measures are removed or retired and two measures are added. The two new measures relate to opioid prescribing, while the Body Mass Index measure and the Rheumatoid Arthritis measure are both removed due to being topped out. Four measures regarding descriptive information about the health plan have been removed since these data can be obtained through other sources. The hours and the costs are greater in this package because in 2017 there were 515 MAOs and in 2020 there are 677 MAOs.

---

Annual Cost to Federal Government: $526,138

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

---

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: 07/01/2020

---