Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)

Forms and Documents

Document Name	Status
Form CMS-10340 Submitter Authorization Form Form	Modified
Form CMS-10340 Submitter Application and Instructions Form and Instruction	Modified
Form CMS-10340 Electronic Data Interchange (EDI) Agreement Form	Modified
CMS-10340 - Supporting Statement A_Encounter Data PRA.docx Supporting Statement A	2021-05-03
United BCBSA_Response to Public Comments - CMS-10340_final.pdf Supplementary Document	2021-04-30
PRA Forms Revisions - Crosswalk_020121.csv Supplementary Document	2021-04-14
SSN Justification.pdf Supplementary Document	2017-08-29

IC Document Collections

IC ID	Document Title	Status
247095	Complete Certification	New
246826	Reviewing Encounter Data Submission Guidance Instruction	New
225030	PRS Contract and Contact Verification Form Instruction	Removed
225029	Connect: Direct Applications for RAPS, Encounter, PDE, and MMP Instruction	Modified
225027	Submitter Authorization Form Form	Modified
225026	Submitter Application and Instructions Form and Instruction	Modified
225025	Electronic Data Interchange (EDI) Agreement Form	Modified
199936	Encounter Data Submission Instruction	Modified

ICR Details

OMB Control No: 0938-1152	ICR Reference No: 202104-0938-010
Status: Received in OIRA	Previous ICR Reference No: 201612-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/03/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2021
Responses	1,068,205,855	769,396,692
Time Burden (Hours)	35,618,759	19,481
Cost Burden (Dollars)	0	0

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Abstract: CMS uses the risk adjustment data to develop individual risk scores for risk adjusted payment under Part C. As required by law, CMS also establishes the risk adjustment methodology and annually publishes the risk adjustment factors for MA organizations and other interested entities in the Advance Notice of Methodological Changes for MA Payment Rates (every February) and the Announcement of Medicare Advantage Payment Rates (every April). Risk adjustment data in particular is used to calibrate the CMS-HCC risk adjustment models using MA patterns of diagnoses, utilization, and expenditures. While establishing a risk adjustment model appropriate for the MA program is the paramount reason for collecting MA risk adjustment, there are other important uses of the data that will improve other key functions undertaken by CMS. Data is used for the calculation of Medicare Disproportionate Share Hospital (DSH) payments. CMS collects inpatient stay information for the Medicare managed care enrollees. In particular, we collect the admission date, discharge date, Health Insurance Claim Number (HICN), and Medicare hospital number/CCN. Further, we also use the data for quality review and improvement activities. For example, MA risk adjustment data may be used in the development and calculation of quality measures for MA organizations. Other uses for the data include geographical acuity studies, utilization trends and detection of abuse as defined in the False Claim Act. Additional uses for the data include verifying the accuracy and validity of the reasonable costs claimed on Cost Reports submitted by section 1876 Cost HMOs/CMPs and section 1833 HCPPs. Finally, as stated in the regulation, we use the data for Medicare coverage purposes. For example, we can use risk adjustment data for the determination of whether day limits have been exhausted and, if not, how many such days are left.

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Authorizing Statute(s): US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part D Payment
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
   US Code: 42 USC 1395w-23 Name of Law: Data Collection
  

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:
	86 FR 9348	02/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22438	04/28/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Complete Certification
Connect: Direct Applications for RAPS, Encounter, PDE, and MMP
Electronic Data Interchange (EDI) Agreement	CMS-10340	MAO Electronic Data Interchange (EDI) Agreement
Encounter Data Submission
PRS Contract and Contact Verification Form
Reviewing Encounter Data Submission Guidance
Submitter Application and Instructions	CMS-10340	CSSC Operations Submitter Application (Form and Instruction)
Submitter Authorization Form	CMS-10340	CSSC Operations Submitter Authorization Form

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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	1,068,205,855	769,396,692	0	45	298,809,118	0
Annual Time Burden (Hours)	35,618,759	19,481	0	11,791	35,587,487	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: The updated estimate is 35,606,814 total transaction hours. The total annual transaction hours have increased concurrent with significant enrollment growth in the MA program. There has been an overall increase in the number of encounter data submissions (1,068,204,429 in 2019 compared to an average of 769,389,091 (2015-2017)). CM replaced the Institutional, Professional, and DME companion guides with the Encounter Data Submission and Processing Guide, and update language within the package to reduce duplication and improve clarity. In addition, all Part D sponsors were required to complete a Payment Reconciliation System (PRS) Contract and Contact Verification Form to verify contracts and the appropriate contacts for receipt of the PRS reports. This form is no longer used, therefore, we have removed this form from this PRA package.

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Annual Cost to Federal Government: $18,700,000

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.     Yes

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.     Yes

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: 05/03/2021

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