Medicare Advantage and Prescription Drug Plan Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Field Test (CMS-10793)

Forms and Documents

Document Name	Status
Form CMS-10793 MA-PD/PDP CAHPS Field Test Survey Form and Instruction	New
Form CMS-10793 MA-Only CAHPS Field Test Survey Form and Instruction	New
CMS-10793 Supporting Statement A.docx Supporting Statement A	2022-02-04
CMS Response to Public Comments Received for CMS-10793_1-26-22.docx Supplementary Document	2022-01-31
CMS-10793 Supporting Statement B.docx Supporting Statement B	2022-01-31

IC Document Collections

IC ID	Document Title	Status
251371	MA-PD/PDP CAHPS Field Test Survey Form and Instruction	New
251370	MA-Only CAHPS Field Test Survey Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202201-0938-021
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CMMI
Title: Medicare Advantage and Prescription Drug Plan Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Field Test (CMS-10793)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/07/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	5,000	0
Time Burden (Hours)	1,290	0
Cost Burden (Dollars)	0	0

---

Abstract: CMS has fielded the MA (Consumer Assessment of Healthcare Providers and Systems) CAHPS Survey annually since 1998 and the MA-PD and PDP CAHPS Surveys annually since 2006. The Medicare CAHPS is a national survey of health and prescription drug plans conducted at the contract level for MA-only, MA-PD, and PDP contracts. Medicare CAHPS provides data to permit preparation of plan performance measures to assist Medicare beneficiaries in their selection of a health and/or prescription drug plan and help policymakers and others assist the Medicare program and Medicare plans design and monitor patient-centered quality improvement initiatives. This request is to conduct a field test with the main goal of testing the effects of new survey content and a web-based mode on patterns of response and survey scores.

---

Authorizing Statute(s): US Code: 42 USC 1395w-104 Name of Law: Beneficiary protections for qualified prescription drug coverage
  

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:
	86 FR 62173	11/09/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 6565	02/04/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
MA-Only CAHPS Field Test Survey	CMS-10793	2022 Medicare Advantage Plan Survey Field Test Version
MA-PD/PDP CAHPS Field Test Survey	CMS-10793, CMS-10793	2022 Medicare Advantage Plan Survey Field Test Version ,   2022 Prescription Drug Plan Survey

---

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	5,000	0	0	0	5,000	0
Annual Time Burden (Hours)	1,290	0	0	0	1,290	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:

---

Annual Cost to Federal Government: $507,000

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.     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

---

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: 02/07/2022

---