SUPPORT for Patients and Communities Act Section 1003 Demonstration Evaluation (CMS-10786)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10786 Survey: Rounds 1 and 2	Form and Instruction	New	Repair queued
Form CMS-10786 Focus Group: Rounds 1 and 2	Form and Instruction	New	Repair queued
Responding to Public Comments 121321.docx	Supplementary Document	Uploaded 2022-02-22	Repair queued
CMS-10786 - Supporting Statement B (2022 version 2).docx	Supporting Statement B	Uploaded 2022-02-22	Repair queued
CMS-10786 - Supporting Statement A (2022 version 2).docx	Supporting Statement A	Uploaded 2022-02-22	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251708	Survey: Rounds 1 and 2	Form and Instruction	New
251706	Focus Group: Rounds 1 and 2	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202202-0938-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: SUPPORT for Patients and Communities Act Section 1003 Demonstration Evaluation (CMS-10786)
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: 02/23/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	28,810	0
Time Burden (Hours)	7,378	0
Cost Burden (Dollars)	0	0

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Abstract: To collect the information required by statute, the evaluation of the demonstration will include a survey (at 3,689 total hours per round) of MAT prescribers and focus groups (at 105 total hours per round) with Medicaid SUD treatment or recovery providers. The information collected from the provider surveys and focus groups will be used by the evaluation team, CMS, and its federal partners to inform the mandated Final Report to Congress regarding the SUPPORT Act section 1003 demonstration. All data will be reported at the aggregate level. The information collected from the provider surveys will be used to understand how MAT prescribing has changed during the demonstration, identify challenges to prescribing, and compare the incremental effect of the post-planning period, relative to those states who participated only in the planning period, on increased capacity for SUD treatment or recovery service delivery. The focus groups will provide strategic information on the impact of key aspects of implementation, such as perceived challenges associated with Medicaid enrollment or MAT delivery, access to referral placements, the value of state-provided technical assistance, and benefits and unanticipated outcomes experienced by providers during the demonstration. The data collected will allow for an understanding of challenges and facilitators to state demonstration implementation plans, as well as unintended consequences, both positive and negative, with respect to service delivery and demonstration outcomes.

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Authorizing Statute(s): PL: Pub.L. 115 - 271 1003 Name of Law: SUPPORT Act
  

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 53060	09/24/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 9625	02/22/2022
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Focus Group: Rounds 1 and 2	CMS-10786	Focus Group Participant Questionnaire
Survey: Rounds 1 and 2	CMS-10786	Survey of Medicaid Opioid Use Disorder Treatment Providers

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ICR Summary of Burden

table that charts list 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	28,810	0	0	28,810	0	0
Annual Time Burden (Hours)	7,378	0	0	7,378	0	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: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $51,841

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]? 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? Yes

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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: 02/23/2022

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