The PACE Organization (PO) Monitoring and Audit Process in Part 460 of 42 CFR (CMS-10630)

ICR 202205-0938-008

OMB: 0938-1327

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2022-05-10
Supplementary Document
2022-05-09
Supplementary Document
2022-05-09
Supplementary Document
2022-05-09
IC Document Collections
IC ID
Document
Title
Status
225129 Modified
ICR Details
0938-1327 202205-0938-008
Received in OIRA 201911-0938-013
HHS/CMS CM-CPC
The PACE Organization (PO) Monitoring and Audit Process in Part 460 of 42 CFR (CMS-10630)
Revision of a currently approved collection   No
Regular 05/10/2022
  Requested Previously Approved
36 Months From Approved 02/28/2023
40 35
31,200 21,000
0 0

42 CFR 460.190 and 460.192 described CMS’s regulatory authority to monitor, through audit or other means, the Programs for All-Inclusive Care of the Elderly (PACE). This monitoring includes review of books, contracts, medical records, patient care documentation and any other records that pertain to any aspect of services performed, reconciliation of benefit liabilities, and determination of amounts payable. CMS developed a strategy to address our oversight and audit responsibilities. We have combined both the trial year and ongoing audit protocols into one universal audit protocol that is streamlined and outcomes based to reduce the financial and administrative burdens for both CMS and PACE organizations.

US Code: 42 USC 1395eee Name of Law: Social Security Act
   US Code: 42 USC 1396u–4 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 72244 12/21/2021
87 FR 28014 05/10/2022
Yes

1
IC Title Form No. Form Name
Trial Year and Routine Audits CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template ,   Appeals Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Summary of any pre-audit issues ,   PACE Supplemental Questionnaire ,   PACE Audit Process and Data Request Protocol ,   Corrective Action Plan (CAP) Process ,   Audit Survey ,   Service Delivery Request and Appeals Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Grievances Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Personnel Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Root Cause Analysis Template ,   Service Delivery Request Impact Analysis Template ,   Service Delivery Request Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Coordination of Care ,   Required Services ,   Special Recommendations

  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 40 35 0 5 0 0
Annual Time Burden (Hours) 31,200 21,000 0 10,200 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Burden has increased to due to an increase in participation POs (135 to 140), data collection instruments increased from 22 to 24 documents and increase regarding the timeframe for administration of the audit. As a result, the total number of hours spent on audit from 2020 to 2023 will increase from 600 hours total to 780 hours total per PO.

$9,950,090
No
    No
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/10/2022


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