CMS-10692 - Supporting Statement B

Supporting Statement – Part B

Collections of Information Employing Statistical Methods

Home and Community Based Services (HCBS) Incident Management Survey

Please note that survey responses will be reported based only on responses received. There is no intent to extrapolate findings to non-respondents. Thus, many of the statistical inference questions noted below are not applicable to this survey process.

1 . Describe (including a numerical estimate) the potential respondent universe and any sampling or other respondent selection method to be used. Data on the number of entities (e.g., establishments, State and local government units, households, or persons) in the universe covered by the collection and in the corresponding sample are to be provided in tabular form for the universe as a whole and for each of the strata in the proposed sample. Indicate expected response rates for the collection as a whole. If the collection had been conducted previously, include the actual response rate achieved during the last collection.

The sample will be 100% of the potential respondent universe. The HCBS Incident Management Survey will be disseminated to all 51 state Medicaid agencies (including the District of Columbia) to assess incident management systems in 1915(c) waivers. A sampling method will not be used. CMS is requesting states complete a survey for each HCBS 1915(c) waiver operating in the state, and is requesting that the operating agency complete the survey for the respective waiver with input from the State Medicaid Agency. As noted in the survey, if incident management systems are aligned across waivers or the same individual is responsible for multiple waivers, the survey will allow the state to indicate such and complete the survey only once if it applies to multiple waivers. On average, there are over 270 waivers at a given time: each state has approximately five 1915(c) waivers. Although it is not precisely known how many distinct incident management systems are in operation throughout the country, some states employ the same incident management system across their waivers and therefore will require only one survey response, while others employ an incident management system specific to each waiver and will require multiple responses. Based on the results of a pilot survey, it is estimated that states will submit on average two responses each, totaling approximately 102 different respondents from 50 states and DC. Based on the past release of an unrelated survey that was similar in scope, we anticipate the response rate to be 75 percent.

2. Describe the procedures for the collection of information including:

• Statistical methodology for stratification and sample selection, N/A. Stratification and sampling will not be used.

• Estimation procedure,

N/A. Estimation procedure will not be used.

• Degree of accuracy needed for the purpose described in the justification,

N/A. This does not apply.

• Unusual problems requiring specialized sampling procedures, and N/A. No specialized sampling procedures needed.

• Any use of periodic (less frequent than annual) data collection cycles to reduce burden. N/A. No use of periodic data collection cycles.

2. Describe methods to maximize response rates and to deal with issues of non-response. The accuracy and reliability of information collected must be shown to be adequate for intended uses. For collections based on sampling, a special justification must be provided for any collection that will not yield 'reliable' data that can be generalized to the universe studied.

The survey will be disseminated via an intuitive web-based tool to an up-to-date listserv of state Medicaid agency contacts. The tool allows CMS to identify non-respondents and send follow-up reminder emails. Individualized follow-up emails will be sent two weeks after the initial dissemination date, and every week thereafter to states that have yet to complete the survey.

The survey will be publicized via regularly scheduled Medicaid stakeholder webinars and states will be informed that the purpose of this survey is to help CMS identify best practices that states have adopted in reporting incidents, responding to reports, collecting information, training individuals involved in incident management, and employing tactics for preventing incidents, which in turn will help them improve incident reporting and prevention in their own states.

2. Describe any tests of procedures or methods to be undertaken. Testing is encouraged as an effective means of refining collections of information to minimize burden and improve utility. Tests must be approved if they call for answers to identical questions from 10 or more respondents. A proposed test or set of tests may be submitted for approval separately or in combination with the main collection of information.

There are no tests of procedures or methods that will be undertaken for this survey. Most of the responses to questions in this survey are multiple choice and select all that apply. To minimize confusion, we provide a standard list of definitions regarding key terms used throughout the survey to make sure that all respondents are using terms similarly.

2. Provide the name and telephone number of individuals consulted on statistical aspects of the design and the name of the agency unit, contractor(s), grantee(s), or other person(s) who will actually collect and/or analyze the information for the agency.

Consultation was not specifically sought for the survey’s statistical aspects as data will not be extrapolated to represent non-responding states or waivers. Lewis & Ellis, Inc. will lead data collection and analysis with the assistance of Navigant Consulting. Contact info is as follows:

Cabe Chadick, FSA, MAAA Senior Vice President & Principal

Lewis & Ellis, Inc. (972)-850-0850

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