Medicaid Managed Care and Supporting Regulations (CMS-10108)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10108 Network Adequacy and Access Assurances Tool	Form and Instruction	Modified	Available
Form CMS-10108 MLR Reporting Tool	Form	Modified	Available
Form CMS-10108 Managed Care Program Annual Report (MCPAR)	Form	Modified	Available
Form CMS-10108 Medicaid Managed Care Regulations (States)	Form	Modified	Repair queued
CMS-10108_Supporting Statement A (2023 version 9).docx	Supporting Statement A	Uploaded 2023-05-03	Repair queued
Response to public comments (2023 version 3).docx	Supplementary Document	Uploaded 2023-05-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8764	Medicaid Managed Care Regulations (States)	Form and Instruction	Modified	Network Adequacy and Access Assurances Tool
8764	Medicaid Managed Care Regulations (States)	Form	Modified	MLR Reporting Tool
8764	Medicaid Managed Care Regulations (States)	Form	Modified	Managed Care Program Annual Report (MCPAR)
8764	Medicaid Managed Care Regulations (States)	Form	Modified
8764	Medicaid Managed Care Regulations (States)	Other-Contract Portal	Modified
179886	Medicaid Managed Care Regulations (Private Sector)		Modified

ICR Details

OMB Control No: 0938-0920	ICR Reference No: 202304-0938-003
Status: Historical Active	Previous ICR Reference No: 202205-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Medicaid Managed Care and Supporting Regulations (CMS-10108)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/03/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	06/30/2025
Responses	13,743,255	0	13,742,805
Time Burden (Hours)	1,682,636	0	1,682,411
Cost Burden (Dollars)	0	0	0

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Abstract: These information collections requirements implement regulations that allow states greater flexibility to implement mandatory managed care programs, implement new beneficiary protections, and eliminate certain requirements viewed by state agencies as impediments to the growth of managed care programs. Information collected includes information about managed care programs, grievances and appeals, enrollment broker contracts, and managed care organizations capacity to provide health care services.

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Authorizing Statute(s): US Code: 42 USC 438.414 Name of Law: Information about the grievance system to providers
   US Code: 42 USC 438.416 Name of Law: Record keeping and reporting requirements
   US Code: 42 USC 438.604 Name of Law: Data that must be certified
   US Code: 42 USC 438.710 Name of Law: Due process: Notice of sanction and pre-determination hearing
   US Code: 42 USC 438.408 Name of Law: Resolution and notification: Grievances and appeals
   US Code: 42 USC 438.722 Name of Law: Disenrollment during termination hearing process
   US Code: 42 USC 438.724 Name of Law: Notice to CMS
   US Code: 42 USC 438.810 Name of Law: Expenditures for enrollment broker services
   US Code: 42 USC 438.10 Name of Law: Information Requirements
   US Code: 42 USC 438.6 Name of Law: Contract Requirements
   US Code: 42 USC 438.12 Name of Law: Provider Discrimination prohibited
   US Code: 42 USC 438.50 Name of Law: State Plan Requirements
   US Code: 42 USC 438.56 Name of Law: Disenrollment: Requirements and limitations
   US Code: 42 USC 438.102 Name of Law: Provider-enrollee communications
   US Code: 42 USC 438.114 Name of Law: Emergency and post-stabilization services
   US Code: 42 USC 438.202 Name of Law: State responsibilities
   US Code: 42 USC 438.204 Name of Law: Elements of State quality strategies
   US Code: 42 USC 438.8 Name of Law: Provisions that apply to PIHPs and PAHPs
   US Code: 42 USC 438.206 Name of Law: Availablity of services
   US Code: 42 USC 438.207 Name of Law: Assurances of adequate capacity and services
   US Code: 42 USC 438.242 Name of Law: Health information systems
   US Code: 42 USC 438.402 Name of Law: General requirements
   US Code: 42 USC 438.240 Name of Law: Quality assessment and performance improvement program
   US Code: 42 USC 438.404 Name of Law: Notice of Action
   US Code: 42 USC 438.406 Name of Law: Handling of grievances and appeals
   US Code: 42 USC 438.410 Name of Law: Expedited resolution of appeals
  

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:
	88 FR 2625	01/17/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 19957	04/04/2023
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
Medicaid Managed Care Regulations (Private Sector)
Medicaid Managed Care Regulations (States)	CMS-10108, CMS-10108, CMS-10108	Managed Care Program Annual Report (MCPAR) ,   MLR Reporting Tool ,   Network Adequacy and Access Assurances Tool

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	13,743,255	13,742,805	0	450	0	0
Annual Time Burden (Hours)	1,682,636	1,682,411	0	225	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 2023 collection of information request proposes to add burden for a new submission process, via online portal, for states to submit contracts to CMS per § 438.3(a) and to note an omission from prior packages for the burden for states to submit their managed care plan contracts via email. Overall, this iteration adds 450 responses and 225 hours. We are not proposing any changes to our three active templates: -Managed Care Program Annual Report (MCPAR), -Medical Loss Ratio (MLR) Reporting Template, and -Network Adequacy and Access Assurances Tool.

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Annual Cost to Federal Government: $61,324,880

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? 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: 05/03/2023

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