State Data for the Medicare Modernization Act (MMA) (CMS-10143)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10143 - Supporting Statement Part A (2023 version 5).docx	Supporting Statement A	Uploaded 2023-10-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8816	Monthly State File of Medicaid/Medicare Dual Eligible Enrollees	Instruction	Modified
235245	? 423.910 (One-time System Update)		Unchanged

ICR Details

OMB Control No: 0938-0958	ICR Reference No: 202310-0938-008
Status: Received in OIRA	Previous ICR Reference No: 202005-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No: FCHCO
Title: State Data for the Medicare Modernization Act (MMA) (CMS-10143)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/31/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2023
Responses	648	648
Time Burden (Hours)	5,856	5,856
Cost Burden (Dollars)	0	0

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Abstract: The Medicare Advantage Prescription Drug (MAPD) State User Guide contains technical guidance for the state and file layouts of the MMA Request (state sends to CMS) and Response (CMS returns to state) files. Please see the attached Crosswalk and Track Change version of the guide for details. The MMA request file identifies all dually eligible beneficiaries in the state for the current month. As noted above in section A1, the phase-down process requires a monthly count of all full-benefit dually eligible beneficiaries with a dual status code of 02, 04, and 08 and an active Part D plan enrollment in the month.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 1935(c) Name of Law: State phasedown
  

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 58281	08/25/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 73855	10/27/2023
Did the Agency receive public comments on this ICR? No

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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
Monthly State File of Medicaid/Medicare Dual Eligible Enrollees
§ 423.910 (One-time System Update)

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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	648	648	0	0	0	0
Annual Time Burden (Hours)	5,856	5,856	0	0	0	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:

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Annual Cost to Federal Government: $34,252

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.     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.     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: 10/31/2023

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