Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10843.PRA Comments and Responses from CMS-0057-P.docx	Supplementary Document	Uploaded 2024-02-14	Repair queued
CMS-10843_Supporting Statement Part A (final rule).docx	Supporting Statement A	Uploaded 2024-02-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257431	Implementation and Maintenance of the Provider Access API, Payer-to-Payer API, and PARDD API and Related Collections		Modified

ICR Details

OMB Control No: 0938-1437	ICR Reference No: 202402-0938-005
Status: Active	Previous ICR Reference No: 202212-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: OBRHI
Title: Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/21/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/14/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved
Responses	365	0	0
Time Burden (Hours)	6,896,438	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This proposed rule would place new requirements on Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data, and streamline processes related to prior authorization, while continuing CMS’ drive toward interoperability, and reducing burden in the health care market. This proposed rule would also add new requirements for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System eligible clinicians participating in the Promoting Interoperability performance category of the Quality Payment Program. These policies taken together play a key role in reducing overall payer and provider burden and improving patient access to health information.

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Authorizing Statute(s): EO: EO 13813 Name/Subject of EO: Promoting Healthcare Choice and Competition
   US Code: 42 USC 1395w-4(q)(2) Name of Law: Social Security Act
   US Code: 42 USC 1395w-22(h) Name of Law: Social Security Act
   US Code: 42 USC 1395w-22(g)(1) Name of Law: Social Security Act
   US Code: 42 USC 1396(a)(6) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: EO: EO 13813 Name/Subject of EO: Promoting Healthcare Choice and Competition
US Code: 42 USC 1395w-4(q)(2) Name of Law: Social Security Act
US Code: 42 USC 1395w-22(h) Name of Law: Social Security Act
US Code: 42 USC 1395w-22(g)(1) Name of Law: Social Security Act
US Code: 42 USC 1396(a)(6) Name of Law: Social Security Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU87	Final or interim final rulemaking	89 FR 8758	02/08/2024

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Implementation and Maintenance of the Provider Access API, Payer-to-Payer API, and PARDD API and Related Collections

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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	365	0	365	0	0	0
Annual Time Burden (Hours)	6,896,438	0	6,893,025	3,413	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 information collection request.

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Annual Cost to Federal Government: $79,300,000

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: 02/14/2024

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