[Medicaid] Annual State Report on Value Based Purchasing Arrangements (VBP) Supplemental Rebate Agreements (CMS-10722)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10722 Annual State Report on CMS VBP Supplemental Rebate Agreements	Form	Modified	Available
Form CMS-10722 Annual State Report on CMS VBP Supplemental Rebate Agreements	Form	Modified	Repair queued
CMS-10722 - Supporting Statement A (2024 version 4).docx	Supporting Statement A	Uploaded 2024-05-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242409	Annual State Report on CMS VBP Supplemental Rebate Agreements	Form	Modified	Annual State Report on CMS VBP Supplemental Rebate Agreements
242409	Annual State Report on CMS VBP Supplemental Rebate Agreements	Form	Modified

ICR Details

OMB Control No: 0938-1385	ICR Reference No: 202405-0938-003
Status: Active	Previous ICR Reference No: 202106-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Annual State Report on Value Based Purchasing Arrangements (VBP) Supplemental Rebate Agreements (CMS-10722)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/07/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/03/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years. CMCS/Division of Pharmacy should demonstrate that they have published collected information ahead of the reapproval of this package.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	51	0	51
Time Burden (Hours)	306	0	306
Cost Burden (Dollars)	0	0	0

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Abstract: Under section 1902(a)(30)(A) of the Social Security Act, we are granted the authority to require that methods and procedures be established by states relating to the utilization of, and the payment for, care and services available under the state plan process (including but not limited to utilization review plans) as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that state payments to providers of Medicaid services are consistent with efficiency, economy, and quality of care. The reported data is being collected to safeguard against unnecessary utilization of such care and services and to assure that state payments to providers of Medicaid services are consistent with efficiency, economy, and quality of care. CMS will collect this data to ensure that VBP programs adopted by states continue to meet these standards.

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Authorizing Statute(s): US Code: 42 USC 1902(a)(30)(A) Name of Law: Social Security Act
  

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:
	89 FR 9155	02/09/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 31754	04/25/2024
Did the Agency receive public comments on this ICR? No

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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
Annual State Report on CMS VBP Supplemental Rebate Agreements	CMS-10722	Annual State Report on CMS VBP Supplemental Rebate Agreements

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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	51	51	0	0	0	0
Annual Time Burden (Hours)	306	306	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: $5,124

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: 05/03/2024

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