Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10184 Monthly Sample Selection List	Form and Instruction	Removed	Available
Form CMS-10184 Summary of Eligibility and Payment Review Findings	Form and Instruction	Removed	Repair queued
Form CMS-10184 Detailed Payment Review Findings	Form	Removed	Available
Form CMS-10184 Reporting Individual Payment Findings	Form	Removed	Available
Form CMS-10184 Review Findings	Form	Removed	Available
Form CMS-10184 Detailed Active Case Review Findings	Form	Removed	Available
Form CMS-10184 Reporting Individual Review Findings	Form	Removed	Available
Form CMS-10184 Monthly Sample Selection List	Form	Removed	Available
Form CMS-10184 Monthly Sampling Lists	Form	Removed	Available
Form CMS-10184 MEQC substitution Summary of Findings	Form and Instruction	Removed	Available
Form CMS-10184 Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction	Removed	Available
Form CMS-10184 MEQC substitution Detailed Case Review Findings	Form	Removed	Available
Form CMS-10184 MEQC Substitution	Form and Instruction	Removed	Available
Form CMS-10184 Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction	Removed	Available
CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 080224.docx	Supporting Statement A	Uploaded 2024-08-28	Repair queued
CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 080224.docx	Supporting Statement A	Uploaded 2024-08-28	Available
CMS - 10184 - Supporting Statement - Part B - Eligibility.docx	Supporting Statement B	Uploaded 2024-08-23	Repair queued
CMS - 10184 - Supporting Statement - Part B - Eligibility.docx	Supporting Statement B	Uploaded 2024-08-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46149	Corrective Action Report		Unchanged
46148	Summary of Eligibility and Payment Review Findings	Form and Instruction	Removed	Monthly Sample Selection List
46148	Summary of Eligibility and Payment Review Findings	Form and Instruction	Removed
46147	Reporting Individual Payment Findings	Form	Removed	Detailed Payment Review Findings
46147	Reporting Individual Payment Findings	Form	Removed
46146	Reporting Individual Review Findings	Form	Removed	Review Findings
46146	Reporting Individual Review Findings	Form	Removed	Detailed Active Case Review Findings
46146	Reporting Individual Review Findings	Form	Removed
46145	Communications and Review Support		Unchanged
46144	Monthly Sampling Lists	Form	Removed	Monthly Sample Selection List
46144	Monthly Sampling Lists	Form	Removed
46143	Pre-cycle Report		Unchanged
193769	Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction	Removed	MEQC substitution Summary of Findings
193769	Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction	Removed
190303	Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form	Removed	MEQC substitution Detailed Case Review Findings
190303	Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction	Removed	MEQC Substitution
190303	Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction	Removed

ICR Details

OMB Control No: 0938-1012	ICR Reference No: 202408-0938-027
Status: Active	Previous ICR Reference No: 202405-0938-026
Agency/Subagency: HHS/CMS	Agency Tracking No: OFM -- IPPS
Title: Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/25/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/28/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise this collection. Any burden revisions should be considered and reflected between three connected CMCS PERM collections (OMB 0938-0994, 0938-0974, and 0938-1012)

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved
Responses	108	0	0
Time Burden (Hours)	36,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Improper Payments Information Act (IPIA) of 2002 requires CMS to produce national error rates for Medicaid and SCHIP. To comply with the IPIA, CMS needs the information to be collected in order to provide some Federal overview of state eligibility determinations to ensure correctness and consistency among states and to use the State-specific error rates as the basis for calculating national eligibility error rates for Medicaid and SCHIP.

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Authorizing Statute(s): PL: Pub.L. 107 - 300 2 Name of Law: The Improper Payments Information Act of 2002
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV34	Final or interim final rulemaking	89 FR 68986	08/28/2024

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Communications and Review Support
Corrective Action Report
Monthly Sampling Lists	CMS-10184	Monthly Sample Selection List
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	CMS-10184, CMS-10184	MEQC Substitution ,   MEQC substitution Detailed Case Review Findings
Pre-cycle Report
Reinstatement of Prior Burden Estimates for CMS-10184E	CMS-10184	MEQC substitution Summary of Findings
Reporting Individual Payment Findings	CMS-10184	Detailed Payment Review Findings
Reporting Individual Review Findings	CMS-10184, CMS-10184	Detailed Active Case Review Findings ,   Review Findings
Summary of Eligibility and Payment Review Findings	CMS-10184	Monthly Sample Selection List

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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	108	0	0	-1,475	0	1,583
Annual Time Burden (Hours)	36,000	0	0	-910,164	0	946,164
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The July 5, 2017, Final Rule (82 FR 31158) shifted costs and a significant hourly burden for conducting eligibility reviews from states (MEQC) to the Federal Government and its contractors (PERM). However, these changes would be largely offset by Federal government savings in reduced payments to states in matching funds. Hourly burden for states was significantly reduced due to the removal of the MEQC collection from the submission, which was estimated at 912,164 hours (946,164 total hours in most recent approved package, less PERM estimate of 34,000 Hours). MEQC has created a separate burden estimate for activities within CMS-319 OMB Control # - 0938-0147. Current burden estimate includes additional burden for inclusion of Puerto Rico in the amount of 2,000 hours for a total burden estimate of 36,000 hours. Prior approved cost of $26,044,672 has been reduced to $2,315,520 for a total of $23,729,152 reduction due to labor rate changes and reduction of hours mentioned.

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Annual Cost to Federal Government: $46,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 08/28/2024

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