CMS-10680 - Supporting Statement B (2025 version 2) clean (1)

Supporting Statement – Part B

Collections of Information Employing Statistical Methods

Please note that survey responses will be reported based only on responses received. There is no intent to extrapolate findings to non-respondents. Thus, many of the statistical inference questions noted below are not applicable to this survey process.

1. Describe (including a numerical estimate) the potential respondent universe and any sampling or other respondent selection method to be used. Data on the number of entities (e.g., establishments, State and local government units, households, or persons) in the universe covered by the collection and in the corresponding sample are to be provided in tabular form for the universe as a whole and for each of the strata in the proposed sample. Indicate expected response rates for the collection as a whole. If the collection had been conducted previously, include the actual response rate achieved during the last collection.

The sample will be 100% of the potential respondent universe. The EVV compliance survey was disseminated to all 51 state Medicaid agencies (50 states and the District of Columbia) and the Medicaid agencies of five US territories. A sampling method will not be used. CMS is requesting the Medicaid Agency complete one survey for their state on their status of EVV implementation for PCS by January 1, 2020 and HHCS by January 1, 2023. States will be required to complete the survey in order to demonstrate that they are complaint with Section 1903(l) of the Social Security Act. The response rate is 100 percent. States are also required to resubmit surveys to CMS when there are changes to timelines that the state anticipates achieving compliance or when states implement programs under new Medicaid authorities for which EVV applies.

Survey troubleshooting, data collection, and analysis is conducted by the MBHPG staff. Information is currently collected through an electronic form-based survey submitted via e-mail. Respondents complete the survey by entering the requested data into fields in the form and when finished will submit the compliance survey to CMS via e-mail. The form collects the same exact information the previous web-based survey collected. Prior to implementation of the web-based survey, this information was not collected.

2. Describe the procedures for the collection of information including:

• Statistical methodology for stratification and sample selection,

N/A. Stratification and sampling will not be used.

• Estimation procedure,

N/A. Estimation procedure will not be used.

• Degree of accuracy needed for the purpose described in the justification,

N/A. This does not apply.

• Unusual problems requiring specialized sampling procedures, and

N/A. No specialized sampling procedures needed.

• Any use of periodic (less frequent than annual) data collection cycles to reduce burden.

Quarterly review of survey responses or survey updates as needed until compliance is met.

3. Describe methods to maximize response rates and to deal with issues of non-response. The accuracy and reliability of information collected must be shown to be adequate for intended uses. For collections based on sampling, a special justification must be provided for any collection that will not yield 'reliable' data that can be generalized to the universe studied.

CMS notified all states that it would begin using a form-based compliance survey to collect EVV data. For states that had demonstrated compliance, no updates were needed. For states that had not yet achieved compliance, the state Medicaid Agency contacts were notified via e-mail to complete a form-based survey and to submit it to the CMS EVV mailbox. States will be required to submit compliance surveys whenever states experience changes in compliance status or implement new Medicaid authorities that require EVV in order to demonstrate compliance with Section 1903(l) of the Social Security Act.

4. Describe any tests of procedures or methods to be undertaken. Testing is encouraged as an effective means of refining collections of information to minimize burden and improve utility. Tests must be approved if they call for answers to identical questions from 10 or more respondents. A proposed test or set of tests may be submitted for approval separately or in combination with the main collection of information.

There are no tests of procedures or methods that will be undertaken for this survey.

5. Provide the name and telephone number of individuals consulted on statistical aspects of the design and the name of the agency unit, contractor(s), grantee(s), or other person(s) who will actually collect and/or analyze the information for the agency.

Consultation was not specifically sought for the survey’s statistical aspects as data will not be extrapolated to represent non-responding states or waivers.

Data collection and analysis is performed by CMS DLTSS staff. Contact Information is as follows:

[email protected].

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