This ICR is approved consistent with revised supporting statement and revised instruments, in response to public comments. Because the public specifically noted that it would have liked to have had the chance to comment on reporting requirements which CMS finalizes in its "technical specifications," CMS agrees to include the technical specifications document in the ICR package in the future and to make it available to the public during the public comment periods. ICR packages that do not contain this information and were not made available for public comment will be considered incomplete. CMS also understands that all burden-impacting changes--even technical changes like procedure and diagnosis codes that are revised annually--are subject to the PRA and require an opportunity for public comment before they are implemented. This includes changes that would require respondents to change their workflow processes or computer programs in order to accommodate those changes.
Inventory as of this Action
Requested
Previously Approved
12/31/2011
36 Months From Approved
12,709
0
0
286,944
0
0
0
0
0
CMS' regulatory authority to establish reporting requirements for Part C Medicare Advantage (MA) organizations is described in 42 CFR ?422.516 (a). It is noted that each MA organization must have an effective procedure to develop, compile, evaluate, and report to CMS, to its enrollees, and to the general public, at the times and in the manner that CMS requires, and while safeguarding the confidentiality of the doctor-patient relationship, statistics and other information with respect to the following:
(1) The cost of its operations.
(2) The patterns of utilization of its services.
(3) The availability, accessibility, and acceptability of its services.
(4) To the extent practical, developments in the health status of its enrollees.
(5) Other matters that CMS may require.
With both growth in the number of participating organizations and the types of plan "packages" available to Medicare beneficiaries, the need for more extensive, in depth, and effective monitoring has increased. Therefore, CMS is requesting a 3 year OMB approval of additional Part C data reporting.
CMS has received many inquiries pertaining to the performance of Medicare Advantage Organizations (MAOs). CMS has not been able to address many of these inquiries because of an absence of data. CMS needs to initiate data collection in these and other areas that have been the subject of recent inquiries by both governmental and private groups in order to improve its performance monitoring of MAOs. In response to this, CMS has identified a set of 13 measures for collection beginning in 2009. CMS is requesting a three-year Office of Management and Budget (OMB) approval of the reporting of these measures from MAOs. MAOs will be required to collect these data beginning on January 1, 2009. The supporting statement provides more elaboration on the reasons that these reporting requirements are needed including statutory and regulatory requirements. However, some of the changes include:
CMS included cost plans in its reporting requirements outlined in the Federal Register notice on June 26, 2008. After careful consideration, CMS has determined that because of the unique operation of cost plans, CMS will not require cost plans to comply with the following reporting requirements: benefit utilization; procedure frequency; and serious reportable adverse events. The other significant revisions to Part C reporting requirements are due to statutory and regulatory revisions that have occurred after June 26, 2008. Besides the 12 measures reported in the June 26, 2008 Federal Register Notice, in this notice, an additional measure has been added: Special Needs Plans (SNPs) Care Management. This measure was added because of Section 164 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires all SNPs to have an evidenced-based model of care with appropriate networks of providers and specialists. In addition, several measures , including agent commission structure, training and testing of agents, and plan oversight of agents, were revised as a result of MIPPA and the finalization of our regulation entitled, Medicare Program; Revisions to the Medicare Advantage and Prescription Drug Program" (CMS 4131-F)
$300,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666
No
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:
(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;
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.
Form CMS-10261 Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)
OMB.TRK.Comments-9-25-09..doc
TRK-Attachment III-changes.xls
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)