Appeals of Quality Bonus Payment Determinations

Forms and Documents

Document Name	Status
CMS-10346.REVISED Supporting Statement Part A (3-29-11).doc Supporting Statement A	2011-04-18

IC Document Collections

IC ID	Document Title	Status
195883	Appeals of Quality Bonus Payment Determinations (CMS-10346)	New

ICR Details

OMB Control No: 0938-1129	ICR Reference No: 201101-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Appeals of Quality Bonus Payment Determinations
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 with change	Conclusion Date: 05/06/2011
	Date Received in OIRA: 01/05/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved
Responses	25	0	0
Time Burden (Hours)	200	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1853(o) of the Social Security Act requires us to make Quality Bonus Payments (QBPs) to Medicare Advantage (MA) organizations that achieve performance rating scores of at least 4 stars under a five star rating system. Beginning in 2012, the star ratings we assign for purposes of QBPs under section 1858(o) of the Act will directly affect the monthly payment amount MA organizations receive from us under their contracts. In effect, this information collection request addresses a review process through which MA organizations may seek review of determinations governing their star rating ("QBP status") when the MA organization's rating is less than 4 stars. Regarding the appeals process, MA organizations have 5 calendar days from the date of CMS' release of its QBP determinations to request a technical report from CMS explaining the development of their QBP status. The technical report will be provided in writing by electronic mail to the MA organization and CMS within 30 days of CMS' receipt of the organization's request for the report by the technical report contractor. If, after reviewing the technical report, the MA organization believes that CMS was incorrect in its QBP determination, within 7 calendar days, the MA organization may request an appeal to be conducted by a hearing officer designated by CMS. The hearing officer's decision would be final and binding on both the MA organization and CMS. The hearing officer will be required to issue his/her decision on or before May 15 of the year preceding the year in which the plans for which the QBP is to be applied will be offered.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1853 Name of Statute: null
   Statute at Large: 18 Stat. 1856 Name of Statute: null
   PL: Pub.L. 111 - 152 1102 Name of Law: Medicare Advantage Payments
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 152 1102 Name of Law: Medicare Advantage Payments

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ00	Final or interim final rulemaking	76 FR 21432	04/15/2011

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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: 1

IC Title	Form No.	Form Name
Appeals of Quality Bonus Payment Determinations (CMS-10346)

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ICR Summary 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	25	0	25	0	0	0
Annual Time Burden (Hours)	200	0	200	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: CMS is proposing a review process through which MA organizations may seek review of determinations governing their star rating ("QBP status") when the MA organization's rating is less than 4 stars.

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Annual Cost to Federal Government: $1,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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? Uncollected

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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: 01/05/2011

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