Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD ) (CMS-10385)

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
197257	Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD) (CMS-10385)	New

ICR Details

OMB Control No: 0938-1125	ICR Reference No: 201104-0938-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD ) (CMS-10385)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 04/13/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/13/2011
	Date Received in OIRA: 04/12/2011
Terms of Clearance: Approved with the understanding that the associated final rule will act as the 60-day notice for the regular ICR following this emergency approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	6 Months From Approved
Responses	168	0	0
Time Burden (Hours)	840	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Patient Protection and Affordable Care Act (the Affordable Care Act) applies new Medicaid eligibility and enrollment business rules for seamless coordination between the Medicaid and CHIP programs, and the Health Insurance Exchanges, known as "the Exchanges". In cases where the State's Medicaid Management Information System (MMIS), State's Eligibility System(s), or State's Exchange requires the support of system development and/or enhancement activities, States are eligible to receive FFP at the enhanced rate, if the system(s) will be designed and implemented to meet the seven standards and conditions. CMS has developed the Expedited Checklist: Medicaid Eligibility & Enrollment Information System(s) - Advance Planning Document (E&E-APD) specific to this purpose, for eligibility and enrollment system developments for State convenience.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): US Code: 19 USC 1903(a) and (b) Name of Law: MMIS Section; FFP
   US Code: 19 USC 1903(r) Name of Law: MMIS Section; FFP
  

Citations for New Statutory Requirements: US Code: 19 USC 1903(r) Name of Law: MMIS Section; FFP
US Code: 19 USC 1903(a) and (b) Name of Law: MMIS Section; FFP

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

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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
Expedited Checklist: Medicaid Eligibility & Enrollment Systems - Advance Planning Document (E&E-APD) (CMS-10385)

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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	168	0	168	0	0	0
Annual Time Burden (Hours)	840	0	840	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: This is a new collection.

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Annual Cost to Federal Government: $34,188

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: 04/12/2011

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