Community Based Care Transitions Program (CCTP) Implementation and Monitoring

Forms and Documents

Document Name	Status
Form CMS-10403 Initial and Terminal Administration of the Survey Form and Instruction	New
CMS-10403.Supporting Statement Part B.docx Supporting Statement B	2011-10-25
Appendix A Section 3026 Affordable Care Act.pdf Supplementary Document	2011-10-25
Appendix C july 22 2011 FRN 60 day.pdf Supplementary Document	2011-10-25
CMS-10403.Supporting Statement Part A final 06 01 12.docx Supporting Statement A	2012-06-15

IC Document Collections

IC ID	Document Title	Status
199899	Initial and Terminal Administration of the Survey Form and Instruction	New

ICR Details

OMB Control No: 0938-1167	ICR Reference No: 201110-0938-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Community Based Care Transitions Program (CCTP) Implementation and Monitoring
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: 06/21/2012
	Date Received in OIRA: 10/25/2011
Terms of Clearance: This collection is approved for a three-month pilot as described in supporting statement A. At the conclusion of the pilot, CMS may use a non-substantive change request to seek approval for the full data collection effort as outlined in the supporting statements originally submitted to OMB for review under this package. Any such request should include a brief progress report uploaded as a supplementary document that describes the results of the pilot as well as any changes sought in the full data collection arising from CMS' experience with the pilot.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	36 Months From Approved
Responses	1,900	0	0
Time Burden (Hours)	475	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Medicare Community-Based Care Transitions Program (CCTP), authorized by Section 3026 of the 2010 Affordable Care Act, is a major component of the Partnership for Patients initiative, one goal of which is to decrease preventable complications during transition from a care setting, such as a hospital, to home, community, or another care setting. Appendix A contains a copy of the relevant portion of the legislation. The CCTP will provide funding to test models for improving care transitions from the hospital to the community for high-risk Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) initiated the CCTP in early 2011 and will operate the program for five years. Congress has authorized $500 million to cover the cost of the program. CMS expects that program agreements will be in place to authorize community-based organizations (CBOs), in partnership with acute care hospitals, to begin providing care transition services in November 2011 and, if successful, continue doing so for up to five years. The planned collection of a participant experience survey is part of the implementation and monitoring strategy that will review the performance of organizations contracted to provide transitional care services under the CCTP. This clearance package seeks approval for the participant experience survey.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3026 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3026 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 44009	07/22/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 65514	10/21/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Initial and Terminal Administration of the Survey	CMS-10403, CMS-10403, CMS-10403, CMS-10403, CMS-10403	CCTP - 1st Administration ,   CCTP - 2nd Administration ,   CCTP -Spanish Version ,   CCTP 2nd Admin ,   CCTP 1st Admin Participant Exp Survey

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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	1,900	0	1,900	0	0	0
Annual Time Burden (Hours)	475	0	475	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 information collection

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Annual Cost to Federal Government: $960,850

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

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: 10/25/2011

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