For-Profit PACE Study

Forms and Documents

Document Name	Status
Form CMS-10427 For-Profit PACE Study Form and Instruction	New
CMS-10427 Supporting_DocB_10 24 12.docx Supporting Statement B	2012-10-25
Response_to_Comments_60_FRN_07_09_2012.docx Supplementary Document	2012-07-17
Crosswalk CMS-10427.doc Supplementary Document	2012-07-18
06965_PACE_OMB_APP_A_06_20_12.docx Supplementary Document	2012-07-16
CMS-10427 Supporting_DocA_10 24 12.docx Supporting Statement A	2012-10-25

IC Document Collections

IC ID	Document Title	Status
203502	For-Profit PACE Study Form and Instruction	New

ICR Details

OMB Control No: 0938-1180	ICR Reference No: 201207-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: For-Profit PACE Study
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: 11/01/2012
	Date Received in OIRA: 07/27/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	24 Months From Approved
Responses	813	0	0
Time Burden (Hours)	447	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This OMB package requests clearance for an enrollee survey to support an evaluation of the for-profit Program of All-Inclusive Care of the Elderly (PACE) plans. The PACE program aims to provide integrated care and services to the frail elderly at risk of institutionalization to enable them to remain in the community. Under the Balanced Budget Act of 1997, the not-for-profit PACE plans were established as permanent providers under the Medicare and Medicaid programs. The BBA also mandated a demonstration of for-profit PACE plans. A 2005-2006 evaluation was conducted of the PACE program, but it focused solely on the not-for-profit PACE sites because no for-profit PACE plans were operational at that time. The objective of this evaluation is to evaluate the for-profit PACE plans; specifically to understand the extent of variation between the permanent not-for-profit PACE plans and the for-profit PACE plans. The evaluation will address the question of how access to and quality of care delivered to enrollees in for-profit PACE plans differ from not-for-profit PACE plans. The evaluation will analyze the outcome measures of access to and quality of care for enrollees of the not-for-profit and for-profit PACE plans. While the evaluation will use secondary data to identify comparable not-for-profit and for-profit PACE enrollee samples, primary data collection is necessary to obtain the data for the outcome measures. We will conduct a telephone survey of the sampled enrollees to collect data on the patient's health and functional status, access to and satisfaction with health care services, satisfaction with caregivers, and quality of life. The survey for this evaluation is adapted from the survey administered for the evaluation of the not-for-profit PACE programs.

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Authorizing Statute(s): PL: Pub.L. 105 - 33 4804 Name of Law: Balanced Budget Act of 1997
  

Citations for New Statutory Requirements: PL: Pub.L. 105 - 33 4804 Name of Law: Balanced Budget Act of 1997

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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:
	77 FR 20403	04/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40063	07/06/2012
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
For-Profit PACE Study	CMS-10427	PACE 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	813	0	813	0	0	0
Annual Time Burden (Hours)	447	0	447	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: $525

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]? No

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: 07/27/2012

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