Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)

Forms and Documents

Document Name	Status
Form CMS-10237 Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application Form and Instruction	Modified
CMS-10237 - CY 2018 Supporting Statement - Passback2.docx Supporting Statement A	2017-02-27
Final CY 2018 Consolidated Public comments for 60 day Part C App 10-20-16.pdf Supplementary Document	2016-11-03

IC Document Collections

IC ID	Document Title	Status
8785	Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0935	ICR Reference No: 201610-0938-011
Status: Historical Active	Previous ICR Reference No: 201509-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/28/2017
	Date Received in OIRA: 11/07/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	01/31/2019
Responses	310	0	500
Time Burden (Hours)	10,941	0	18,043
Cost Burden (Dollars)	0	0	0

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Abstract: In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
   US Code: 42 USC 1395mm Name of Law: null
   PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
  

Citations for New Statutory Requirements: None

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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:
	81 FR 44610	07/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 75409	10/31/2016
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
Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application	CMS-10237, CMS-10237, CMS-10237, CMS-10237	CY 2018 Part C - Medicare Advantage and 1876 Cost Plan Expansion Application ,   CY 2018 Medicare Advantage HSD Exception Request Template ,   CY 2018 Medicare Advantage Facility HSD Table ,   CY 2018 Medicare Advantage Provider HSD Table

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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	310	500	0	-190	0	0
Annual Time Burden (Hours)	10,941	18,043	0	-7,102	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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: CMS used the Contract Year (CY) 2017 data to estimate the number of projected applications/responses that we will receive for CY2018. For the CY2017 application cycle CMS noted an approximate 46% decrease in the SAE applications. We believe this decrease was attributed to the policy change which required SAE applicants to submit Health Service Delivery (HSD) tables for the entire provider network (both active and pending counties) that the plan was proposing to expand into with the SAE request. Previously in the CY 2016 application cycle SAE applicants were only required to submit HSD tables for the pending/proposed service areas. In addition, CMS noted an approximate 44% decrease in the number of SNP applications submitted when compared to CY 2016. We believe the reduction in the SNP applications in CY2017 was attributed to the policy change to remove the requirement for D-SNPs to submit applications based upon their subtypes. The technical/clarification changes are not anticipated to have any impact on the burden estimates for the CY 2018 MA application process. CMS believes the changes will assist applicants in enhancing their understanding of the application requirements and process. As such, there are no significant changes in the application content from CY2017 to CY 2018 therefore the burden is expected to remain constant for the applicant.

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Annual Cost to Federal Government: $1,944,079

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]? 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: 11/07/2016

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