Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)

Forms and Documents

Document Name	Status
CMS-R-284 - Supporting Statement B rev 01-23-2019 FINAL PRA 01-18-2019 O....docx Supporting Statement B	2019-05-31
CMS-R-284 - Supporting Statement A (2019 version 3).docx Supporting Statement A	2019-06-24

IC Document Collections

IC ID	Document Title	Status
7980	Medicaid Statistical Information System (MSIS) Other-Data Dictionary	Removed
205266	Transformed - Medicaid Statistical Information System (T-MSIS) Other-Data Dictionary	Modified

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 201905-0938-019
Status: Active	Previous ICR Reference No: 201604-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)
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: 07/01/2019
	Date Received in OIRA: 05/31/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved	07/31/2019
Responses	660	0	788
Time Burden (Hours)	6,600	0	7,880
Cost Burden (Dollars)	0	0	0

---

Abstract: State data are reported by the federally mandated electronic process, known as MSIS is currently collecting eligibility and claim data in 5 separate files. These data are the basis of actuarial forecasts for Medicaid service utilization and costs; of analysis and cost savings estimates required for legislative initiatives relating to Medicaid and for responding to requests for information from CMS components, the Department, Congress and other customers. The expanded version of MSIS is now referred to as TMSIS will incorporate 3 additional files (Provider, Managed Care Plans, and Third Party Liability).

---

Authorizing Statute(s): PL: Pub.L. 105 - 32 4753 Name of Law: BBA
   PL: Pub.L. 108 - 173 103 Name of Law: MMA
   US Code: 42 USC 1935 Name of Law: Medicare Prescription Drugs
   PL: Pub.L. 114 - 148 6504 Name of Law: ACA
   US Code: 42 USC 1396b(r) Name of Law: MMIS
   US Code: 42 USC 1301 Name of Law: HIPAA Law
  

Citations for New Statutory Requirements: US Code: 45 USC 3434 Name of Law: HIPAA

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 4075	02/14/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 23794	05/23/2019
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Transformed - Medicaid Statistical Information System (T-MSIS)
Medicaid Statistical Information System (MSIS)

---

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	660	788	0	-176	48	0
Annual Time Burden (Hours)	6,600	7,880	0	-1,760	480	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: Miscellaneous Actions

Short Statement: In this 2019 iteration, we are: -Removing 1,760 hours of burden due to the decommissioning of MSIS and fully transitioning to T-MSIS. -Adjusting the number of T-MSIS respondents from 51 to 55. This change accounts for the addition of two territories (Puerto Rico and Virgin Islands) and two program entities (Iowa CHIP and Pennsylvania CHIP). -Adding the Record Segment Definitions document.

---

Annual Cost to Federal Government: $15,620,540

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  No

---

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: 05/31/2019

---