D-SNP Enrollee Advisory Committee and SNP Standardized Questions on Health Risk Assessments (CMS-10799)

Forms and Documents

Document Name	Status
CMS-10799 - Supporting Statement A (CMS-4192-P version 5).docx Supporting Statement A	2022-01-12

IC Document Collections

IC ID	Document Title	Status
251118	D-SNP Enrollee Advisory Committee and SNP Standardized Questions on Health Risk Assessments Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202201-0938-008
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: D-SNP Enrollee Advisory Committee and SNP Standardized Questions on Health Risk Assessments (CMS-10799)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/13/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	383	0
Time Burden (Hours)	10,769	0
Cost Burden (Dollars)	0	0

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Abstract: Section 1859(f)(5)(A)(ii)(I) of the Act requires each SNP to conduct an initial assessment and an annual reassessment of the individual’s physical, psychosocial, and functional needs. We previously codified this requirement at § 422.101(f)(1)(i) as a required component of the D-SNP’s model of care. In current practice, we allow each SNP to develop its own HRA, as long as it meets the statutory and regulatory requirements. We propose to amend § 422.101(f)(1)(i) to require that all SNPs (chronic condition special needs plans, D-SNPs, and institutional special needs plans) include one or more standardized questions on the topics of housing stability, food security, and access to transportation as part of their HRAs.

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Authorizing Statute(s): US Code: 42 USC 1856(b)(1), 1857(e), 1859(f)(5 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU30	Proposed rulemaking	87 FR 1842	01/12/2022

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 1842	01/12/2022
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
D-SNP Enrollee Advisory Committee and SNP Standardized Questions on Health Risk Assessments

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ICR Summary of Burden

	Total Request	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	383	0	0	383	0	0
Annual Time Burden (Hours)	10,769	0	0	10,769	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Our Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs rule (January 12, 2022; 87 FR 1842) (CMS-4192-P, RIN 0938-AU30) proposes to revise regulations related to dual eligible special needs plans (D-SNPs) and other special needs plans. This information collection request is for the proposed requirement at § 422.107(f) that any Medicare Advantage (MA) organization offering a D-SNP must establish one or more enrollee advisory committees in each State to solicit direct input on enrollee experiences. This information collection request also covers the proposed requirement at § 422.101(f)(1)(i) for all SNPs to include standardized questions on housing stability, food security, and access to transportation as part of their health risk assessments (HRAs). Overall, we estimate 383 respondents, 383 responses, and 10,769 hours.

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Annual Cost to Federal Government: $15,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? 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? No

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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: 01/13/2022

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