Medicaid Managed Care and Supporting Regulations (CMS-10108)
Revision of a currently approved collection
No
Regular
06/07/2022
Requested
Previously Approved
36 Months From Approved
06/30/2024
13,742,805
13,742,723
1,682,411
1,682,083
0
0
These information collections requirements implement regulations that allow states greater flexibility to implement mandatory managed care programs, implement new beneficiary protections, and eliminate certain requirements viewed by state agencies as impediments to the growth of managed care programs. Information collected includes information about managed care programs, grievances and appeals, enrollment broker contracts, and managed care organizations capacity to provide health care services.
US Code:
42 USC 438.410
Name of Law: Expedited resolution of appeals
US Code:
42 USC 438.414
Name of Law: Information about the grievance system to providers
US Code:
42 USC 438.416
Name of Law: Record keeping and reporting requirements
US Code:
42 USC 438.604
Name of Law: Data that must be certified
US Code:
42 USC 438.710
Name of Law: Due process: Notice of sanction and pre-determination hearing
US Code:
42 USC 438.408
Name of Law: Resolution and notification: Grievances and appeals
US Code:
42 USC 438.722
Name of Law: Disenrollment during termination hearing process
US Code:
42 USC 438.724
Name of Law: Notice to CMS
US Code:
42 USC 438.810
Name of Law: Expenditures for enrollment broker services
US Code:
42 USC 438.10
Name of Law: Information Requirements
US Code:
42 USC 438.6
Name of Law: Contract Requirements
US Code:
42 USC 438.12
Name of Law: Provider Discrimination prohibited
US Code:
42 USC 438.50
Name of Law: State Plan Requirements
US Code:
42 USC 438.56
Name of Law: Disenrollment: Requirements and limitations
US Code:
42 USC 438.102
Name of Law: Provider-enrollee communications
US Code:
42 USC 438.114
Name of Law: Emergency and post-stabilization services
US Code:
42 USC 438.202
Name of Law: State responsibilities
US Code:
42 USC 438.204
Name of Law: Elements of State quality strategies
US Code:
42 USC 438.8
Name of Law: Provisions that apply to PIHPs and PAHPs
US Code:
42 USC 438.206
Name of Law: Availablity of services
US Code:
42 USC 438.207
Name of Law: Assurances of adequate capacity and services
US Code:
42 USC 438.242
Name of Law: Health information systems
US Code:
42 USC 438.402
Name of Law: General requirements
US Code:
42 USC 438.240
Name of Law: Quality assessment and performance improvement program
US Code:
42 USC 438.404
Name of Law: Notice of Action
US Code:
42 USC 438.406
Name of Law: Handling of grievances and appeals
The burden has increased slightly as two new burden estimates were added. These burden estimates accommodate the use of reporting templates for existing reporting requirements at 42 CFR 438.207(d) for network adequacy and access and 438.74 for medical loss ratio. The resulting increase is 328 hours.
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:
(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;
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.
Form CMS-10108 Medicaid Managed Care Regulations (States) 42 CFR 438.6, 438.10, 438.50, 438.202, 438.722, 438.724, and 438.810
CMS-10108_Supporting Statement A (5-11-22).docx
Medicaid Managed Care Regulations (States) 42 CFR 438.6, 438.10, 438.50, 438.202, 438.722, 438.724, and 438.810