Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project

Forms and Documents

Document Name	Status
Form CMS-10209 Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project Form and Instruction	Modified
CMS-10209.Response to 30 day comments on the QIP CCIP Tools_5-31-12.xlsx Supplementary Document	2012-06-20
CMS-10209_High_Level_Comment_Summary.pdf Supplementary Document	2011-11-14
CMS-10209_QIP_CCIP_Response_To_Comments(60-day).pdf Supplementary Document	2011-11-14
CMS-10209.REVISED Supporrting Statement Part A (05-31-12).docx Supporting Statement A	2012-06-20

IC Document Collections

IC ID	Document Title	Status
179877	Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1023	ICR Reference No: 201111-0938-008
Status: Historical Active	Previous ICR Reference No: 201007-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/21/2012
	Date Received in OIRA: 11/15/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved
Responses	1,904	0	0
Time Burden (Hours)	28,560	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Social Security Act, ?1852 e(1), (2) and (3)(a)(i), and regulations at Part 42, ?422.152 describe CMS' regulatory authority to require each Medicare Advantage Organization (MAO) coordinated care plan that offers one or more MA plans to have an ongoing quality assessment and performance improvement program. This program must include measuring performance using standard measures required by the Centers for Medicare and Medicaid Services (CMS), and report its performance to CMS.

---

Authorizing Statute(s): Statute at Large: 18 Stat. 1852 Name of Statute: null
  

Citations for New Statutory Requirements: None

---

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:
	76 FR 40370	07/08/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 68466	11/04/2011
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project	CMS-10209, CMS-10209	CCIP_Reporting_Tool ,   QIP_Reporting_Tool

---

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	1,904	0	0	0	1,116	788
Annual Time Burden (Hours)	28,560	0	0	0	9,648	18,912
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:

---

Annual Cost to Federal Government: $1,675,520

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

---

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: 11/15/2011

---