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. The revised Part C application is created to capture the
applicants' information.
While there is an increase in
burden hours from the 2014 contract year (CY) by +1,374, the 30-day
package's revision to section 3.11 of the application does not
increase our burden estimate. The change is described below. PART C
-MEDICARE ADVANTAGE and 1876 COST PLAN EXPANSION APPLICATION: Based
on current internal review of the CY2014 burden estimates we are
revising them for CY2015. Specifically, an additional 15 hours of
burden was added to complete the Initial CCP, PFFS network, EGWP
application and an additional 2 hours of burden was added to
complete the SAE CCP, PFFS network, EGWP applications. The increase
in burden in not due to any statutory changes, regulatory changes
or public comments. Instead the increase reflects a more realistic
timeframe on how long it takes an applicant to complete the
applications mentioned above. CY2015 changes to application: 1. CMS
added new attestations to section 3.1. Waiver request will need to
be completed if the applicant attests "no" to the new attestation
(section 3.1 #3). 2. CMS added attestations after the 60 day
comment period for section 3.11. Attestations are related to
admitting privileges of contracted providers at contracted
facilities and pertaining to delivery of transplant services.
CY2015 changes to application after 60 day comment period by: 1.
Removing Section IV of Partial County Justification referring to
Provider Network Assessment for partial counties because this
section no longer applies due to the HPMS automated review of
partial county networks. 2. Removing Section 4.14 Partial County
Network Assessment Table because this table no longer applies due
to the HPMS automated review of partial county networks. PART C
-MEDICARE ADVANTAGE and 1876 COST PLAN EXPANSION
APPLICATION-Appendix 1 Special Needs Plan Proposal: 1.) Removing
the upload requirement for the D-SNP State Medicaid Agency Contract
Negotiation Status Document from the application. 2.) Removing
attestation #6, "Provide the State Medicaid contract begin date,
under the D-SNP State Medicaid Agency Contracts Attestation
section." 3.) Removing attestation #7, "Provide the State Medicaid
contract end date, under the D-SNP State Medicaid Agency Contracts
Attestation section." 4.) Removing attestation #8, "Does the
applicant want the State Medicaid Agency Contract to be reviewed to
determine if it qualifies as a FIDE SNP for the contract period(s)
identified in numbers 6 and 7", as it similar to Attestation #2
which says "Applicant wishes the contract with the State Medicaid
Agency(ies) to be reviewed to determine if it qualifies as a fully
integrated dual eligible SNP (FIDE)." 5.) Removing approximately
240 attestations from the Model of Care section. All of the changes
to Appendix 1 Special Needs Plan Proposal decrease burden by
approximately 1 hour.
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.
2015 Consolidated Public comment Part C App (response to 60day).xlsx
2015 High Levels Summary of Changes (30day) CLEAN 10-30-13.pdf
CMS-10237 - Supporting Statement for CY 2015 Applications [rev 10-31-2013 by OSORA PRA].doc
Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application