Medicare Health Care Quality (MHCQ) Demonstration Evaluation: Focus Group and Interview Protocols (CMS-10497)

Forms and Documents

Document Name	Status
Form CMS-10497 Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols - MHS Form and Instruction	New
Form CMS-10497 Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols--GHS Form and Instruction	New
Supporting Statement -- Version 08-01-13.docx Supporting Statement A	2013-11-25

IC Document Collections

IC ID	Document Title	Status
209608	Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols - MHS Form and Instruction	New
209607	Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols--GHS Form and Instruction	New

ICR Details

OMB Control No: 0938-1263	ICR Reference No: 201312-0938-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21021
Title: Medicare Health Care Quality (MHCQ) Demonstration Evaluation: Focus Group and Interview Protocols (CMS-10497)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/03/2014
	Date Received in OIRA: 12/06/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved
Responses	36	0	0
Time Burden (Hours)	108	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Medicare Health Care Quality (MHCQ) Demonstration was developed to address concerns about the current payment methodology in the U.S. health care system, which typically fragments care while also encouraging both omissions in and duplication of care. To rectify this situation, Congress directed the Centers for Medicare & Medicaid Services (CMS) to test major changes to the delivery and payment systems to improve the quality of care while also increasing efficiency across the health care system. Focus groups and interviews will occur at the Gundersen Health System (GHS) and the Meridian Health System (MHS) demonstration sites.

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Authorizing Statute(s): US Code: 42 USC 1395cc 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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 51730	08/21/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 67150	11/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols--GHS	CMS-10497, CMS-10497, CMS-10497, CMS-10497, CMS-10497	GHS Beneficiary FG Recruitment Script ,   GHS Caregiver FG Recruitment Script ,   GHS FG Inform Consent ,   GHS Beneficiaries Protocol ,   GHS Caregivers Protocol
Medicare Health Care Quality (MHCQ) Demonstration Evaluation Focus Group and Interview Protocols - MHS	CMS-10497, CMS-10497, CMS-10497, CMS-10497, CMS-10497	MHS Beneficiary Recruitment Script ,   MHS Caregiver FG Recruitment Script ,   MHS Focus Group Inform Consent ,   MHS Caregivers Protocol ,   MHS Beneficiaries Protocol

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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	36	0	0	36	0	0
Annual Time Burden (Hours)	108	0	0	108	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: This is a new collection.

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Annual Cost to Federal Government: $60,868

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

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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: 12/06/2013

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