As discussed
with CMS, any collection of information by CMS with regard to the
effort to collect coverage determinations and appeals information
for each of the 201 sponsoring organizations in the MA and Part D
programs prior to the approval of this package is in violation of
the Paperwork Reduction Act and will be noted in the Information
Collection Budget.
Inventory as of this Action
Requested
Previously Approved
04/30/2020
36 Months From Approved
04/30/2017
241
0
195
52,261
0
23,595
0
0
0
42 CFR 422.502 describes CMS'
regulatory authority to evaluate, through inspection or other
means, Medicare Advantage Part C organizations. These records
include books, contracts, medical records, patient care
documentation and other records that pertain to any aspect of
services performed, reconciliation of benefit liabilities, and
determination of amounts payable. 42 CFR 423.503 states that CMS
must oversee a Part D plan sponsor's continued compliance with the
requirements for a Part D plan sponsor. 423.514 states that the
Part D plan sponsor must have an effective procedure to develop,
compile, evaluate, and report to CMS, to its enrollees, and to the
general public, at the times and in the manner that CMS requires,
statistics regarding areas such as cost of operations, patterns of
utilization availability, accessibility, and acceptability of
services. CMS developed a strategy to address our oversight and
audit responsibilities within the context of limited
audit/oversight resources. We intend to combine all Part C and Part
D guides into one universal guide as it will promote efficiency and
effectiveness and reduce financial and time burdens for both CMS
and Medicare-contracting entities.
Statute at
Large: 18
Stat. 1857 Name of Statute: null
Statute at Large: 18
Stat. 1860 Name of Statute: null
Under Routine Audits, the total
hour burden has been adjusted from 121 hours to 701 hours to more
accurately reflect the entirety of the audit process. Additionally,
PACE organizations have been removed from this collection request
and will be submitted under a different PRA package, as the
collection instruments and burden estimates for this collection and
a PACE audit differ greatly. Additionally, ad hoc audits have been
removed from the burden estimate because ad hoc audits have not
exceeded 3 per year in the last 5 years and routine audits have not
exceeded 30 in the last 3 years. Therefore, we believe the total
number of 40 routine audits more accurately reflects the burden
associated with this collection. Consequently, the total burden has
been adjusted from 23,595 hours to 28,040 hours. Additionally, we
increased the number of respondents who will submit coverage
determinations, organization determinations and appeals universes,
as we will be conducting industry-wide monitoring of timeliness to
be used for Star Rating purposes. The changes to the burden are
reflected and discussed in this document. We have also prepared a
detailed crosswalk of all the changes to the burden, as well as
crosswalks detailing all changes to documents from the 60-day to
the 30-day comment period. Please see the crosswalks for
changes.
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-10191 Medicare Parts C and D Program Audit Protocols and Data Requests
2017_30_day_Comment_Response_Document_Passback1_032817 CLEAN.pdf
CMS-10191 - Supporting Statement A - Passback3 (002)_MOEG edits CLEAN.docx
Medicare Parts C and D Program Audit Protocols and Data Requests