Medicaid Managed Care and Supporting Regulations (CMS-10108)

Forms and Documents

Document Name	Status
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 Form	Modified
CMS-10108_Supporting Statement A (5-11-22).docx Supporting Statement A	2022-05-13

IC Document Collections

IC ID	Document Title	Status
8764	Medicaid Managed Care Regulations (States) 42 CFR 438.6, 438.10, 438.50, 438.202, 438.722, 438.724, and 438.810 Form	Modified
179886	Medicaid Managed Care Regulations (Private Sector) 42 CFR 438.8, 438.10, 438.12, 438.102, 438.207, 438.208, 438.210, 438.236, 438.240, 438.242, 438.404, and 438.416	Modified

ICR Details

OMB Control No: 0938-0920	ICR Reference No: 202205-0938-015
Status: Received in OIRA	Previous ICR Reference No: 202011-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Medicaid Managed Care and Supporting Regulations (CMS-10108)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/07/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2024
Responses	13,742,805	13,742,723
Time Burden (Hours)	1,682,411	1,682,083
Cost Burden (Dollars)	0	0

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Abstract: 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.

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Authorizing Statute(s): 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
  

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:
	87 FR 12458	03/04/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 28830	05/11/2022
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
Medicaid Managed Care Regulations (Private Sector) 42 CFR 438.8, 438.10, 438.12, 438.102, 438.207, 438.208, 438.210, 438.236, 438.240, 438.242, 438.404, and 438.416
Medicaid Managed Care Regulations (States) 42 CFR 438.6, 438.10, 438.50, 438.202, 438.722, 438.724, and 438.810	CMS-10108, CMS-10108, CMS-10108	Managed Care Program Annual Report (MCPAR) ,   MLR Reporting Tool ,   Network Adequacy and Access Assurances Tool

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ICR Summary of Burden

	Total Request	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	13,742,805	13,742,723	0	82	0	0
Annual Time Burden (Hours)	1,682,411	1,682,083	0	328	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: 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.

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Annual Cost to Federal Government: $59,561,736

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 06/07/2022

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