| Title |
Target Rollout |
Attachment Type |
PRA Applicability |
Release |
# of Burden |
|
| Date |
None |
SPA |
Other (describe) |
(Y, N, or Unsure) |
Number |
Hours |
|
| CHIP Annual Report Templates (CARTS) (OMB-10398, OMB 0938-1148 #1) |
16-Jan |
|
|
Data Collection |
Y |
1 |
1,344 |
|
| Health Home SPA (CMS-10398, OMB 0938-1148 #22) |
16-Jan |
|
X |
|
Y |
1 |
2,240 |
|
| Medicaid and Adult Core Set Measures Reporting Template (CMS-10398, OMB 0938-1148 #26) |
16-Jan |
|
|
Data Collection |
Y |
1 |
1,456 |
|
| Medicaid Premium and Cost Sharing (CMS-10398, OMB 0938-1148 #29) |
16-Jan |
|
|
Data Collection |
Y |
1 |
280 |
|
| Maternal and Infant Health Quality (CMS-NEW, OMB 0938-NEW) |
16-Jan |
|
|
Data Collection |
Y |
1 |
112 |
|
| Health Home Core Set Measures (CMS-NEW, OMB 0938-NEW) |
16-Jan |
|
|
Data Collection |
Y |
1 |
2,240 |
|
| CHIP MACPro Templates (CMS-10398, OMB 0938-1148 #17) |
16-Jan |
|
X |
|
Y |
1 |
2,044 |
|
| Alternative Benefit Plans (CMS-10398, OMB 0938-1148 #18) |
16-Jan |
|
X |
|
Y |
1 |
728 |
|
| Medicaid State Plan |
|
|
| Admin |
Jun-16 |
|
X |
|
Y |
5 and 8 |
40 |
|
| Eligibility |
Jun-16 |
|
X |
|
Y |
5 |
20 |
|
| Premium and Cost Sharing |
Jun-16 |
|
X |
|
Y |
5 |
40 |
|
| Institutional Eligibility |
TBD |
|
X |
|
Y |
7 |
20 |
|
| Provider Admin |
TBD |
|
X |
|
Y |
8 |
40 |
|
| Plan Liens, Recoveries, TPL |
TBD |
|
X |
|
Y |
6 |
20 |
|
| Alternative Benefit Plan |
TBD |
|
X |
|
Y |
6 |
8 |
|
| Administrative Data |
TBD |
|
X |
|
Y |
8 |
20 |
|
| Benefits and Reimbursement |
TBD |
|
X |
|
Y |
6 |
20 |
|
| Service Delivery System |
TBD |
|
X |
|
Y |
7 |
20 |
|
| Recovery Audit Contractor |
Jun-16 |
|
X |
|
Y |
5 |
20 |
|
| 1915(i) HCBS |
TBD |
|
X |
|
Y |
6 |
20 |
|
| 1915(j) Personal Assistance Services |
TBD |
|
X |
|
Y |
7 |
20 |
|
| 1915(k) Community First Choice |
TBD |
|
X |
|
Y |
6 |
2 |
|
| Health Homes |
TBD |
|
X |
|
Y |
4 |
80 |
|
| CHIP State Plan |
|
|
| Admin |
Jun-16 |
|
X |
|
Y |
5 and 8 |
50 |
|
| Eligibility |
Jun-16 |
|
X |
|
Y |
5 |
50 |
|
| General Cost Sharing |
TBD |
|
X |
|
Y |
6 |
20 |
|
| General State Plan |
TBD |
|
X |
|
Y |
8 |
20 |
|
| Benefits and Reimbursement |
TBD |
|
X |
|
Y |
6 |
20 |
|
| Service Delivery System |
TBD |
|
X |
|
Y |
7 |
20 |
|
| Waivers and Demonstrations |
|
|
| 1115 Demonstrations |
TBD |
|
X |
|
Y |
8 |
40 |
|
| Performance Metrics and Database Analytics |
TBD |
|
X |
|
Y |
8 |
20 |
|
| 1915(c) HCBS |
TBD |
|
X |
|
Y |
7 |
40 |
|
| Managed Care - Quality Assurance |
TBD |
|
X |
|
Y |
7 |
20 |
|
| Managed Care - Cost Effectiveness |
TBD |
|
|
|
Y |
7 |
20 |
|
| Managed Care - Program Description and Operations (includes 1915(a) - (d)) |
TBD |
|
X |
|
Y |
7 |
20 |
|
| Managed Care - Contract Rate System & Rate Setting |
TBD |
|
X |
|
Y |
7 |
4 |
|
| Reporting |
|
|
| Balancing Incentive Program (BIP) |
TBD |
|
X |
|
Y |
5 |
20 |
|
| 372 Reporting |
TBD |
|
X |
|
Y |
7 |
43 |
|
| Payment Suspension |
Jun-15 |
|
X |
|
Y |
5 |
20 |
|
| Recovery Audit Contractor (RAC) Reporting |
Jun-15 |
|
X |
|
Y |
5 |
20 |
|
| Adult Quality Measures |
TBD |
|
X |
|
Y |
4 |
40 |
|
| CHIPRA Quality Measures |
TBD |
|
X |
|
Y |
4 |
40 |
|
| Health Home Quality Measures |
TBD |
|
|
Data Collection |
Y |
4 |
40 |
|
| HCBS Quality Measures |
TBD |
|
|
Data Collection |
Y |
8 |
40 |
|
| APD |
|
|
| Initial Advance Planning Document (IAPD) |
TBD |
|
|
|
Y |
8 |
48 |
|
| Planned Advance Planning Document (PAPD) |
TBD |
|
|
|
Y |
8 |
20 |
|
| State Medicaid HIT Plans (SMHP) |
TBD |
|
|
|
Y |
8 |
16 |
|
| Initial Application |
TBD |
|
|
|
Y |
All |
20 |
|
| FMAP |
TBD |
|
|
|
Y |
8 |
4 |
|
| Basic Health Plan |
TBD |
|
|
|
Y |
8 |
20 |
|
|
|
|
|
|
Total Hours |
|
1125 |
|
|
|
|
|
|
Avg. No States |
|
56 |
|
|
|
|
|
|
Burden Hours |
|
96,844 |
|