4. ICRs Regarding Verification Plan Submission and Updates (§ 435.557)

The following changes will be submitted to OMB for approval under control number 0938-1148 (CMS-10398 #11).

In section II.I. of this IFC, States are required to verify compliance, deemed compliance or status as a specified excluded individual for certain adults who are eligible for, or are enrolled in, Medicaid. Specifically, States must verify whether an applicant or beneficiary demonstrated community engagement, is deemed to have demonstrated community engagement for all or part of a month that the individual was in a mandatory or optional excepted status, or is a “specified excluded individual” to whom the community engagement requirement does not apply. Additionally, States are required to conduct ex parte verifications by maximizing reliance on electronic data sources in verifying compliance with the community engagement requirement, including deemed compliance, or that an individual is a “specified excluded individual” and in ( printed page 33432) what circumstances States may require individuals to provide additional information.

The regulation in § 435.945(j) requires States to “develop, and update as modified, and submit to the Secretary, upon request, a verification plan describing the verification policies and procedures adopted by the State agency to implement the provisions set forth in §§ 435.940 through 435.956,” which relate to the verification of income, assets and citizenship status, amongst other eligibility criteria. In this IFC, we incorporate this requirement for the purpose of verifying that an individual has met or is excluded from the community engagement requirement. As such, CMS has updated the MAGI verification plan to include a supplement specific to community engagement. States will be required to document and submit to CMS their verification plans describing how, consistent with Federal standards, the State will determine and verify:

Demonstration of compliance with the community engagement requirement.

Mandatory exceptions for deemed compliance.

Status as a specified excluded individual.

Optional exceptions for short-term hardship events for deemed compliance.

Use of ex parte processes and use of reliable data sources at both application and renewal, and more frequently at State option, including when the State will request information from individuals.

Controls to ensure consistency, timeliness, and proper documentation of determinations.

Section 1902(xx)(5) of the Act requires States to conduct ex parte verification of the community engagement requirement, directing States to verify compliance with, or exception (for deemed compliance) or exclusion from, the community engagement requirement using reliable information available to the State, including information in the individual's record and more recent information obtained from electronic data sources without requiring additional information from an applicant or a beneficiary. States must use reliable information available to the State to verify compliance with the community engagement requirement, which includes, but is not limited to, their existing data sources, the Federal Data Services Hub, or other data sources to determine income and other eligibility criteria. A State's own case records, claims systems or payments, or encounter data are also reliable information available to the State for purposes of verification requirements under Section 1902(xx)(5) of the Act.

To comply with the requirements for the verification plan, we estimate that each of the 43 States and the District of Columbia have a one-time burden of 124 hours to develop the verification plan. Of the 124 hours, we estimate that it will take 60 hours at $87.52/hr for a Business Operations Specialists to prepare the verification plan, 60 hours at $95.32/hr for an Operations Research Analyst to prepare and review the data, and 4 hours at $128.00/hr for a General and Operations Manager to review the data and submit the verification plan. In aggregate, we estimate a one-time burden of 5,456 hours (124 hr × 44 jurisdictions) at a cost of $505,226 (44 × [(60 hr × $87.52/hr) + (60 hr × $95.32/hr) + (4 hr × $128.00/hr)]). Accounting for the Federal administrative match of 50 percent, the requirement will cost States $252,613 ($505,226 × 0.50). We have summarized the total burden in Table 10.

Additionally, we assume recurring burden associated with updating and maintaining the initial verification plan supplement submission. We estimate 5 States per year will make verification plan updates. For each of these States, we estimate it will take 5 hours at $87.52/hr for a Business Operations Specialist and 5 hours at $95.32/hr for an Operations Research Analyst to update their verification plan. We also estimate that it will take 1 hour at $128.00/hr for General and Operations Managers to review the data and submit the verification plan. In aggregate, we estimate an annual burden of 55 hours (11 hr/response × 5 jurisdictions) at a cost of $5,211 (5 × [(5 hr × $87.52/hr) + (5 hr × $95.32/hr) + (1 hr × $128.00/hr)]). Accounting for the Federal administrative match of 50 percent, the requirement will cost States $2,606 ($5,211 × 0.50). We have summarized the total burden in Table 11.

We have summarized the total burden for the verification plan submission and annual updates in Table 12.