The Medicare Advantage and Prescription Drug Program: Part C Explanation of Benefits and Supporting Regulations

Forms and Documents

Document Name	Status
Form CMS-10453 EOB Form and Instruction	New
summary of comments for PRA package 7-1-13.docx Supplementary Document	2013-08-07
Crosswalk between 60-day and 30-day notices 6-4-13.xlsx Supplementary Document	2013-08-07
CMS-10453_Supporting_Statement_Part_A.docx Supporting Statement A	2013-08-07

IC Document Collections

IC ID	Document Title	Status
208197	EOB Form and Instruction	New

ICR Details

OMB Control No: 0938-1228	ICR Reference No: 201308-0938-013
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 20277
Title: The Medicare Advantage and Prescription Drug Program: Part C Explanation of Benefits and Supporting Regulations
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 without change	Conclusion Date: 04/07/2014
	Date Received in OIRA: 08/13/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	6,768	0	0
Time Burden (Hours)	97,760	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The MA program was enacted in Title II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) on December 8, 2003. The MA program attempts to broadly reform and expand availability of private health plan options to Medicare beneficiaries. Section 103 of the Medicare Improvements for Patients and providers Act of 2008 (MIPPA), Pub. L. 110-275, enacted on July 15, 2008, established new statutory prohibitions and limitations for MA plans and Medicare prescription drug plans. On September 18, 2009, we published the Final Rule-4131F in the Federal Register (E8-21674). Among provisions of that final rule was a requirement for plan disclosure of information to enrollees as specified in ?422.111(b) and ?423.128(b). The final rule, published April 15, 2011, added new section 422.11(b)(12) to require MA organizations to periodically furnish directly to enrollees, in the manner specified by CMS and in a form easily understood by such enrollees, a written explanation of benefits when benefits are provided under CFR section 422. Plans disclose this information to plan enrollees on a monthly or quarterly basis each year a minimum enrollment period has been met, in conjunction with the annual renewal materials (currently the ANOC and EOC) described in ?422.111(b). CMS has developed templates for each plan type based on whether plans wish to provide information on a per claim/quarterly basis or on a monthly basis (attached, section II worksheet). Templates are for the following plan types: HMO, PPO, MSA, and PFFS.

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Authorizing Statute(s): PL: Pub.L. 110 - 275 103 Name of Law: The Medicare Improvements for Patients and Providers Act of 2008.
   PL: Pub.L. 108 - 117 201 Name of Law: The Medicare Prescription Drug Improvement, and Modernization Act of 2003
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 175 103 Name of Law: The Medicare Improvements for Patients and Providers Act of 2008
PL: Pub.L. 108 - 117 201 Name of Law: The Medicare Prescription Drug Improvement, and Modernization Act of 2003

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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:
	77 FR 70445	11/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42957	07/18/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
EOB	CMS-10453, CMS-10453, CMS-10453, CMS-10453, CMS-10453, CMS-10452, CMS-10453, CMS-10453, CMS-10453	Example of HMO Monthly Summary ,   HMO Quarterly Summary ,   HMO Monthly ,   MSA Monthly EOB ,   MSA Quarterly Summary ,   PFFS monthly EOB ,   PFFS quarterly summary ,   PPA Monthly EOB ,   PPO quarterly summary

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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	6,768	0	6,768	0	0	0
Annual Time Burden (Hours)	97,760	0	97,760	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: This final rule requires MA organizations to periodically provide each enrollee with enrollee specific data to use to compare utilization and out-of-pocket costs in the current plan year to projected utilization and out of pocket costs for the following plan year. Plans must disclose this information to plan enrollees in each year in which a minimum enrollment period has been met, in conjunction with the annual renewal materials (currently the ANOC and EOC) described in ?422.111(b). CMS has developed templates for each plan type based on whether plans wish to provide per claim/quarterly information or on a monthly basis

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Annual Cost to Federal Government: $0

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: 08/13/2013

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