Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)

Forms and Documents

Document Name	Status
Form CMS-10418 Notice of Rebate to Enrollees Form	Modified
Form CMS-10418 Annual MLR Report Form	Modified
AHIP Comments CMS 10418 Revised 2013 MLR Report Instructions and Forms.pdf Supplementary Document	2014-03-26
CMS-10418 - 2013 MLR Form Instructions - Revised REDLINE .docx Supplementary Document	2014-02-27
AHIP Supplemental Comments on the Draft 2013 MLR Report Instructions and Forms.pdf Supplementary Document	2014-02-10
AHIP Comments on the Draft 2013 MLR Report Instructions and Forms.pdf Supplementary Document	2014-02-10
CMS 10418 Revised Comment and Response 2014 0321.pdf Supplementary Document	2014-03-26
CMS 10418 Revised Crosswalk of Changes 20140 321 CLEAN.pdf Supplementary Document	2014-03-26
CMS 10418 - Supporting Statement 508.pdf Supporting Statement A	2014-02-10

IC Document Collections

IC ID	Document Title	Status
201985	Retention of Records	Modified
201983	Notice of Rebate to Enrollees Form	Modified
201982	Disbursement of Rebate Checks	Modified
201981	Annual MLR Report Form	Modified

ICR Details

OMB Control No: 0938-1164	ICR Reference No: 201402-0938-006
Status: Historical Active	Previous ICR Reference No: 201304-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: 21406
Title: Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/03/2014
	Date Received in OIRA: 02/11/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved	05/31/2016
Responses	6,465,473	0	9,868,957
Time Burden (Hours)	293,768	0	303,550
Cost Burden (Dollars)	0	0	0

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Abstract: Section 2718 of the PHS Act and its implementing regulation requires health insurance issuers (issuers) offering group or individual health insurance coverage to submit an annual report to the Secretary of the Department of Health and Human Services concerning the amount the issuer spends each year on claims, quality improvement expenses, non-claims costs, Federal and State taxes, licensing and regulatory fees, the amount of earned premium for the reporting year, its medical loss ratio and any rebate it may owe to subscribers. In addition, the implementing regulation requires issuers to maintain all documents and other evidence which support the data that is provided in an issuer's annual report to the Secretary.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2718 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 1001(5) Name of Law: Bringing down the cost of health care coverage
  

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:
	78 FR 70059	11/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 5417	01/31/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Annual MLR Report	CMS-10418	MLP Annual Report
Disbursement of Rebate Checks
Notice of Rebate to Enrollees	CMS-10418, CMS-10418, CMS-10418	Notice_#1_to_Subscribers_in_Individual_Market ,   Notice_#2_Group_Markets_Rebate_to_Policyholder ,   Notice_#3_Group_Markets_Rebate_to_Subscribers
Retention of Records

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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	6,465,473	9,868,957	0	327	-3,403,811	0
Annual Time Burden (Hours)	293,768	303,550	0	19,656	-29,438	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Based upon HHS' experience in the MLR data collection and evaluation process, HHS is updating its annual burden hour estimates to reflect the actual numbers of submissions, rebates and rebate notices. The 2013 MLR Reporting Form and instructions reflect changes for the 2013 reporting year and beyond that are set forth in the March 2012 publication update to 45 CFR 158.120 regarding aggregation of student health plans on a nationwide basis. The instructions also address applicability guidance issued by the Departments of Labor, Treasury and HHS concerning expatriate plan reporting prior to plan years ending before or on December 31, 2015. The 2013 MLR Reporting Form and instructions reflect guidance published on December 30, 2013. The optional treatment provided by the guidance will affect a minimal number of issuers and polices without any significant increase to the burden estimate. In 2014, it is expected that issuers will send fewer notices and rebate checks to policyholders and subscribers which will reduce burden on issuers. On the other hand, the requirement to report data on student health plans will increase burden for some issuers. It is estimated that there will be a net reduction in total burden from 303,550 to 293,768.

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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]? Yes

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: 02/11/2014

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