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

Forms and Documents

Document Name	Status
Form CMS-10418 Private Company for Disbursement of checks Form	Modified
Form CMS-10418 Annual MLR Report Form and Instruction	Modified
CMS 317 - Supporting Statement Part A 30day.docx Supporting Statement A	2020-11-12

IC Document Collections

IC ID	Document Title	Status
201985	Retention of Records	Modified
201983	Private Company for Disbursement of checks Form	Modified
201982	Notice of rebates to Subscribers and Policyholders	Modified
201981	Annual MLR Report Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1164	ICR Reference No: 202011-0938-007
Status: Received in OIRA	Previous ICR Reference No: 202006-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/13/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	9,166,846	0
Time Burden (Hours)	232,427	0
Cost Burden (Dollars)	0	0

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 16631	03/24/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 49654	08/14/2020
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Private Company for Disbursement of checks	CMS-10418, CMS-10418, CMS-10418, CMS-10418	MLR Notice 1 - Individual Market to Subscribers ,   MLR Notice 2 Group Markets - Rebate to Policyholder ,   MLR Notice 3 - Group Markets - Rebate to Subscribers ,   MLR Notice Individual Market to Subscribers Optional B
Annual MLR Report	CMS-10418, CMS-10418, CMS-10418	MLR Reporting Form ,   MLR Form Instructions ,   Risk Corridors Plan Level Form
Notice of rebates to Subscribers and Policyholders
Retention of Records

---

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	9,166,846	0	0	0	5,248,438	3,918,408
Annual Time Burden (Hours)	232,427	0	0	0	31,005	201,422
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: Based upon CMS’ experience in the MLR data collection and evaluation process, CMS is updating its annual burden hour estimates to reflect the actual numbers of submissions, rebates and rebate notices. In 2020, it is expected that issuers will submit fewer reports on average, and on average send more notices and rebate checks to policyholders and subscribers, which will overall increase burden on issuers. In addition, issuers of qualified health plans no longer have to submit on the annual report the data for the risk corridors program established under section 1342 of the Patient Protection and Affordable Care Act, because that submission requirement no longer applies, which reduced the burden on issuers. It is estimated that there will be a net increase in total burden from 200,597 to 232,427. The annual report of MLR data for each reporting year is due to the Secretary by July 31 of the following year.

---

Annual Cost to Federal Government: $117,162

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]? 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? Yes

---

Common Form ICR:  No

---

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: 11/13/2020

---