Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)

Forms and Documents

Document Name	Status
508_CMS-10476_Attachment_C_Crosswalk.pdf Supplementary Document	2022-01-12
508_CMS-10476_Attachment_B_Crosswalk.pdf Supplementary Document	2022-01-12
CMS-10476 - Supporting Statement A (CMS-4192-P version 5).docx Supporting Statement A	2022-01-12

IC Document Collections

IC ID	Document Title	Status
209359	Annual Reporting and Recordkeeping Requirements Instruction	Modified

ICR Details

OMB Control No: 0938-1232	ICR Reference No: 202201-0938-011
Status: Received in OIRA	Previous ICR Reference No: 202006-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/12/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2024
Responses	601	587
Time Burden (Hours)	36,748	21,159
Cost Burden (Dollars)	0	0

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Abstract: Under the Affordable Care Act (ACA), and implementing regulations at 42 CFR, Medicare Advantage (MA) organizations and Prescription Drug Plan (PDP) sponsors are required to submit annual medical loss ratio (MLR) reports (at the contract level) to the Secretary of HHS concerning the amount spent on claims, quality improvement expenses, non-claims costs, Federal and State taxes, licensing and regulatory fees, and revenue. Plan sponsors must provide a remittance to the Secretary if the amount spent in a reporting year on certain costs compared to its revenue (excluding Federal and States taxes and licensing and regulatory fees) is below a certain ratio, referred to as the medical loss ratio (MLR). MA organizations and Part D sponsors are required to report their MLR to CMS, and are subject to financial and other penalties for a failure to meet a statutory requirement that they have an MLR of at least 85 percent. The Affordable Care Act requires several levels of sanctions for failure to meet the 85 percent minimum MLR requirement, including remittance of funds to CMS, a prohibition on enrolling new members, and ultimately contract termination. Plan sponsors will use the MLR Reporting Tool to provide contract-level MLR information to CMS. The information provided in this MLR Report is the basis for computing the contract's MLR percentage and remittance amount, if any, for a contract year.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education Reconciliation Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education Reconciliation Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU30	Proposed rulemaking	87 FR 1842	01/12/2022

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 1842	01/12/2022
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Annual Reporting and Recordkeeping Requirements	CMS-10476	MLR Report

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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	601	587	0	14	0	0
Annual Time Burden (Hours)	36,748	21,159	0	15,589	0	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Our January 12, 2022 rule (87 FR 1842) (CMS-4192-P, RIN 0938-AU30) proposes to amend §§ 422.2460 and 423.2460 to reinstate the detailed MLR reporting requirements that were in effect for CYs 2014 through 2017. We also proposed to expand those detailed reporting requirements to include separate reporting of amounts spent on MA supplemental benefits. Revisions take into account: (1) the additional burden for MA organizations and Part D sponsors to report their MLRs under the proposed reporting requirements; and (2) the elimination of the burden for MA organizations to calculate and apply the deductible factor to the MLR calculation for MA MSA contracts because the software used to report Medicare MLRs under the proposed requirements would automatically calculate this burden. Overall, we estimate an increase of 14 responses and 15,589 hours.

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Annual Cost to Federal Government: $337,497

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.     Yes

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? No

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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: 01/12/2022

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