The PBP and Formulary are existing
tools that were used in the CY2006 and CY2007 bid season by the MA
and PDP organizations. The PBP has been utilized by MA
organizations since CY2001 to describe their plan benefit package
offerings for each contract year. The tool collects data such as
copayments, coinsurance, deductibles, authorization rules,
referrals, out-of-network benefits, and optional narrative
notes.
The PBP and Formulary
are existing tools that were used in the CY2006 and CY2007 bid
season by the MA and PDP organizations. The PBP has been utilized
by MA organizations since CY2001 to describe their plan benefit
package offerings for each contract year. The tool collects data
such as copayments, coinsurance, deductibles, authorization rules,
referrals, out-of-network benefits, and optional narrative notes.
The formulary tool was first introduced in CY2006 due to the MMA's
need to collect critical data regarding the Part D Prescription
Drug benefit such as covered drugs, tiering, prior authorization,
and step therapy management programs. Justification for Emergency
PRA Clearance of Plan Benefit Package Software: During
implementation of the MMA for CY2007, CMS recognized numerous MMA
policy clarifications that required changes for the CY2008 PBP and
formulary tools. We have worked closely with the CMS policy and
operations staff to identify the MMA policy clarifications that
require changes to the software as well as usability changes that
will improve the tools. The changes to the PBP include enhancements
to the software for describing the out-of-network benefits,
Medicare Savings Account (MSA) benefits, Point of Service (POS)
benefits, Visitor/Travel benefits, and collecting Medicare Rx
information on gap coverage. The changes to the formulary include
enhancements to submission process by developing a drug reference
table and by collecting excluded drug indicators, specialty drug
indicators, and drug types. Since CMS always also strives to
improve the data collection tools to minimize filing burden on the
plans and to maximize the output of the tools for the Medicare
beneficiary education materials, we host online comment sessions to
solicit feedback from the industry. CMS hosts these sessions twice
throughout the year during non-peak months for the bidders to
ensure the industry has every opportunity to provide comments and
suggested enhancements for the following year. Therefore CMS must
wait until the Bid submission and review season is completed later
in the fall. Given the life cycle of these tools illustrated above,
CMS does not have sufficient time to complete the normal PRA
clearance process while making corrections and enhancements to the
software, allowing time for industry feedback, and ensuring that
organizations have ample time to complete and submit their tools by
the statutory deadline in June 2007. The normal PRA clearance
process would result in violating this statutory deadline which
would prevent MA and PDP organizations from providing benefits to
millions of Medicare beneficiaries.
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:
(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;
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.
CMS-R-262 Appendix A - CY2008 PBPForm Sprtng Stmnt - FINAL.doc
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)