Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2)

Forms and Documents

Document Name	Status
Response and #1_60-day Comment PUBLIC SUBMISSION (2).doc Supplementary Document	2008-08-21
Supporting Statement - Part A.docANOC.doc Supporting Statement A	2008-08-21

IC Document Collections

IC ID	Document Title	Status
186438	Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2): CMS-10260 Instruction	New

ICR Details

OMB Control No: 0938-1051	ICR Reference No: 200809-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2)
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 with change	Conclusion Date: 11/25/2008
	Date Received in OIRA: 09/04/2008
Terms of Clearance: This ICR is approved consistent with the understanding that the reporting requirements are not duplicated in 0938-0753. CMS agrees to adjust the burden estimates, supporting statements, and information collection materials in 0938-0753 accordingly. Because this collection appears to require adjustments on an annual basis, this collection is approved for 12 months.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2009	36 Months From Approved
Responses	670	0	0
Time Burden (Hours)	8,040	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This final rule implements provisions of the Social Security Act (the Act) establishing and regulating the Medicare Advantage (MA) program. 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 replaces the Medicare+Choice (M+C) program established under Part C of the title XVIII of the Act, while retaining most key features of the M+C program. The MA program attempts to broadly reform and expand the availability of private health plan options to Medicare beneficiaries.

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Authorizing Statute(s): PL: Pub.L. 108 - 117 201 Name of Law: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AN06	Final or interim final rulemaking	70 FR 4588	01/28/2005

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 21138	04/18/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 47953	08/15/2008
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
Medicare Advantage Disclosure Requirements referenced in 42 CFR 422.111(d)(2): CMS-10260

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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	670	0	0	670	0	0
Annual Time Burden (Hours)	8,040	0	0	8,040	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: New collection requirements for 422.111(d)(2)-disclosure requirements for changes to a MA plan. Organizations will use a combined standardized document to notify enrollees of plan changes for the upcoming year.

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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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

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: 09/04/2008

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