Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007

Forms and Documents

Document Name	Status
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Form and Instruction	New
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Form and Instruction	New
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Form and Instruction	New
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Federal) Form and Instruction	New
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Form and Instruction	New
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Private) Form and Instruction	New
CMS-10265 Burden Table-FINAL.doc Supplementary Document	2009-10-29
Sect 111_PRA_Responses_12-17-08.doc Supplementary Document	2009-02-25
Revised_Attachment C_1.16.09.doc Supplementary Document	2009-02-17
Revised_AttachmentA_1.16.09.doc Supplementary Document	2009-02-17
Revised_Attachment D_1.16.09.doc Supplementary Document	2009-02-17
CMS-10265.Supporting Statement Part A.doc Supporting Statement A	2009-02-17

IC Document Collections

IC ID	Document Title	Status
188585	Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Form and Instruction	New
188584	Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Form and Instruction	New
188583	Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Form and Instruction	New
188582	Mandatory Insurer Reporting (Non-GHP, Federal) Form and Instruction	New
188581	Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Form and Instruction	New
188580	Mandatory Insurer Reporting (Non-GHP, Private) Form and Instruction	New
188579	Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative) Instruction	New
188578	Mandatory Insurer Reporting (Private, Administrative) Instruction	New
188577	Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up) Instruction	New
188576	Mandatory Insurer Reporting (Private, System Set-up) Instruction	New
188575	Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't) Instruction	New
188574	Mandatory Insurer Reporting (GHP-Private) Instruction	New

ICR Details

OMB Control No: 0938-1074	ICR Reference No: 200903-0938-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007
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: 11/06/2009
	Date Received in OIRA: 03/27/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved
Responses	6,920,504	0	0
Time Burden (Hours)	2,120,478	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) seeks to collect various data elements for the applicable reporting entities for purpose of implementing the mandatory MSP reporting requirements of Section 111 of the MMSEA. This information will be used to ensure that Medicare makes payment in the proper order and/or takes necessary recovery actions. The purpose of this submission is to set forth what information will be collected pursuant to Section 111 and the process for such collection. Section 111 mandates the reporting of information specified by the Department of Health and Human Services Secretary in the form and manner specified by the Secretary (including frequency) Data the Secretary will collect is necessary for both pre-payment and post-payment coordination of benefit purposes, including the recovery actions. Section 111 establishes separate mandatory reporting requirements for group health plan arrangements as well as for liability insurance (including self-insurance), no-fault insurance, and workers' compensation, also referred to as non-group health plan. With the passage of Section 111, CMS now has the authority to mandate the reporting of insurer MSP information.

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Authorizing Statute(s): PL: Pub.L. 110 - 173 111 Name of Law: Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 173 111 Name of Law: Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements

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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:
	73 FR 45013	08/01/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 7233	02/13/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (GHP-Private)
Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't)
Mandatory Insurer Reporting (Private, System Set-up)
Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up)
Mandatory Insurer Reporting (Private, Administrative)
Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative)
Mandatory Insurer Reporting (Non-GHP, Private)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Federal)	CMS-10265	Interim Non-GHP Record Layout

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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	6,920,504	0	6,920,504	0	0	0
Annual Time Burden (Hours)	2,120,478	0	2,120,478	0	0	0
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: This is a new information collection request; however, as stated under item 4 of this document, these collection activities were created to reduce both burden and redundancy. Successful implementation of mandatory insurer reporting will allow CMS to eliminate or curtail other Coordination of Benefit Contractor data collection processes such as the IRS/SSA/CMS Data Match (0938-0656).

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Annual Cost to Federal Government: $8,000,000

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)? 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: 03/27/2009

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