Medicare Advantage and Prescription Drug Program: Final Marketing Provisions CFR 422.111(a)(3) and 423.128 (a)(3)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10260-PPO Annual Notice of Change & Evidence of Coverage for Preferred Provider Organizations	Form and Instruction	Modified	Available
Form CMS-10260- Annual Notice of Change & Evidence of Coverage for Provider Fee‐for‐Service Plans	Form and Instruction	Modified	Available
Form CMS-10260-PDP's Annual Notice of Change & Evidence of Coverage for Prescription Drug Plans	Form and Instruction	Modified	Available
Form CMS-10260- MAPDP Annual Notice of Change & Evidence of Coverage for Medicare Advantage Prescription Drug Plans	Form and Instruction	Modified	Available
Form CMS-10260-CP Annual Notice of Change & Evidence of Coverage for Cost Plans	Form and Instruction	Modified	Repair queued
Form CMS-10260-MAOP Annual Notice of Change & Evidence of Coverage for Medicare Advantage Only Plans	Form and Instruction	Modified	Available
High Level Summary of ANOCEOC030110.docx	Supplementary Document	Uploaded 2010-07-29	Available
Response to Terms of Clearance06 26 09cleanversion.docx	Supplementary Document	Uploaded 2009-09-25	Available
CMS-10260 Supporting Statement - Part A (2)cjbclean032210.doc	Supporting Statement A	Uploaded 2010-07-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Preferred Provider Organizations
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Provider Fee‐for‐Service Plans
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Prescription Drug Plans
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Medicare Advantage Prescription Drug Plans
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Cost Plans
186438	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Form and Instruction	Modified	Annual Notice of Change & Evidence of Coverage for Medicare Advantage Only Plans

ICR Details

OMB Control No: 0938-1051	ICR Reference No: 200910-0938-005
Status: Historical Active	Previous ICR Reference No: 200809-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage and Prescription Drug Program: Final Marketing Provisions CFR 422.111(a)(3) and 423.128 (a)(3)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/03/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/16/2009
Terms of Clearance: As with previous ICRs under this control number, because this collection appears to require adjustments on an annual basis, this collection is approved for 12 months.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	36 Months From Approved	08/31/2010
Responses	740	0	670
Time Burden (Hours)	8,880	0	8,040
Cost Burden (Dollars)	0	0	0

---

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. Medicare Advantage (MA) organizations and Prescription Drug Plan Sponsors use the information to comply with the eligibility requirements and the MA and Part D contract requirements. CMS will use this information to ensure that correct information is disclosed to Medicare beneficiaries, both potential enrollees and enrollees.

---

Authorizing Statute(s): PL: Pub.L. 110 - 275 103 Name of Law: The Medicare Improvements for Patients and Providers Act of 2008
   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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP24	Final or interim final rulemaking	73 FR 54208	09/18/2008

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 34758	07/17/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 48972	09/25/2009
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	CMS-10260-MAOP, CMS-10260-CP, CMS-10260- MAPDP, CMS-10260-PDP's, CMS-10260-, CMS-10260-PPO	Annual Notice of Change & Evidence of Coverage for Medicare Advantage Only Plans ,   Annual Notice of Change & Evidence of Coverage for Cost Plans ,   Annual Notice of Change & Evidence of Coverage for Medicare Advantage Prescription Drug Plans ,   Annual Notice of Change & Evidence of Coverage for Prescription Drug Plans ,   Annual Notice of Change & Evidence of Coverage for Provider Fee‐for‐Service Plans ,   Annual Notice of Change & Evidence of Coverage for Preferred Provider Organizations

---

ICR Summary of Burden

table that charts list 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	740	670	0	70	0	0
Annual Time Burden (Hours)	8,880	8,040	0	840	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: The change of burden is associated with the MIPPA disclosure and dissemination requirements which were modified for MA organizations and Part D sponsors.

---

Annual Cost to Federal Government: $17,098

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]? No

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

---

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: 10/16/2009

---