Notification of Involuntary Disenrollment by the Centers for Medicare & Medicaid Services for Failure to Pay the Part D Income Related Monthly Adjustment Amount
Notification of Involuntary
Disenrollment by the Centers for Medicare & Medicaid Services
for Failure to Pay the Part D Income Related Monthly Adjustment
Amount
New
collection (Request for a new OMB Control Number)
In accordance
with 5 CFR 1320, the information collection is not approved at this
time. Prior to publication of the final rule, CMS must provide a
summary of any public comments received on the information
collection requirements contained in the proposed rule and any
changes made in response to these comments.
Inventory as of this Action
Requested
Previously Approved
36 Months From Approved
0
0
0
0
0
0
0
0
0
Pursuant to Section 3308 of the
Affordable Care Act, the monthly amount of the Part D beneficiary
premium for beneficiaries whose modified adjusted gross income
(MAGI) exceeds a certain threshold amount (greater than $85,000 for
beneficiaries filing an individual income tax return or married and
filing a separate return; and greater than $170,000 for
beneficiaries filing jointly), will be increased effective January
1, 2011. This increased amount, called the Medicare Part D-Income
Related Monthly Adjustment Amount (Part D-IRMAA), will be paid
through premium withholding unless a beneficiary's monthly benefit
check is not sufficient to pay or he/she is not receiving benefits.
The Social Security Administration will inform all beneficiaries
that are enrolled in a Medicare prescription drug program and
identified as qualifying for Part D-IRMAA. Any individual who fails
to pay the Part D-IRMAA, after he/she has been appropriately billed
and provided an initial grace period, will be disenrolled from
their Medicare prescription drug plan. Once the individual's
Medicare prescription drug coverage has been terminated by CMS and
the individual is disenrolled, the Part D plan sponsor shall
provide the beneficiary with the Notification of Involuntary
Disenrollment by the Centers for Medicare &Medicaid Services
for Failure to Pay the Part D Income Related Monthly Adjustment
Amount. This notice shall inform the beneficiary that his/her
Medicare prescription drug coverage has been terminated by the
Centers for Medicare & Medicaid Services, as well as provide
information concerning how his/her coverage can be reinstated
(without interruption) and who to contact for additional
information
PL:
Pub.L. 111 - 145 3308 Name of Law: Reducing Part D Premium
Subsidy for High-Income Beneficiaries
PL: Pub.L. 111 - 145 3308 Name of Law:
Reducing Part D Premium Subsidy for High-Income
Beneficiaries
Any individual who fails to pay
the Part D-IRMAA, after he/she has been appropriately billed and
provided an initial grace period, will be disenrolled from their
Medicare prescription drug plan. Once the individual's Medicare
prescription drug coverage has been terminated by CMS and the
individual is disenrolled, the Part D plan sponsor shall provide
the beneficiary with the Notification of Involuntary Disenrollment
by the Centers for Medicare &Medicaid Services for Failure to
Pay the Part D Income Related Monthly Adjustment Amount. This
notice shall inform the beneficiary that his/her Medicare
prescription drug coverage has been terminated by the Centers for
Medicare & Medicaid Services, as well as provide information
concerning how his/her coverage can be reinstated (without
interruption) and who to contact for additional information.
$0
No
No
Yes
No
No
Uncollected
Bonnie Harkless
4107865666
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:
(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.
PRA D-IRMAA Supporting Statement - Part A CM.OEORA.doc
Notification of Involuntary Disenrollment by the Centers for Medicare & Medicaid Services for Failure to Pay the Part D Income Related Monthly Adjustment Amount (CMS-10352