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.
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Inventory as of this Action
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Previously Approved
36 Months From Approved
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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.
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No
Yes
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Uncollected
Bonnie Harkless 4107865666
Reginfo record details
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