Medical Loss Ratio - Quarterly Reporting for Mini-med Plans and Expatriate Plans

Forms and Documents

Document Name	Status
Form CMS-10373 Quarterly Reporting Form and Instruction	New
CMS-2011-0034-0004.1 (Aetna).pdf Supplementary Document	2011-05-13
CMS-2011-0034-0003.1( UnitedHealthGroup).pdf Supplementary Document	2011-05-13
CMS-2011-0034-0002.1 (Wellpoint).pdf Supplementary Document	2011-05-13
CMS-10373.Response to Public Comments.docx Supplementary Document	2011-05-13
CMS-10373.Revised Emergency Justification (2-17-11).docx Supplementary Document	2011-03-31
CMS-10373.REVISED Supporting Statement.docx Supporting Statement A	2011-05-13

IC Document Collections

IC ID	Document Title	Status
197131	Quarterly Reporting Form and Instruction	New

ICR Details

OMB Control No: 0938-1132	ICR Reference No: 201103-0938-018
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Loss Ratio - Quarterly Reporting for Mini-med Plans and Expatriate Plans
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/01/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/16/2011
	Date Received in OIRA: 03/31/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	6 Months From Approved
Responses	1,125	0	0
Time Burden (Hours)	69,750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 2718 of the PHS Act requies health insurance issuers offering group or individual health insurance coverage to submit annual reports to the Secretary concerning the amount the issuer spends each year on claims, quality improvement expenses, non-cliams costs, Federal and State taxes and licensing or regulatory fees, and the amount of earned premium for the reporting year. Additionally, for 2011, the interim final rule (IFR) implementing this provision requires quarterly reporting for expatriate plans and mini-med plans. This request for the collection of information solely pertains to the quarterly reporting requirement provided for in the IFR.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2718 Name of Law: Bringing down the cost of health care coverage.
  

Citations for New Statutory Requirements: PL: Pub.L. 11 - 148 2718 Name of Law: Bringing down the cost of health care coverage.

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0950-AA06	Final or interim final rulemaking	75 FR 74864	12/01/2010

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 16789	03/25/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 16789	03/25/2011
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Quarterly Reporting	CMS-10373, CMS-10373	Instrument ,   Instructions

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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	1,125	0	1,125	0	0	0
Annual Time Burden (Hours)	69,750	0	69,750	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.

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Annual Cost to Federal Government: $21,600

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 03/31/2011

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