Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements

Forms and Documents

Document Name	Status
Form CMS-10418 Notice of Rebate to Enrollees Form	Modified
CMS 10418 2012 MLR PRA Package 60day FR Q and As.pdf Supplementary Document	2013-04-05
CMS 10418 2012 MLR 30Day FR Notice Crosswalk of Changes.docx Supplementary Document	2013-04-02
2013 CMS 10418 2012 MLR PRA Package Supporting Statement.docx Supporting Statement A	2013-04-02

IC Document Collections

IC ID	Document Title	Status
201985	Retention of Records	Modified
201983	Notice of Rebate to Enrollees Form	Modified
201982	Disbursement of Rebate Checks	Modified
201981	Annual MLR Report Instruction	Modified

ICR Details

OMB Control No: 0938-1164	ICR Reference No: 201304-0938-002
Status: Historical Active	Previous ICR Reference No: 201204-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 19223
Title: Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/03/2013
	Date Received in OIRA: 04/05/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	36 Months From Approved	05/31/2015
Responses	9,868,957	0	9,936,664
Time Burden (Hours)	303,550	0	479,928
Cost Burden (Dollars)	0	0	0

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Abstract: Section 2718 of the PHS Act and its implementing regulation requires health insurance issuers (issuers) offering group or individual health insurance coverage to submit an annual report to the Secretary of the Department of Health and Human Services concerning the amount the issuer spends each year on claims, quality improvement expenses, non-claims costs, Federal and State taxes, licensing and regulatory fees, the amount of earned premium for the reporting year, its medical loss ratio and any rebate it may owe to subscribers. In addition, the implementing regulation requires issuers to maintain all documents and other evidence which support the data that is provided in an issuer's annual report to the Secretary.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2718 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 1001(5) Name of Law: Bringing down the cost of health care coverage
  

Citations for New Statutory Requirements: None

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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:
	77 FR 71801	12/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 12320	02/22/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Annual MLR Report	CMS-10418	MLR_Annual_Form
Disbursement of Rebate Checks
Notice of Rebate to Enrollees	CMS-10418, CMS-10418, CMS-10418	Notice_#1_to_Subscribers_in_Individual_Market ,   Notice_#2_Group_Markets_Rebate_to_Policyholder ,   Notice_#3_Group_Markets_Rebate_to_Subscribers
Retention of Records

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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	9,868,957	9,936,664	0	0	-67,707	0
Annual Time Burden (Hours)	303,550	479,928	0	0	-176,378	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: Based upon HHS' experience in the MLR data collection and evaluation process, HHS is updating its annual burden hour estimates to reflect the actual numbers of submissions, rebates and rebate notices. In addition, the notice requirement for issuers that do not owe rebates applied only to the 2011 reporting year, and does not apply to 2012 and subsequent MLR reporting years. The 2012 MLR Reporting Form and instructions also reflect changes for the 2012 reporting year and beyond that are set forth in the December 2011 Final Rule as to whether certain already reported expenditures such as ICD-10 conversion costs are taken into account in calculating an issuer's MLR. In addition, as a result of Tri-Agency guidance, we have revised the MLR Form Instructions to reflect that for the 2012 MLR reporting year, expatriate plans are considered compliant with MLR requirements. For the 2012 MLR reporting year, issuers with only expatriate business are not required to file an MLR Form. Issuers with health insurance coverage which is subject to MLR requirements who also have expatriate experience must report the same limited information regarding their expatriate experience as they do regarding other lines of business that are not subject to the MLR rebate requirements. Therefore, there is a total decrease of 176,378 burden hours (from, 479,928 hours to 303,550). We have simplified the method by which issuers can enter their data into the reporting form. For the 2012 MLR reporting year, all data cells will be unlocked so that issuers can copy and paste data into the reporting form instead of manually entering data cell by cell. To assist issuers in populating cells that were previously locked and pre-calculated, CMS will provide a reference tool with formula calculations, which issuers may use if they find it helpful. The new method will reduce the burden on issuers as well as the possibility of error in formula results. The 2012 MLR Reporting Form and instructions also reflect changes for the 2012 reporting year and beyond that are set forth in the December 2011 Final Rule as to whether certain already reported expenditures such as ICD-10 conversion costs are taken into account in calculating an issuer's MLR. In addition, as a result of Tri-Agency guidance, we have revised the MLR Form Instructions to reflect that for the 2012 MLR reporting year, expatriate plans are considered compliant with MLR requirements. For the 2012 MLR reporting year, issuers with only expatriate business are not required to file an MLR Form. Issuers with health insurance coverage which is subject to MLR requirements who also have expatriate experience must report the same limited information regarding their expatriate experience as they do regarding other lines of business that are not subject to the MLR rebate requirements.

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Annual Cost to Federal Government: $72,288

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: 04/05/2013

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