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 attempts to
broadly reform and expand availability of private health plan
options to Medicare beneficiaries. Section 103 of the Medicare
Improvements for Patients and providers Act of 2008 (MIPPA), Pub.
L. 110-275, enacted on July 15, 2008, established new statutory
prohibitions and limitations for MA plans and Medicare prescription
drug plans. On September 18, 2009, we published the Final
Rule-4131F in the Federal Register (E8-21674). Among provisions of
that final rule was a requirement for plan disclosure of
information to enrollees as specified in ?422.111(b) and
?423.128(b). The final rule, published April 15, 2011, added new
section 422.11(b)(12) to require MA organizations to periodically
furnish directly to enrollees, in the manner specified by CMS and
in a form easily understood by such enrollees, a written
explanation of benefits when benefits are provided under CFR
section 422. Plans disclose this information to plan enrollees on a
monthly or quarterly basis each year a minimum enrollment period
has been met, in conjunction with the annual renewal materials
(currently the ANOC and EOC) described in ?422.111(b). CMS has
developed templates for each plan type based on whether plans wish
to provide information on a per claim/quarterly basis or on a
monthly basis (attached, section II worksheet). Templates are for
the following plan types: HMO, PPO, MSA, and PFFS.
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
PL: Pub.L. 110 - 175 103 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
This final rule requires MA
organizations to periodically provide each enrollee with enrollee
specific data to use to compare utilization and out-of-pocket costs
in the current plan year to projected utilization and out of pocket
costs for the following plan year. Plans must disclose this
information to plan enrollees in each year in which a minimum
enrollment period has been met, in conjunction with the annual
renewal materials (currently the ANOC and EOC) described in
?422.111(b). CMS has developed templates for each plan type based
on whether plans wish to provide per claim/quarterly information or
on a monthly basis
$0
No
No
No
No
No
Uncollected
William Parham
4107864669
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.
Form CMS-10453 EOB
summary of comments for PRA package 7-1-13.docx
Crosswalk between 60-day and 30-day notices 6-4-13.xlsx
EOB