The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PRA 2015 - List of Chagnes_2013_12_20_V3.pdf	Supplementary Document	Uploaded 2014-01-17	Available
CMS-R-262 - Supporting Statement Part A [CY 2015 rev 1-17-2014 by OSORA PRA].docx	Supporting Statement A	Uploaded 2014-01-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43667	CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262	Instruction	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 201401-0938-012
Status: Historical Active	Previous ICR Reference No: 201301-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: 21328
Title: The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
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: 05/08/2014
	Date Received in OIRA: 01/24/2014
Terms of Clearance: As this ICR is associated with the issuance of annual guidance, this ICR is approved for one year.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved	05/31/2014
Responses	6,169	0	6,070
Time Burden (Hours)	57,477	0	56,710
Cost Burden (Dollars)	0	0	4,366,651

---

Abstract: CMS requires that MA and PDP organizations submit a completed formulary and PBP as part of the annual bidding process. During this process, organizations prepare their proposed plan benefit packages for the upcoming contract year and submit them to CMS for review and approval.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Prescription Drug, Improvement, and Modernization Act of2003 (MMA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65656	11/01/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3208	01/17/2014
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262	CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262	CY 2015 MTMP Screenshots ,   PBP 2015 Data Entry System (Rx screen shots) ,   PBP 2015 Data Entry System (section A screen shots) ,   PBP 2015 Data Entry System (section B screen shots) ,   PBP 2015 Data Entry System (section C screen shots) ,   PBP 2015 Data Entry System (section D screen shots)

---

ICR Summary of Burden

table that charts list 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	6,169	6,070	0	0	99	0
Annual Time Burden (Hours)	57,477	56,710	0	0	767	0
Annual Cost Burden (Dollars)	0	4,366,651	0	0	-4,366,651	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: The minimal change to burden is attributable to an increase in the number of formulary submissions. This change is a direct result of plan business decisions. The number of reporting organizations increased from 641 contracts to 652 contracts based on the most recent numbers extracted from HPMS. This number represents the total number of organizations that will submit at least one (1) PBP. Because an organization can submit a formulary that covers multiple contract numbers, only a subset of the 652 organizations will submit distinct formularies. While PBP changes resulting from the new Medicare-Medicaid Plan (MMP) program are listed in this package, they are exempt from the PRA process and have been excluded from the burden estimate.

---

Annual Cost to Federal Government: $944,996

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]? No

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

---

Common Form ICR:  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:

(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: 01/24/2014

---