The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Forms and Documents

Document Name	Status
CY2016 PRA 60-day comments 12082014_updated.docx Supplementary Document	2014-12-19
CMS-R-262 - Supporting Statement A [rev 12-19-2014 by OSORA PRA].docx Supporting Statement A	2014-12-19

IC Document Collections

IC ID	Document Title	Status
43667	CY2016 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262) Instruction	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 201412-0938-008
Status: Historical Active	Previous ICR Reference No: 201401-0938-012
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) (CMS-R-262)
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: 02/18/2015
	Date Received in OIRA: 12/19/2014
Terms of Clearance: As this ICR is associated with the issuance of annual guidance, this ICR must be revised accordingly each year.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	36 Months From Approved	05/31/2015
Responses	5,872	0	6,169
Time Burden (Hours)	56,411	0	57,477
Cost Burden (Dollars)	0	0	0

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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.

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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

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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:
	79 FR 57931	09/26/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 75815	12/19/2014
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
CY2016 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 2016 MTMP – Fees Page Mockups ,   CY 2016 PBP Data Entry System Screens (section A) ,   CY 2016 PBP Data Entry System Screens (section B) ,   CY 2016 PBP Data Entry System Screens (section C) ,   CY 2016 PBP Data Entry System Screens (section D) ,   CY 2016 PBP Data Entry System Screens (section Rx)

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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	5,872	6,169	0	-148	-149	0
Annual Time Burden (Hours)	56,411	57,477	0	-533	-533	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The minimal change to burden is attributable to an increase in the number of formulary submissions as well as a decrease in the number of reporting organizations Additionally the Cost to the Government decreased due to efficiencies gained in the development of the modules. This results in a net decrease of overall burden to industry, but an increase to burden to the individual entities. The number of reporting organizations decreased from 652 contracts to 598 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 598 organizations will submit distinct formularies.

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Annual Cost to Federal Government: $849,060

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

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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: 12/19/2014

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