Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)

Forms and Documents

Document	Type	Status	Availability
CMS-10556 - Supporting Statement A [rev 04-10-2015 by OSORA PRA].docx	Supporting Statement A	Uploaded 2015-04-10	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
216060	Contract Requirements (§ 438.6(n))		New
216059	Availability of Information and the Criteria for Medical Necessity Determinations (§§ 438.915(a), 440.395(c)(1), and 457.496(e)(1))		New

ICR Details

OMB Control No: 0938-1280	ICR Reference No: 201504-0938-007
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 05/29/2015
	Date Received in OIRA: 04/13/2015
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The proposed rule (RIN 0938-AS24, CMS-2333-P) would apply mental health parity requirements to Medicaid Managed Care Organizations (MCOs), Section 1937 Alternative Benefit Plans (ABPs), and the CHIP. Two provisions of this NPRM implicate PRA requirements: Medical Necessity Disclosure: Sections 438.915(a), 440.395(c)(1), and 457.496(e)(1) would require that the medical necessity determination criteria used by MCOs, PIHPs, and PAHPs with respect to MH/SUD benefits be made available to potential participants, beneficiaries, or contracting providers upon request. CMS is not proposing that a specific form be used for these disclosures. Contract Requirements: Section 438.6(n) would require states to include contract provisions in all applicable MCO, PIHP, and PAHP contracts to comply with the proposed requirements of this rule.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2001(c) Name of Law: Patient Protection and Affordable Care Act of 2010
   PL: Pub.L. 111 - 3 502 Name of Law: Children’s Health Insurance Program Reauthorization Act of 2009
   PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2001(c) Name of Law: Patient Protection and Affordable Care Act of 2010
PL: Pub.L. 111 - 3 502 Name of Law: Children’s Health Insurance Program Reauthorization Act of 2009
PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS24	Proposed rulemaking	80 FR 19418	04/10/2015

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 19418	04/10/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Availability of Information and the Criteria for Medical Necessity Determinations (§§ 438.915(a), 440.395(c)(1), and 457.496(e)(1))
Contract Requirements (§ 438.6(n))

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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 ICR.

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Annual Cost to Federal Government: $0

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: 04/13/2015

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