Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)

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

OMB: 0938-1280

IC ID: 220884

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Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)
 
No New
 
Voluntary
 
42 CFR 440.395(c)(1) 42 CFR 457.496(e)(1) 42 CFR 438.915(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

47,467,922 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 142,403 142,403 0 0 0 0
Annual IC Time Burden (Hours) 35,601 35,601 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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