Terms of the
previous clearance remain in effect. OMB files this comment in
accordance with 5 CFR 1320.11( c ). This OMB action is not an
approval to conduct or sponsor an information collection under the
Paperwork Reduction Act of 1995. This action has no effect on any
current approvals. If OMB has assigned this ICR a new OMB Control
Number, the OMB Control Number will not appear in the active
inventory. For future submissions of this information collection,
reference the OMB Control Number provided. OMB is withholding
approval at this time. Prior to publication of the final rule, the
agency should provide a summary of any comments related to the
information collection and their response, including any changes
made to the ICR as a result of comments. In addition, the agency
must enter the correct burden estimates.
Inventory as of this Action
Requested
Previously Approved
03/31/2020
36 Months From Approved
03/31/2020
616
0
616
28,980
0
28,980
0
0
0
Under the Affordable Care Act (ACA),
and implementing regulations at 42 CFR, Medicare Advantage (MA)
organizations and Prescription Drug Plan (PDP) sponsors are
required to submit annual medical loss ratio (MLR) reports (at the
contract level) to the Secretary of HHS concerning the amount spent
on claims, quality improvement expenses, non-claims costs, Federal
and State taxes, licensing and regulatory fees, and revenue. Plan
sponsors must provide a remittance to the Secretary if the amount
spent in a reporting year on certain costs compared to its revenue
(excluding Federal and States taxes and licensing and regulatory
fees) is below a certain ratio, referred to as the medical loss
ratio (MLR). MA organizations and Part D sponsors are required to
report their MLR to CMS, and are subject to financial and other
penalties for a failure to meet a statutory requirement that they
have an MLR of at least 85 percent. The Affordable Care Act
requires several levels of sanctions for failure to meet the 85
percent minimum MLR requirement, including remittance of funds to
CMS, a prohibition on enrolling new members, and ultimately
contract termination. Plan sponsors will use the MLR Reporting Tool
to provide contract-level MLR information to CMS. The information
provided in this MLR Report is the basis for computing the
contract's MLR percentage and remittance amount, if any, for a
contract year.
PL: Pub.L. 111 - 148 1103 Name of Law:
Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education
Reconciliation Act
The currently approved
Supporting Statement sets out the ongoing costs of MLR reporting
based on the current version of the MLR Report, which collects the
data needed by an MA organization or Part D sponsor to calculate
and verify the MLR and remittance amount, if any, for each
contract, such as incurred claims, total revenue, expenditures on
quality improving activities, non-claims costs, taxes, licensing
and regulatory fees, and any remittance owed to CMS. In the Policy
and Technical Changes to the Medicare Advantage and the Medicare
Prescription Drug Benefit Programs for Contract Year 2019 proposed
rule (CMS-4182-P; RIN 0938-AT08)), we are proposing that, for
contract year 2018 and subsequent contract years, MA organizations’
and Part D sponsors’ annual data MLR submissions would consist of
either (a) the MLR and the amount of any remittance due to CMS, for
each credible or partially credible contract; or (b) a submission
noting that the contract is not subject to the 85 percent minimum
MLR requirement and the remittance requirement, for each
non-credible contract. The revised MLR information collection will
eliminate or reduce the burden associated with each of the
following tasks: (1) reviewing MLR Report filing instructions and
external materials referenced therein and inputting figures and
plan-level data in accordance with the instructions; (2) drafting
narrative descriptions of methodologies used to allocate expenses;
(3) performing an internal review of the MLR Report prior to
submission; (4) uploading and submitting the MLR Report; and (5)
correcting or providing explanations for any suspected errors or
omissions discovered by CMS or our contractor during initial review
of the submitted MLR Report. We estimate that the administrative
burden associated with the MLR reporting requirements will be
reduced from 47 hours per contract under the current collection to
36 hours per contract under the revised collection. The MLR
information that MA organizations and Part D sponsors submit to CMS
on an annual basis beginning with contract year 2018 was already
being submitted as part of the detailed MLR Reports that MA
organizations and Part D sponsors submitted to CMS for contract
years 2014 through 2017. Because MA organizations and Part D
sponsors will not need to establish any new processes for gathering
this data, we do not anticipate that MA organizations and Part D
sponsors will incur any additional first time costs in connection
with this data collection. The currently approved Supporting
Statement estimates that 616 MA and Part D contracts will be
subject to the MLR data submission requirements for each contract
year. Our previous estimate of 616 was based on the number of MA
and Part D contracts that we expected would be subject to the MLR
requirements at the time that we published the May 23, 2013 final
rule (78 FR 31284). We are revising this estimate to reflect the
average number of MA and Part D contracts subject to the MLR data
submission requirements for contract years 2014 to 2018. Based on
this more recent data, we estimate that 587 MA and Part D contracts
will be subject to the MLR data submission requirements for each
contract year.
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.
508_CMS-10476_Attachment_D_Crosswalk.pdf
508_CMS-10476_Supporting_Statement_A (rev OSORA PRA).docx
Annual Report and Recordkeeping Requirements