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.
table that charts list comparision
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 organizationsâ and Part D sponsorsâ 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