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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section Rx (VBID)	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section Rx	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section D	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section C	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section B (VBID)	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section B	Form	Modified	Available
Form CMS-R-262 CY 2019 PBP Data Entry System Screens - Section A and Upload	Form	Modified	Available
Form CMS-R-262 Medication Therapy Management Program (MTMP)	Form	Modified	Available
CY2019 PRA 30-day comments 2.06.2018.docx	Supplementary Document	Uploaded 2018-02-08	Available
CMS-R-262 - CY2019_PBP_Sprtng_Stmnt - Passback2 - 02232018 CLEAN.docx	Supporting Statement A	Uploaded 2018-02-26	Available
Appendix_B_PRA2019 - List of Changes _2017_12_22.pdf	Supplementary Document	Uploaded 2018-01-04	Available
CY2019 PRA 60-day comments 12.04.2017.docx	Supplementary Document	Uploaded 2018-01-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section Rx (VBID)
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section Rx
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section D
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section C
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section B (VBID)
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section B
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	CY 2019 PBP Data Entry System Screens - Section A and Upload
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Form	Modified	Medication Therapy Management Program (MTMP)
43667	CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)	Instruction	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 201801-0938-001
Status: Historical Active	Previous ICR Reference No: 201701-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
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 with change	Conclusion Date: 02/27/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/04/2018
Terms of Clearance: As this ICR is associated with the issuance of annual guidance, this ICR must be revised accordingly each year.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	05/31/2018
Responses	5,675	0	5,185
Time Burden (Hours)	56,450	0	50,619
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:
	82 FR 44416	09/22/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 61762	12/29/2017
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
CY2019 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, CMS-R-262, CMS-R-262	Medication Therapy Management Program (MTMP) ,   CY 2019 PBP Data Entry System Screens - Section A and Upload ,   CY 2019 PBP Data Entry System Screens - Section B ,   CY 2019 PBP Data Entry System Screens - Section B (VBID) ,   CY 2019 PBP Data Entry System Screens - Section C ,   CY 2019 PBP Data Entry System Screens - Section D ,   CY 2019 PBP Data Entry System Screens - Section Rx ,   CY 2019 PBP Data Entry System Screens - Section Rx (VBID)

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ICR Summary of Burden

table that charts list 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	5,675	5,185	0	446	44	0
Annual Time Burden (Hours)	56,450	50,619	0	5,397	434	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase to burden is attributable to an increase in the number of plans/PBP per organization, along with a decrease in the number of reporting organizations, as well as an increase in the number of formulary submissions and the addition of the new opioid upload. The number of reporting organizations decreased from 524 contracts to 520 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 520 organizations will submit distinct formularies.

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Annual Cost to Federal Government: $1,122,229

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 01/04/2018

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