Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)

Forms and Documents

Document Name	Status
CMS-10476 - Supporting Statement A (rev 04-27-2018 by OSORA PRA).docx Supporting Statement A	2018-05-02
508_CMS-10476_Attachment_D_Data Form Crosswalk.pdf Supplementary Document	2018-05-02
CMS-10476_Attachment_E_Response_to_Comments 2-20-18.doc Supplementary Document	2018-04-19

IC Document Collections

IC ID	Document Title	Status
209359	Annual Reporting and Recordkeeping Requirements Instruction	Modified

ICR Details

OMB Control No: 0938-1232	ICR Reference No: 201804-0938-019
Status: Active	Previous ICR Reference No: 201711-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/03/2018
	Date Received in OIRA: 05/03/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	03/31/2020
Responses	587	0	616
Time Burden (Hours)	21,158	0	28,980
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education Reconciliation Act
   PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: 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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT08	Final or interim final rulemaking	83 FR 16440	04/16/2018

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 56336	11/28/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 16440	04/16/2018
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Annual Reporting and Recordkeeping Requirements	CMS-10476	MLR Data Form

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ICR Summary 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	587	616	0	-29	0	0
Annual Time Burden (Hours)	21,158	28,980	0	-7,822	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: We expect that 587 contracts will be subject to the MLR requirements, which is 29 fewer contracts our previous estimate of 616. The table below also indicates that the reduction in the amount of MLR data that is submitted to CMS on an annual basis will result in MA organizations and Part D spending on average 36 hours per MA or Part D contract on administrative work, compared to 47 hours per contract under the currently approved collection. We estimate that, as a result of the reduction in the number of contracts subject to the MLR requirements, and the reduction in the number of hours spent on administrative work, the total burden of the MLR reporting requirements across all MA organizations and Part D sponsors will decrease by 7,820 hours, from 28,952 hours under the currently approved collection to 21,132 hours under the revised collection. The table also indicates that the estimated average cost per contract will decrease from $6,372 under the currently approved collection to $5,045 under the revised collection (-$1,542 per contract).

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Annual Cost to Federal Government: $217,429

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.     Yes

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: 05/03/2018

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