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
0938-0763_Explanation for changes_comments_cm_final_response_Final Clean.docx	Supplementary Document	Uploaded 2019-04-03	Available
PBP2020-ListofChanges 2.0 -2018-2-20.pdf	Supplementary Document	Uploaded 2019-02-21	Available
PBP2020-ListofChanges-2018-12-12.pdf	Supplementary Document	Uploaded 2019-02-12	Available
CY2020 PRA 60-day comments responses.docx	Supplementary Document	Uploaded 2019-02-12	Available
CMS-R-262_CY2020_PBP_Sprtng_Stmnt_12_19_2020.pdf	Supporting Statement A	Uploaded 2019-02-12	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)	Instruction	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 201901-0938-009
Status: Historical Active	Previous ICR Reference No: 201801-0938-001
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: 04/05/2019
	Date Received in OIRA: 02/13/2019
Terms of Clearance: Previous terms continue: 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	04/30/2022	36 Months From Approved	04/30/2019
Responses	6,763	0	5,675
Time Burden (Hours)	65,354	0	56,450
Cost Burden (Dollars)	0	0	0

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 49389	10/01/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 734	01/31/2019
Did the Agency receive public comments on this ICR? Yes

---

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)	R-262, R-262, R-262, R-262, R-262, R-262, R-262, R-262	MTMP CY2020 Enhancement Mockups ,   Section A-1 ,   #1a Inpatient Hospital-Acute – Base 1 ,   #19 VBID/MA Uniformity Flexibility/SSBCI ,   OON – General – Base 1 ,   Plan Deductible LPPO/RPPO Base 1 ,   Medicare Rx General 1 ,   VBID – General

---

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	6,763	5,675	0	1,088	0	0
Annual Time Burden (Hours)	65,354	56,450	0	8,904	0	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 actual plans submitting/PBPs per organization from 10 plans/PBP to 11 plans/PBP, along with an increase in the number of reporting organizations from 520 to 570, as well as an increase in the number of Page 11 formulary submissions from 475 formularies submitted to 493. The number of reporting organizations increased from 520 contracts to 570 contracts based on the most recent numbers extracted from HPMS for organizations planning to provide Medicare to beneficiaries. 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 570 organizations will submit distinct formularies

---

Annual Cost to Federal Government: $1,207,520

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

---

Common Form ICR:  No

---

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: 02/13/2019

---