Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)

Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)

OMB: 0938-1280

IC ID: 220884

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Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)
 
No Modified
 
Voluntary
 
42 CFR 457.496(e)(1) 42 CFR 438.915(a) 42 CFR 440.395(c)(1)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

68,710,529 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 206,130 0 0 63,727 0 142,403
Annual IC Time Burden (Hours) 51,533 0 0 15,932 0 35,601
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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