CMS-10141 Compensation Structure for Plans

Comprehensive Addiction and Recovery Act of 2016 (CARA) / Medicare Prescription Drug Benefit Program (CMS-10141)

Attachment 2a - Compensation Structure for Plans

Business Continuity Plans under 422.504(o) and 423.505(p)

OMB: 0938-0964

Document [pdf]
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Attachment 2a - Description of Compensation Structure for
Plans Using Contracted Marketing Organizations
The structures to be provided are the initial and renewal
compensation amounts paid by the plan to the contracted
marketing organization(s).
(Optional form - if your organization has the schedule(s)
in a workbook, or some other format, you may submit that
documentation in lieu of Attachment 2a)

Contracted Marketing Organization Compensation Schedule
(Submit one per schedule)




Initial Compensation Structure:

Renewal Compensation Structure:

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0938-0964 (Expires XX/XX/XXXX). The time required to complete this information collection is estimated to
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time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


File Typeapplication/pdf
File TitleAttachment 1 - Compensation Certification
AuthorGerard Mulcahy
File Modified2020-02-07
File Created2017-11-30

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