Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (CMS-10265)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10265 Interim Non-GHP Record Layout	Form and Instruction	Modified	Repair queued
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Private - Maintenance/Administration)	Form and Instruction	Modified	Repair queued
Form CMS-10625 Interim Non-GHP Record Layout	Form and Instruction	Modified	Repair queued
Form CMS-10625 Mandatory Insurer Reporting (NGHP-Private)	Form and Instruction	Modified	Repair queued
CMS-10265_Supporting Statement Part A - clean.docx	Supporting Statement A	Uploaded 2020-12-08	Repair queued
Crosswalk.pdf	Supplementary Document	Uploaded 2020-11-24	Repair queued
5 Attach D 7_27_2020 vj508.pdf	Supplementary Document	Uploaded 2020-11-24	Available
4 Attach C 7_27_2020 vj508.pdf	Supplementary Document	Uploaded 2020-11-24	Repair queued
SSN Justification.pdf	Supplementary Document	Uploaded 2020-11-24	Repair queued
Definitions and Reporting Responsibilities.pdf	Supplementary Document	Uploaded 2020-11-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
244619	Mandatory Insurer Reporting for Prescription Drug (GHP RREs-Private, Maintenance/Administrative)	Instruction	New
188583	Mandatory Insurer Reporting (Non-GHP, Private - Maintenance/Administration)	Form and Instruction	Modified	Interim Non-GHP Record Layout
188583	Mandatory Insurer Reporting (Non-GHP, Private - Maintenance/Administration)	Form and Instruction	Modified
188580	Mandatory Insurer Reporting (NGHP-Private)	Form and Instruction	Modified	Interim Non-GHP Record Layout
188580	Mandatory Insurer Reporting (NGHP-Private)	Form and Instruction	Modified
188578	Mandatory Insurer Reporting (GHP-Private, Maintenance/Administrative)	Instruction	Modified
188574	Mandatory Insurer Reporting (GHP-Private)	Instruction	Modified

ICR Details

OMB Control No: 0938-1074	ICR Reference No: 202011-0938-013
Status: Historical Active	Previous ICR Reference No: 201706-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: OFM
Title: Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (CMS-10265)
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: 01/18/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/09/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2025	36 Months From Approved	01/31/2022
Responses	5,239,931	0	5,019,248
Time Burden (Hours)	618,060	0	485,826
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) seeks to collect various data elements for the applicable reporting entities for purpose of implementing the mandatory MSP reporting requirements of Section 111 of the MMSEA. This information will be used to ensure that Medicare makes payment in the proper order and/or takes necessary recovery actions. The purpose of this submission is to set forth what information will be collected pursuant to Section 111 and the process for such collection. Section 111 mandates the reporting of information specified by the Department of Health and Human Services Secretary in the form and manner specified by the Secretary (including frequency) Data the Secretary will collect is necessary for both pre-payment and post-payment coordination of benefit purposes, including the recovery actions. Section 111 establishes separate mandatory reporting requirements for group health plan arrangements as well as for liability insurance (including self-insurance), no-fault insurance, and workers' compensation, also referred to as non-group health plan. With the passage of Section 111, CMS now has the authority to mandate the reporting of insurer MSP information.

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Authorizing Statute(s): PL: Pub.L. 110 - 173 111 Name of Law: Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements
   US Code: 42 USC 1395y(b)(7)(A)(i)(II Name of Law: Exclusions from coverage and medicare as secondary payer
   PL: Pub.L. 115 - 271 4002 Name of Law: Support Act
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 271 4002 Name of Law: Support Act

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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:
	85 FR 58360	09/18/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 78853	12/07/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Mandatory Insurer Reporting (GHP-Private)
Mandatory Insurer Reporting (GHP-Private, Maintenance/Administrative)
Mandatory Insurer Reporting (NGHP-Private)	CMS-10625	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Private - Maintenance/Administration)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting for Prescription Drug (GHP RREs-Private, Maintenance/Administrative)

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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	5,239,931	5,019,248	0	790	219,893	0
Annual Time Burden (Hours)	618,060	485,826	0	4,345	127,889	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: Burden has increased due to multiple reasons. Beginning in January 2020 CMS started to collect prescription drug information per the requirements cited in Section 4002 of the SUPPORT Act and 42 U.S.C. 1395y(b)(7)(A)(i)(II) which also applies to the increase in the burden cost for GHPs. Burden has also increased due to the number increase of NGHP records and TPOCs received.

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Annual Cost to Federal Government: $19,166,000

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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? No

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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: 12/09/2020

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