Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)

ICR 202201-0938-010

OMB: 0938-1346

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ICR Details
0938-1346 202201-0938-010
Received in OIRA 202010-0938-003
Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)
Revision of a currently approved collection   No
Regular 01/13/2022
  Requested Previously Approved
36 Months From Approved 11/30/2024
2,495 2,495
24,632 24,632
0 0

This proposed collection of information is essential to appropriate and timely compliance monitoring by CMS, in order to ensure that all active MAO contracts offering network-based plans maintain an adequate network. Currently, CMS verifies that MAOs are compliant with the current CMS network adequacy criteria by performing a contract-level network review, which occurs when CMS requests that an MAO upload provider and facility Health Service Delivery (HSD) tables for a given contract to the Health Plan Management System (HPMS). If an MAO does not have its contract-level network formally reviewed by CMS after the initial contract application process, then there is no CMS requirement for a network adequacy review unless one of the above listed triggering events occurs. Therefore, CMS is proposing this collection of information in order to improve monitoring of MAOs’ network adequacy. This collection of information requires the uploading of HSD tables to the Network Management Module (NMM) in HPMS for any contract that has not had an entire network review performed by CMS in the previous three years of contract operation. The collection process will occur at the contract level for each MAO that qualifies, and CMS will assess each contract against the current CMS network adequacy criteria. Each time an MAO’s contract undergoes an entire network review during any of the triggering events listed on page one, the three-year anniversary date for that contract will be reset, and CMS will maintain an HPMS report to keep track of this date for every active network-based contract.

US Code: 42 USC 1852 Name of Law: Health Insurance for the Aged and Disabled: Benefits and Beneficiary Protections

0938-AU30 Proposed rulemaking 87 FR 1842 01/12/2022

  87 FR 1842 01/12/2022

IC Title Form No. Form Name
Three-Year Network Adequacy Review for Medicare Advantage Organizations CMS-10636, CMS-10636, CMS-10636, CMS-10636 Provider Table ,   Facility Table ,   Exception Template ,   Justification Template

  Total Request 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 2,495 2,495 0 0 0 0
Annual Time Burden (Hours) 24,632 24,632 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Mitch Bryman 410 786-5258 [email protected]


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:
    (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;
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.

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