Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)

ICR 202201-0938-011

OMB: 0938-1232

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2022-01-12
Supplementary Document
2022-01-12
Supporting Statement A
2022-01-12
IC Document Collections
IC ID
Document
Title
Status
209359 Modified
ICR Details
0938-1232 202201-0938-011
Received in OIRA 202006-0938-003
HHS/CMS CM-CPC
Medical Loss Ratio (MLR) Data Form for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) (CMS-10476)
Revision of a currently approved collection   No
Regular 01/12/2022
  Requested Previously Approved
36 Months From Approved 01/31/2024
601 587
36,748 21,159
0 0

Under the Affordable Care Act (ACA), and implementing regulations at 42 CFR, Medicare Advantage (MA) organizations and Prescription Drug Plan (PDP) sponsors are required to submit annual medical loss ratio (MLR) reports (at the contract level) to the Secretary of HHS concerning the amount spent on claims, quality improvement expenses, non-claims costs, Federal and State taxes, licensing and regulatory fees, and revenue. Plan sponsors must provide a remittance to the Secretary if the amount spent in a reporting year on certain costs compared to its revenue (excluding Federal and States taxes and licensing and regulatory fees) is below a certain ratio, referred to as the medical loss ratio (MLR). MA organizations and Part D sponsors are required to report their MLR to CMS, and are subject to financial and other penalties for a failure to meet a statutory requirement that they have an MLR of at least 85 percent. The Affordable Care Act requires several levels of sanctions for failure to meet the 85 percent minimum MLR requirement, including remittance of funds to CMS, a prohibition on enrolling new members, and ultimately contract termination. Plan sponsors will use the MLR Reporting Tool to provide contract-level MLR information to CMS. The information provided in this MLR Report is the basis for computing the contract's MLR percentage and remittance amount, if any, for a contract year.

PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education Reconciliation Act
  
PL: Pub.L. 111 - 148 1103 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1857(e) Name of Law: Health Care and Education Reconciliation Act

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

  87 FR 1842 01/12/2022
No

1
IC Title Form No. Form Name
Annual Reporting and Recordkeeping Requirements CMS-10476 MLR Report

  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 601 587 0 14 0 0
Annual Time Burden (Hours) 36,748 21,159 0 15,589 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Our January 12, 2022 rule (87 FR 1842) (CMS-4192-P, RIN 0938-AU30) proposes to amend §§ 422.2460 and 423.2460 to reinstate the detailed MLR reporting requirements that were in effect for CYs 2014 through 2017. We also proposed to expand those detailed reporting requirements to include separate reporting of amounts spent on MA supplemental benefits. Revisions take into account: (1) the additional burden for MA organizations and Part D sponsors to report their MLRs under the proposed reporting requirements; and (2) the elimination of the burden for MA organizations to calculate and apply the deductible factor to the MLR calculation for MA MSA contracts because the software used to report Medicare MLRs under the proposed requirements would automatically calculate this burden. Overall, we estimate an increase of 14 responses and 15,589 hours.

$337,497
No
    Yes
    No
Yes
No
No
No
Mitch Bryman 410 786-5258 [email protected]

  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:
 
 
 
 
 
 
 
    (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.
01/12/2022


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