Good Cause Processes (CMS-10544)

ICR 202205-0938-002

OMB: 0938-1271

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2022-05-05
IC Document Collections
IC ID
Document
Title
Status
215417
Modified
ICR Details
0938-1271 202205-0938-002
Received in OIRA 201806-0938-003
HHS/CMS CM-FFS
Good Cause Processes (CMS-10544)
Reinstatement without change of a previously approved collection   No
Regular 05/05/2022
  Requested Previously Approved
36 Months From Approved
41,289 0
27,499 0
0 0

Beneficiaries are provided a protection outlined in regulation at 42 CFR 417.460, 422.74, and 423.44 that provides CMS with the ability to reinstate an individual's enrollment into a Medicare Advantage, Part D or cost plan in certain circumstances where the individual's non-payment of plan premiums was due to circumstances that the individual could not reasonably foresee or could not control, such as an unexpected hospitalization. This submission calculates the administrative cost by Medicare Advantage, Part D and cost plans to process such requests on behalf of CMS.

US Code: 18 USC 1851(g)(3)(B)(i) Name of Law: Social Security Act (Part C)
   US Code: 18 USC 1860D-1(b)(1)(B) Name of Law: Social Security Act (Part D)
   US Code: 18 USC 1876(c)(3)(B) Name of Law: Social Security Act (Payments to Health Maintenance Organizations and Competitive Medical Plans)
  
None

Not associated with rulemaking

  87 FR 9627 02/22/2022
87 FR 26760 05/05/2022
No

1
IC Title Form No. Form Name
Good Cause Processes (Sec. 417.460, 422.74, and 423.44)

  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 41,289 0 0 0 31,281 10,008
Annual Time Burden (Hours) 27,499 0 0 0 20,834 6,665
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The annual Burden hours increased from 6,665 to 27,499 due to the number of respondents increasing from 10,008 to 41,289. This increase was a result of the increased number of plans that are disenrolling members for nonpayment of premiums, the increased number of beneficiaries disenrolled under these policies and the increased number of beneficiaries requesting reinstatement.

$0
No
    No
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [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.
05/05/2022


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