Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)

Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 440.395(c)(1) 42 CFR 457.496(e)(1) 42 CFR 438.915(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 602	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	213,314	7,183	206,131
Annual IC Time Burden (Hours)	17,776	598	17,178
Annual IC Cost Burden (Dollars)	66,811	66,811	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.