Non-Substantive Memo Request

To: Jamie Wilson

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: Sabrina Edmonston

Medicare Oversight and Enforcement Group (MEAG)

Center for Medicare (CM)

Date: February XX, 2023

Subject: Non-Substantive Change Request – Spanish Version of the Notice of Denial of Medical Coverage (or Payment) - NDMCP CMS-10003, OMB 0938-0829

This memo requests approval of a non-substantive change to the approved information collection, Notice of Denial of Medical Coverage (or Payment) - NDMCP CMS-10003, OMB 0938-0829

Background

Medicare health plans, including Medicare Advantage plans, cost plans, and Health Care Prepayment Plans (HCPPs), are required to issue the Notice of Denial of Medical Coverage (or Payment) (NDMCP) when a request for either a medical service or payment is denied, in whole or in part. Additionally, the notices inform Medicare enrollees of their right to file an appeal, outlining the steps and timeframes for filing. All Medicare health plans are required to use these standardized notices. This collection was last approved by OMB on January 9, 2023 and expires on December 31, 2024.

The information collection request approved by OMB on January 9, 2023 did not include the Spanish version of the Notice of Denial of Medical Coverage (or Payment).

Overview of Requested Changes

CM requests approval of the Spanish version of the Notice of Denial of Medical Coverage (or payment). The English version was reviewed and approved by OMB through the most recent review process. The following provides an overview of the changes that were incorporated into the current Spanish version:

• Updated standardized nondiscriminatory language