[Medicaid] Medicaid Managed
Care and Supporting Regulations (CMS-10855)
New
collection (Request for a new OMB Control Number)
No
Regular
10/24/2024
Requested
Previously Approved
36 Months From Approved
604
0
8,614
0
0
0
This collection of information request
is associated with our September 26, 2024 (89 FR 79020) final rule
(CMS-2434-F; RIN 0938-AU28). We intend to fold the following
collection of information requirements and burden estimates under
CMS-10108 (OMB 0938-0920). However, there are a number of
conflicting activities that make this impractical at this time. To
address those conflicts, as a stop gap measure we are proposing to
submit the collection of information requirements and burden
estimates under CMS-10855 (OMB 0938-1445). When ready we will be
folding them to their proper place under CMS-10108 (OMB 0938-0920).
Most Medicaid beneficiaries receive either all or part of their
health care benefits through Medicaid managed care programs,
including their prescription drug benefits. Because of the
specialized nature of the prescription drug benefit, many of the
Medicaid managed care plans (MCOs, PIHPS, or PAHPS) either own, or
contract with, PBMs to administer the pharmacy benefit. In §
438.3(s), Medicaid MCOs, PIHPs, and PAHPs that provide coverage of
covered outpatient drugs (CODs) would be required to structure any
contract that it has with any subcontractor (e.g., PBM) for the
delivery or administration of the COD benefit so that the
subcontractor is required to report separately the amounts related
to the incurred claims described in § 438.8(e)(2) to the managed
care plan. The provisions would ensure that medical loss ratios
(MLRs) reported by MCOs, PIHPs and PAHPs that use subcontractors in
the delivery of COD coverage would be more accurate and
transparent. The separate payment requirements would help States
and managed care plans better understand whether they are
appropriately and efficiently paying for the delivery of CODs, a
significant part of which is funded by the Federal
Government.
US Code:
42
USC 1396a Name of Law: Social Security Act
For States, we estimate a
one-time burden of 40 responses/respondents, 1,000 hours, and
$91,920. For the private sector (managed care plans and PBMs) we
estimate an annual burden of 564 responses/respondents, 7,614
hours, and $699,879. Overall, we estimate a burden of 604
responses/respondents, 8,614 hours, and $791,799. There are no
reporting instruments or instructions other that what is set out in
CMS-2434-F and what is codified in the CFR.
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.
CMS-10855 - Response to 60-Day NPRM Comments (2024 version 3).docx
Managed Care Plans' and their Subcontractors: Identify Costs and Report