Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)
Revision of a currently approved collection
No
Regular
Approved with change
11/13/2024
09/19/2024
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
11/30/2027
36 Months From Approved
12/31/2024
18,232,560
0
16,191,812
3,037,544
0
2,697,556
0
0
0
Section 1852(g)(1)(B) of the Social Security Act (SSA) requires Medicare health plans to provide enrollees with a written notice in understandable language that explains the plan's reasons for denying a request for a service or payment for a service the enrollee has already received. The written notice must also include a description of the applicable appeals processes. Regulatory authority for this notice is set forth in Subpart M of Part 422 at 42 CFR 422.568, 422.572, 417.600(b), and 417.840.
Section 1932 of the Social Security Act (SSA) sets forth requirements for Medicaid managed care plans, including beneficiary protections related to appealing a denial of coverage or payment. The Medicaid managed care appeals regulations are set forth in Subpart F of Part 438 of Title 42 of the CFR. Rules on the content of the written denial notice can be found at 42 CFR 438.404.
This notice combines the existing Notice of Denial of Medicare Coverage with the Notice of Denial of Payment and includes optional language to be used in cases where a Medicare health plan enrollee also receives full Medicaid benefits that are being managed by the Medicare health plan.
Statute at Large:
18 Stat. 1852
Name of Statute: Social Security Act
US Code:
42 USC 1395w-22
Name of Law: Implementation of Medicare Advantage Program
US Code:
42 USC 1396u-2
Name of Law: Provisions Relating to Managed Care
Statute at Large:
19 Stat. 1932
Name of Statute: Social Security Act
The annual hourly burden associated with this collection is estimated to be 3,037,544 hours. The annual hourly burden in the previous submission for this collection was 2,697,556 hours, resulting in an increase in the burden. The increase in burden is largely due to the increase in the number of Medicare health plan enrollees, which results in a greater number of organization determinations made by a Medicare health plan. CMS believes these adjusted burden estimates, drawn from the most current and reliable data available are appropriate for the purpose of developing the burden estimates for the IDN (CMS- 10003).
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.
Form CMS-10003 Notice of Denial of Medical Coverage of Payment - Vietnamese
UHC Comments_NDMCP_10.17.2024.pdf
CMS-10003 - Supporting Statement A_.docx
Crosswalk for CMS 10003.xlsx
Notice of Denial of Medical Coverage (or Payment)