Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)

ICR 202409-0938-016

OMB: 0938-0829

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2024-09-17
Supplementary Document
2024-09-13
Supplementary Document
2024-09-13
IC Document Collections
IC ID
Document
Title
Status
8626 Modified
ICR Details
0938-0829 202409-0938-016
Received in OIRA 202308-0938-002
HHS/CMS CM-CPC
Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)
Revision of a currently approved collection   No
Regular 09/19/2024
  Requested Previously Approved
36 Months From Approved 12/31/2024
18,232,560 16,191,812
3,037,544 2,697,556
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.

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
   Statute at Large: 18 Stat. 1852 Name of Statute: Social Security Act
  
None

Not associated with rulemaking

  89 FR 48901 06/10/2024
89 FR 76113 09/17/2024
Yes

1
IC Title Form No. Form Name
Notice of Denial of Medical Coverage (or Payment) CMS-10003, CMS-10003 Notice of Denial of Medical Coverage ,   Notice of Denial of Medical Coverage of Payment - Spanish

  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 18,232,560 16,191,812 0 0 2,040,748 0
Annual Time Burden (Hours) 3,037,544 2,697,556 0 0 339,988 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
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).

$1,281
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.
09/19/2024


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