Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request (CMS-10913)

Forms and Documents

Document Name	Status
Form CMS-10913 Medicare Part C UM Audits Form and Instruction	New
Form CMS-10913 Medicare Part C UM Annual Data Submission Form and Instruction	New
CMS-10913_SupportingStatementA.docx Supporting Statement A	2024-12-23
60-Day Crosswalk of Changes.pdf Supplementary Document	2024-12-23
60-Day Response to Comments.docx Supplementary Document	2024-12-23

IC Document Collections

IC ID	Document Title	Status
273408	Medicare Part C UM Audits Form and Instruction	New
273407	Medicare Part C UM Annual Data Submission Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202412-0938-017
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CM
Title: Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request (CMS-10913)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/23/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	219	0
Time Burden (Hours)	19,180	0
Cost Burden (Dollars)	0	0

---

Abstract: On April 12, 2023, CMS issued the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly final rule (88 FR 22120), which, in part, finalized updates to the Medicare Advantage (MA) utilization management program requirements in §§ 422.101 and 422.137 that clarified coverage criteria for basic benefits and the annual review of utilization management tools. Pursuant to CMS’s authorities under Section 1857(d) of the Social Security Act to oversee MA organizations’ compliance with program requirements and our authority at § 422.516(a) to collect MA program information, CMS has developed this data collection package to ensure that we evaluate MA organizations’ compliance with §§ 422.101 and 422.137. There are two distinct data collections included in this PRA package, the annual collection of MA organizations’ utilization management data and the utilization management audit protocol data request.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 73420	09/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 104547	12/23/2024
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Medicare Part C UM Annual Data Submission	CMS-10913, CMS-10913	Medicare PartC_UM_Annual Data Submission ,   Utilization Management Annual Submission (UMAS) Record Layout with Examples
Medicare Part C UM Audits	CMS-10913, CMS-10913, CMS-10913, CMS-10913, CMS-10913	CMS List of Targeted Services ,   Medicare PartC UM Audit Protocol Data Request ,   Utilization Management Criteria (UMC) Record Layout with Examples ,   UMSupplementalQuestions ,   Medicare Part C UM Root Cause Analysis

---

ICR Summary of Burden

	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	219	0	0	0	219	0
Annual Time Burden (Hours)	19,180	0	0	0	19,180	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $2,217,600

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/23/2024

---