These forms are needed to establish the reasonable cost of providing covered services to the enrolled Medicare population of an HMO/CMP/HCPP in accordance with Sections 1876 and 1833 of the Social Security Act.
US Code:
42 USC 417
Name of Law: Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans
This iteration proposes minor changes to the worksheets and instructions (see the attached Crosswalks for details). The changes have no impact on our per response time estimates.
Since our last submission to OMB, two cost-based MCOs have terminated, which has affected the estimated total number of respondents. As a result, the estimated number of respondents for HMO/CMPs have been reduced by minus 3 (from 9 to 6) since our last submission, and the number of respondents for HCPPs have been reduced by minus 2 (from 8 to 6). As such, our total time estimate decreased by minus 484 hours (from 1,612 hr to 1,128 hr).
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-276 Final Cost Report
CMS-276 - Supporting Statement A (2025 version 8).docx
Comment - mab-mtzm-jyxs.pdf
Health Care Prepayment Plans (HCPPs) under Section 1833