[Medicaid] Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Comment - mid-oyks-ifu0.pdf	Public Comments	Uploaded 2025-11-24	Repair queued
CMS-10556 - Supporting Statement A (2025 version 7).docx	Supporting Statement A	Uploaded 2025-12-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220885	State Analysis and Transparency Responsibilities (sec. 438.920)		Modified
220884	Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)		Modified
216060	State Contract Requirements (§ 438.3(n))		Modified
216059	Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)		Modified

ICR Details

OMB Control No: 0938-1280	ICR Reference No: 202512-0938-021
Status: Received in OIRA	Previous ICR Reference No: 202211-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Medical Necessity and Contract Amendments Under Mental Health Parity (CMS-10556)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/30/2025

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	473,213	426,719
Time Burden (Hours)	79,050	71,294
Cost Burden (Dollars)	26,992	66,811

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Abstract: The final rule amends the Medicaid and CHIP regulations to implement the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. The final rule applies mental health parity requirements to Medicaid Managed Care Organizations (MCOs), Section 1937 Alternative Benefit Plans (ABPs), and the CHIP. The final rule also contains provisions related to the disclosure of information related to the reason for denial of reimbursement or payment for MH/SUD benefits. The text only clarifies the expectations for disclosing information concerning the denial of reimbursement or payment for MH/SUD benefits. It does not impose any new or revised third-party disclosure requirements.

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Authorizing Statute(s): PL: Pub.L. 111 - 3 502 Name of Law: Children’s Health Insurance Program Reauthorization Act of 2009
   PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008
   PL: Pub.L. 111 - 148 2001(c) Name of Law: Patient Protection and Affordable Care Act of 2010
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2001(c) Name of Law: Patient Protection and Affordable Care Act of 2010
PL: Pub.L. 111 - 3 502 Name of Law: Children’s Health Insurance Program Reauthorization Act of 2009
PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 46213	09/25/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 59836	12/22/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Availability of Information and the Criteria for Medical Necessity Determinations (Regulated Entities)
State Analysis and Transparency Responsibilities (sec. 438.920)
State Contract Requirements (§ 438.3(n))
Submitting Requests for Medical Necessity Disclosures (Potential Participants, Beneficiaries, and Contracting Providers)

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ICR Summary of Burden

table that charts list 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	473,213	426,719	0	46,494	0	0
Annual Time Burden (Hours)	79,050	71,294	0	7,756	0	0
Annual Cost Burden (Dollars)	26,992	66,811	0	-39,819	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: In this 2025 iteration, we are adjusting our burden estimates based on more recent data. We have also corrected the non-labor cost.

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Annual Cost to Federal Government: $607,005

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]? Yes

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

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Common Form ICR:  No

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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: 12/30/2025

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