OMB control number
Medical Necessity Disclosure Under MHPAEA and Claims Denial Disclosure Under MHPAEA (CMS-10307)
OMB 0938-1080 · HHS/CMS.
OMB 0938-1080
Medical Necessity Disclosure under MHPAEA The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (P.L.110-343) requires that group health plans and group health insurance issuers offering mental health or substance use disorder (MH/SUD) benefits in addition to medical and surgical (med/surg) benefits ensure that that they do not apply any more restrictive financial requirements (e.g., co-pays, deductibles) and/or treatment limitations (e.g., visit limits) to MH/SUD benefits than those requirements and/or limitations applied to substantially all med/surg benefits.Medical Necessity Disclosure under MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to provide, upon request, the criteria for medical necessity determinations made with respect to MH/SUD benefits to current or potential participants, beneficiaries, or contracting providers. The Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (75 FR 5410, February 2, 2010) sets forth rules for providing criteria for medical necessity determinations. The final rules retain the provisions from the interim final rules and extend them to small employers and the individual market. CMS oversees non-Federal governmental plans or related health insurance and health insurance plans offered in the individual market.MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to supply, upon request, the reason for any denial of payment for MH/SUD services to the participant or beneficiary involved in the case.
The latest form for Medical Necessity Disclosure Under MHPAEA and Claims Denial Disclosure Under MHPAEA (CMS-10307) expires 2027-11-30 and is listed under ICR 202408-0938-032.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10307 Disclosure Request Form | Form and Instruction |
 CMS-10307 Supporting Statement 30-day_8-5-24.docx | Supporting Statement A |
 Disclosure Request Form |
Form and Instruction |
| Medical Necessity Disclosure under MHPAEA sent with Claims Denial Disclosure |
Information collection |
| Medical Necessity Disclosure under MHPAEA |
Information collection |
| Claims Denial Disclosure under MHPAEA |
Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202408-0938-032 | Extension without change of a currently approved collection | 2024-08-26 | ||
| 202102-0938-014 | Revision of a currently approved collection | 2021-02-24 | Approved with change | |
| 201908-0938-016 | No material or nonsubstantive change to a currently approved collection | 2019-08-30 | Approved without change | |
| 201712-0938-008 | Reinstatement without change of a previously approved collection | 2017-12-13 | Approved with change | |
| 201311-0938-020 | Existing collection in use without an OMB Control Number | 2013-11-14 | Approved without change | |
| 200912-0938-008 | New collection (Request for a new OMB Control Number) | 2009-12-17 | Preapproved |
OMB Details
Claims Denial Disclosure under MHPAEA
Federal Enterprise Architecture: Health - Health Care Services