OMB.report

Federal forms, ICRs, and supporting documents

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.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10307 Model Disclosure Template (Korean))Form and Instruction
Form CMS-10307 Model Disclosure Template (Vietnamese)Form and Instruction
Form CMS-10307 Model Disclosure Template (Chinese)Form and Instruction
Form CMS-10307 Model Disclosure Template (Vietnamese)Form and Instruction
Form CMS-10307 Model Disclosure Template (Spanish)Form and Instruction
Form CMS-10307 Model Disclosure Template (Tagalog)Form and Instruction
Form CMS-10307 Model Disclosure Template (Korean_Form and Instruction
Form CMS-10307 Model Disclosure Template (Arabic)Form and Instruction
Form CMS-10307 Model Disclosure Template (English)Form and Instruction
Form CMS-10307 Disclosure Request FormForm and Instruction
CMS-10307 Supporting Statement 30-day_8-5-24.docxSupporting Statement A
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
Disclosure Request Form Form and Instruction
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

Historical document collections
ReferenceFilingReceivedConcludedAction
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