OMB control number

Part C and Part D Medicare Prescription Payment Plan Model Documents (CMS-10882) - IRA

OMB 0938-1475 · HHS/CMS.

OMB 0938-1475

The purpose of this information collection request for the approval of model documents for the Medicare Prescription Drug Program (Part D) is to meet the requirements of Section 11202 of the Inflation Reduction Act of 2022, Public L. 117-169 (IRA), which established the Medicare Prescription Payment Plan Program. Under this program, MA Organizations offering Part D coverage and Part D sponsors are required to offer enrollees the option to pay their Part D cost sharing in monthly amounts spread out over the plan year based on the formula described in section 1860D-2(b)(2)(E)(iv) of the Act. There are several education and outreach requirements for plan sponsors related to implementation of this program. The proposed documents in this information collection are designed to assist Part D plan sponsors and MA organizations in complying with Sections 1860D-2(b)(2)(E)(v)(II) – (IV) of the Social Security Act (the Act), which set forth the education and outreach responsibilities for Part D sponsors and MA organizations for this program. CMS has developed the six materials in the attached package as model notices to provide standardized and consistent language for potential and active program participants, regardless of which Part D plan they may be enrolled in. CMS will require Part D plans to disseminate these notices, as appropriate, to Part D enrollees to fulfill the requirements of the Sections 1860D-2(b)(2)(E)(v)(II) – (IV) of the Act. The six model notices and their related burden are accounted for in this PRA package. By providing these model notices, CMS is providing standardized messaging for all Part D beneficiaries and reducing administrative burden on Part D sponsors and MA organizations.

The latest form for Part C and Part D Medicare Prescription Payment Plan Model Documents (CMS-10882) - IRA expires 2028-12-31 and is listed under ICR 202507-0938-023.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10882 Likely to Benefit Notice_ KoreanForm and Instruction
Form CMS-10882 Likely to Benefit Notice_ VietnameseForm and Instruction
Form CMS-10882 Likely to Benefit Notice_ ChineseForm and Instruction
Form CMS-10882 Part D Sponsor Notice of Participation Renewal in the Medicare Prescription Payment PlanForm and Instruction
Form CMS-10882 Part D Sponsor Notice of Voluntary Removal from the Medicare Prescription Payment PlanForm and Instruction
Form CMS-10882 Part D Sponsor Notice for Failure to Make Payments under Medicare Prescription Payment Plan – Notification of Termination of Participation in the Medicare Prescription Payment PlanForm and Instruction
Form CMS-10882 Part D Sponsor Notice for Failure to Make Payments under the Medicare Prescription Payment PlanForm and Instruction
Form CMS-10882 Part D Sponsor Notice to Acknowledge Acceptance of Election to the Medicare Prescription Payment PlanForm and Instruction
Form CMS-10882 Medicare Prescription Payment Plan Participation Request FormForm and Instruction
Form CMS-10882 Likely to Benefit InstructionsForm and Instruction
Form CMS-10882 Likely to Benefit Notice_ SpanishForm and Instruction
Form CMS-10882 Likely to Benefit NoticeForm and Instruction
Form CMS-10882 MPPP Model Notices ProgrammingForm and Instruction
M3P 30 Day Comment Grid (10882) FINAL.pdfSupplementary Document
Paytient Comment on Medicare Prescription Payment Plan Guidance.pdfPublic Comments
[EXTERNAL] ICR Comment [0938-1475] [202507-0938-023] MPPP Model Documents.pdfPublic Comments
UHC Comments - M3P Model Documents_8.27.2025.pdfPublic Comments
[EXTERNAL] ICR Comment [0938-1475] [202507-0938-023] MPPP Model Documents Part 2.pdf (document unavailable)Public Comments
[EXTERNAL] ICR Comment_ OMB Control Number_ OMB 0938-1475 Collection Title_ Medicare Prescription Payment Plan Model Documements.pdfPublic Comments
2026_M3P Election Form_Template_ (swap read-sign with AOR).docxPublic Comments
PC_202507-0938-023_080825_025920_1.pdfPublic Comments
CMS-10882_Supporting Statement A_2025-.docxSupporting Statement A
CMS-10882_Supporting Statement A_2025-.docxSupporting Statement A
60-day comments.pdf (document unavailable)Public Comments
Response to Public Comments (CMS-10882).xlsxSupplementary Document
Response to Public Comments (CMS-10882).xlsx Supplementary Document
CMS-10882_ Comment_Crosswalk.docxSupplementary Document
CMS-10882_ Comment_Crosswalk.docx Supplementary Document
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction
MPPP Model Notices Programming Form and Instruction

All Historical Document Collections