Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Pap...
Centers for Medicare & Medicaid Services, Health and Human Services (HHS).
ACTION:
Notice.
SUMMARY:
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the
Federal Register
concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of
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information technology to minimize the information collection burden.
DATES:
Comments must be received by October 13, 2026.
ADDRESSES:
When commenting, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in any one of the following ways:
1.
Electronically.
You may send your comments electronically to
www.regulations.gov.
Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments.
2.
Byregular mail.
You may mail written comments to the following address: CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention: Document Identifier: __ / OMB Control Number: __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see
ADDRESSES
).
Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the
Federal Register
concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.
Information Collections
1.
Type of Information Collection Request:
Extension of a currently approved collection;
Title of Information Collection:
Quality Bonus Payment Appeals;
Use:
Sections 1853(n) and 1853(o) of the Social Security Act (the Act) require CMS to make Quality Bonus Payments (QBPs) to MA organizations that achieve at least 4 stars in a 5-star quality rating system. In addition, section 1854(b)(1)(C) of the Act ties the share of savings that MA organizations must provide to enrollees as the beneficiary rebate to the level of an MA organization's QBP rating. The administrative review process for an MA contract to appeal their QBP status is laid out at § 422.260(c). §§ 422.260(c)(1) and (2) describe a two-step administrative review process that includes a request for reconsideration and a request for an informal hearing on the record, and § 422.260(c)(3) describes limits to requesting an administrative review. Historically, every November CMS has released the preliminary QBP ratings for MA contracts to review their ratings and to submit an appeal request under § 422.260(c) if they believe there is a calculation error or incorrect data are used. Each MA organization continues to be afforded the right to request an administrative review of CMS's determination concerning the organization's qualification for a QBP.
The information collected on the Request for Reconsideration form from MA organizations is considered by the reconsideration official and potentially the hearing officer and CMS Administrator to review CMS's determination of the organization's eligibility for a QBP. The form asks MA organizations to select the Star Ratings measure(s) they believe was miscalculated or used incorrect data and describe what they believe is the issue. Under § 422.260(c)(3)(ii) these are the only bases for appeals. In conducting the reconsideration, the reconsideration official will review the QBP determination, the evidence and findings upon which it was based, and any other written evidence submitted by the organization with their Request for Reconsideration or by CMS before the reconsideration determination is made.
Form Number:
CMS-10346.
OMB Control Number:
0938-1129.
Frequency:
Yearly.
Affected Public:
Private Sector, Business or other for-profit and Not-for-profit institutions.
Number of Respondents:
120.
Total Annual Responses:
20.
Total Annual Hours:
160.
For policy questions regarding this collection contact Joy Binion at 410-786-5004.
2.
Type of Information Collection Request:
Revision of a currently approved collection;
Title of Information Collection:
The Medicare Advantage and Prescription Drug Programs: Part C and Part D Explanation of Benefits;
Use:
Sections 1852(k)(2)(C)(i) and 1860D-(4)(a)(4) of the Act give CMS authority to require EOBs in Part C and Part D, respectively. Corresponding Part C and Part D regulations at §§ 422.111(k) and 423.128(e) further specify the requirements to provide a written EOB directly to enrollees following their use of benefits.
These requirements and the CMS model documents help ensure that Part C and Part D enrollees receive consistent and timely information about costs associated with their medical claims. Part C and Part D EOBs allow enrollees to track their out-of-pocket expenses and benefit utilization in relation to their plan's deductible and out-of-pocket threshold. This customized information positions enrollees to make informed decisions about their healthcare options. Further, the proposed updates to the Part C EOB allow enrollees to better track their utilization of supplemental benefits, which previously were not included in the EOBs in a consistent way, while the proposed updates to the Part D EOB improve clarity and accuracy of information. The EOBs also enable enrollees to make a more practical use of the information found in plans' Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents, as well as information available through tools such as the Medicare Plan Finder. Given the complexity of the health care system, providing readable and plain language information in the EOBs supports improved transparency.
Form Number:
CMS-10453.
OMB Control Number:
0938-1228.
Frequency:
Monthly.
Affected Public:
Private Sector, Business or other for-profit and Not-for-profit institutions.
Number of Respondents:
1,723.
Total Annual Responses:
1,723.
Total Annual Hours:
17,230.
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For policy questions regarding this collection contact Lucia Patrone at 410-786-8621.
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, Office of Strategic Operations and Regulatory Affairs.
www.regulations.gov
www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing
44 U.S.C. 3501-3520
5 CFR 1320.3(c)