Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007

Forms and Documents

Document Name	Status
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Form and Instruction	Modified
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Form and Instruction	Modified
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Form and Instruction	Modified
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Federal) Form and Instruction	Modified
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Form and Instruction	Modified
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Private) Form and Instruction	Modified
April 18 Draft CMS-10265 Burden Table-FINAL vj508.pdf Supplementary Document	2013-08-29
Attachment D_2013 vj508.pdf Supplementary Document	2013-08-29
Attachment C_2013 vj508.pdf Supplementary Document	2013-08-29
Attachment A_2013vj508.pdf Supplementary Document	2013-08-29
March 14 Supporting Statement_A Rev.doc Supporting Statement A	2013-08-29

IC Document Collections

IC ID	Document Title	Status
188585	Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative) Form and Instruction	Modified
188584	Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration) Form and Instruction	Modified
188583	Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration) Form and Instruction	Modified
188582	Mandatory Insurer Reporting (Non-GHP, Federal) Form and Instruction	Modified
188581	Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.) Form and Instruction	Modified
188580	Mandatory Insurer Reporting (Non-GHP, Private) Form and Instruction	Modified
188579	Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative) Instruction	Modified
188578	Mandatory Insurer Reporting (Private, Administrative) Instruction	Modified
188577	Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up) Instruction	Modified
188576	Mandatory Insurer Reporting (Private, System Set-up) Instruction	Modified
188575	Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't) Instruction	Modified
188574	Mandatory Insurer Reporting (GHP-Private) Instruction	Modified

ICR Details

OMB Control No: 0938-1074	ICR Reference No: 201309-0938-002
Status: Historical Active	Previous ICR Reference No: 200903-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: 20380
Title: Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/14/2014
	Date Received in OIRA: 09/10/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved
Responses	6,650,199	0	0
Time Burden (Hours)	931,297	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) seeks to collect various data elements for the applicable reporting entities for purpose of implementing the mandatory MSP reporting requirements of Section 111 of the MMSEA. This information will be used to ensure that Medicare makes payment in the proper order and/or takes necessary recovery actions. The purpose of this submission is to set forth what information will be collected pursuant to Section 111 and the process for such collection. Section 111 mandates the reporting of information specified by the Department of Health and Human Services Secretary in the form and manner specified by the Secretary (including frequency) Data the Secretary will collect is necessary for both pre-payment and post-payment coordination of benefit purposes, including the recovery actions. Section 111 establishes separate mandatory reporting requirements for group health plan arrangements as well as for liability insurance (including self-insurance), no-fault insurance, and workers' compensation, also referred to as non-group health plan. With the passage of Section 111, CMS now has the authority to mandate the reporting of insurer MSP information.

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Authorizing Statute(s): PL: Pub.L. 110 - 173 111 Name of Law: Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements
  

Citations for New Statutory Requirements: None

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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:
	78 FR 29137	05/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 48686	08/09/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Mandatory Insurer Reporting (Private, Administrative)
Mandatory Insurer Reporting (GHP-Private)
Mandatory Insurer Reporting (GHP-State, Local, Tribal Gov't)
Mandatory Insurer Reporting (Private, System Set-up)
Mandatory Insurer Reporting (State, Local, Tribal Govt, System Set-up)
Mandatory Insurer Reporting (State, Local, Tribal Govt., Administrative)
Mandatory Insurer Reporting (Non-GHP, Private)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt.)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Federal)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Private - System Set-up and Administration)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, State, Local, Tribal Govt., System Set-up and Administration)	CMS-10265	Interim Non-GHP Record Layout
Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative)	CMS-10265	Interim Non-GHP Record Layout

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ICR Summary of Burden

	Total Approved	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	6,650,199	0	0	0	-270,305	6,920,504
Annual Time Burden (Hours)	931,297	0	0	0	-1,189,181	2,120,478
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: The overall burden for completing MIR is primarily dependent upon the number of individuals for whom an insurer must report information. Other influencing factors may be: o the accessibility and format of personnel and health plan(s) records; o the number of GHPs offered by an organization; o the frequency of changes between plans or in coverage elections; and o the format the insurer uses in responding to the collection activity. The majority of the burden for completing MIR is system/reporting related and includes the time taken to: 1) review the instructions, 2) search for and compile the needed data, and 3) complete the record/report. Burden can also be attributed to insurer familiarity with the reporting process, data required on fewer covered individuals and for more current periods of time, enhancements to the reporting system, and clarifications made to the instructional materials that address insurer questions or concerns.

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Annual Cost to Federal Government: $8,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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? Uncollected

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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: 09/10/2013

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