View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0763
ICR Reference No:
200703-0938-005
Status:
Historical Active
Previous ICR Reference No:
200607-0938-015
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
03/21/2007
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/17/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/14/2007
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2007
6 Months From Approved
11/30/2009
Responses
4,725
0
4,515
Time Burden (Hours)
10,800
0
10,319
Cost Burden (Dollars)
0
0
0
Abstract:
The PBP and Formulary are existing tools that were used in the CY2006 and CY2007 bid season by the MA and PDP organizations. The PBP has been utilized by MA organizations since CY2001 to describe their plan benefit package offerings for each contract year. The tool collects data such as copayments, coinsurance, deductibles, authorization rules, referrals, out-of-network benefits, and optional narrative notes.
Emergency Justfication:
The PBP and Formulary are existing tools that were used in the CY2006 and CY2007 bid season by the MA and PDP organizations. The PBP has been utilized by MA organizations since CY2001 to describe their plan benefit package offerings for each contract year. The tool collects data such as copayments, coinsurance, deductibles, authorization rules, referrals, out-of-network benefits, and optional narrative notes. The formulary tool was first introduced in CY2006 due to the MMA's need to collect critical data regarding the Part D Prescription Drug benefit such as covered drugs, tiering, prior authorization, and step therapy management programs. Justification for Emergency PRA Clearance of Plan Benefit Package Software: During implementation of the MMA for CY2007, CMS recognized numerous MMA policy clarifications that required changes for the CY2008 PBP and formulary tools. We have worked closely with the CMS policy and operations staff to identify the MMA policy clarifications that require changes to the software as well as usability changes that will improve the tools. The changes to the PBP include enhancements to the software for describing the out-of-network benefits, Medicare Savings Account (MSA) benefits, Point of Service (POS) benefits, Visitor/Travel benefits, and collecting Medicare Rx information on gap coverage. The changes to the formulary include enhancements to submission process by developing a drug reference table and by collecting excluded drug indicators, specialty drug indicators, and drug types. Since CMS always also strives to improve the data collection tools to minimize filing burden on the plans and to maximize the output of the tools for the Medicare beneficiary education materials, we host online comment sessions to solicit feedback from the industry. CMS hosts these sessions twice throughout the year during non-peak months for the bidders to ensure the industry has every opportunity to provide comments and suggested enhancements for the following year. Therefore CMS must wait until the Bid submission and review season is completed later in the fall. Given the life cycle of these tools illustrated above, CMS does not have sufficient time to complete the normal PRA clearance process while making corrections and enhancements to the software, allowing time for industry feedback, and ensuring that organizations have ample time to complete and submit their tools by the statutory deadline in June 2007. The normal PRA clearance process would result in violating this statutory deadline which would prevent MA and PDP organizations from providing benefits to millions of Medicare beneficiaries.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
72 FR 6247
02/09/2007
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262, CMS-R-262
CY 2008 Formulary File Record Layout
,
SECTION B - 6 - HOME HEALTH - BASE 1 SCREEN
,
SECTION B - 7A - PRIMARY CARE PHYSICIAN - BASE 1 SCREEN
,
SECTION B - 8A - OUTPATIENT DIAGNOSTIC PROCEDURES AND TESTS AND LAB SERVICES - BASE 1 SCREEN
,
PRESCRIPTION DRUGS SECTION-ACTUARIALLY EQUIVALENT-DEDUCTIBLE AND PRE-ICL SCREEN
,
Medicare Prescription Drugs Section-Alternative
,
Medicare Prescription Drugs Section-Defined Stan
,
Medicare Prescription Druges Section-Part D-GE
,
Section A - A-1 Screen
,
Section B-1A-Inpartient Hospital Acute-Base
,
Section B-2-SNF-Base 1 Screen
,
Section B-3-CORF-Base 1 Screen
,
Section B-4A-Emergency Care-Base 1 Screen
,
Section B-5-Partial Hospitalization-Base 1
,
Section B-9A-Outpatient Hospital-Base 1 Scre
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
4,725
4,515
0
0
210
0
Annual Time Burden (Hours)
10,800
10,319
0
0
481
0
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:
Annual Cost to Federal Government:
$808,280
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]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Saleda Perryman
Common Form ICR:
No
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:
03/13/2007
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