Good Cause Processes (CMS-10544)

Agency Information Collection Activities: Submission for OMB Review; Comment Request

DATES:

Comments on the collection(s) of information must be received by the OMB desk officer by August 17, 2026.

SUPPLEMENTARY INFORMATION:

Under the Paperwork Reduction Act of 1995 (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 (44 U.S.C. 3506(c)(2)(A)) requires federal agencies to publish a 30-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 that summarizes the following proposed collection(s) of information for public comment.

Information Collection

1. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement/Reapplication/Annual Report Worksheet; Use: Section 10332 of the Patient Protection and Affordable Care Act (ACA) requires the Secretary to make standardized extracts of Medicare claims data under Parts A, B, and D available to "qualified entities" (QEs) for evaluating performance of providers of services and suppliers. implement the requirements outlined in the legislation, CMS established the Qualified Entity Certification Program (QECP) to evaluate an organization's eligibility across three areas: (1) organizational and governance capabilities, (2) addition of claims data from other sources (as required in the statute), and (3) data privacy and security.

This collection covers the application through which organizations provide information to CMS to determine whether they will be approved as a qualified entity. This collection also covers the triennial re-application through which organizations provide information to CMS to determine whether they are approved to continue as a qualified entity and the QECP Annual Report Worksheet (ARW). Form Number: CMS-10394 (OMB control number: 0938-1144); Frequency: Yearly; Affected Public: Business or other for-profits; Number of Respondents: 40; Total Annual Responses: 70; Total Annual Hours: 5,800. (For policy questions regarding this collection contact Kari Gaare at [email protected]. ).

2. Type of Information Collection Request: Re-instatement without change of a previously approved collection; Title of Information Collection: Good Cause Processes; Use: Section 1851(g)(3)(B)(i) of the Act provides that MA organizations may terminate the enrollment of individuals who fail to pay basic and supplemental premiums after a grace period established by the plan. Section 1860D-1(b)(1)(B)(v) of the Act generally directs us to establish rules related to enrollment, disenrollment, and termination for Part D plan sponsors that are similar to those established for MA organizations under section 1851 of the Act. Consistent with these sections of the Act, subpart B in each of the Parts C and D regulations sets forth requirements with respect to involuntary disenrollment procedures at 42 CFR 422.74 and 423.44, respectively. In addition, section 1876(c)(3)(B) establishes that individuals may be disenrolled from coverage as specified in regulations.

These good cause provisions authorize CMS to reinstate a disenrolled individual's enrollment without interruption in coverage if the non-payment is due to circumstances that the individual could not reasonably foresee or could not control, such as an unexpected hospitalization. At its inception, the process of accepting, reviewing, and processing beneficiary requests for reinstatement for good cause was carried out exclusively by CMS. Form Number: CMS-10544 (OMB control number: 0938-1271); Frequency: Occasionally; Affected Public: Individuals and Households, Private Sector and Business or other for-profits; Number of Respondents: 54,789; Total Annual Responses: 54,789; Total Annual Hours: 36,490. (For policy questions regarding this collection contact AnhViet Nguyen at 667-290-9745 or [email protected] ).