[Federal Register Volume 70, Number 165 (Friday, August 26, 2005)]
[Notices]
[Pages 50357-50358]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-17100]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10166]


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

AGENCY: Centers for Medicare & Medicaid Services, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS), Department of Health and Human Services, is publishing 
the following summary of proposed collections for public comment. 
Interested persons are invited to send comments regarding this burden 
estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the Agency's function; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    1. Type of Information Collection Request: New Collection; Title of 
Information Collection: Payment Error Rate Measurement in Medicaid and 
State Children's Health Insurance Program (SCHIP); Form No.: CMS-10166 
(OMB  0938-NEW); Use: The information collected will be used 
by CMS for, among other purposes, estimating improper payments in 
Medicaid and SCHIP as required by the Improper Payments Information Act 
(IPIA) of 2002. To implement the IPIA in Medicaid and SCHIP, CMS will 
use a national contracting strategy to produce Medicaid and SCHIP error 
rates. CMS plans to adopt this approach based on a recommendation that 
CMS hire a Federal contractor to perform payment error rate 
measurement. This recommendation was made during public comment on the 
proposed rule entitled ``Medicaid Program and State Children's Health 
Insurance Program (SCHIP): Payment Error Rate Measurement'' which 
published on August 27, 2004 (69 FR 52620), that contained provisions 
for all states to produce error rates in Medicaid and SCHIP.
    The new error measurement methodology will rely on a Federal 
contractor to conduct medical and data processing reviews using 
generally the same methodologies developed during the past pilot 
projects and produce State-specific and national Medicaid and SCHIP 
error rates based on reviews conducted each Federal fiscal year (FY). 
We expect to begin measuring improper payments made in Medicaid fee-
for-service in FY 2006. We have not yet determined the best method to 
measure improper payments made in Medicaid and SCHIP managed care. 
However, under the national contracting strategy, we expect the Federal 
contractor will implement these reviews and States will submit the same 
information listed below except for medical policies. (Managed care 
claims are not subject to medical reviews so there is no burden to 
providers to submit medical records.) Similarly, we are considering the 
best approach to measure improper payments based on eligibility errors 
within the confines of current law and with minimal budgetary impact. 
It is possible that States will be required to conduct at least part of 
the eligibility tests. However, this notice is not intended to address 
the cost or burden estimates associated with either the managed care or 
eligibility reviews in Medicaid or SCHIP.
    Initially, based on States' annual medical expenditures from the 
previous year, the Federal contractor will group all States into three 
equal strata of small, medium and large and select a random sample of 
an estimated 18 States to be reviewed for each program. (However, CMS 
may revise its sampling methodology in the future and may use a 
methodology to select States that will ensure each State is selected at 
least every three years but that no State is sampled more than once 
every three years. The error rates produced by this selection 
methodology will provide the State with a State-specific error rate 
estimated to be within 3% precision at the 95% confidence level. ) The 
States selected for review would submit to the Federal contractor, 
annual expenditures, quarterly stratified claims data, medical policies 
(which include State statutes, regulations, individual Medicaid 
Provider Manual and Administrative Directives as well as other 
information that the contractor may need to determine errors in the 
medical reviews), and other information so that the contractor can 
determine the specific State sample sizes and conduct medical and data 
processing reviews on the sampled claims. In addition, the contractor 
will request medical records from providers whose claims were sampled; 
the medical records are needed to support the medical reviews. CMS is 
not requiring States and providers to use a specific form, e.g., 
facsimile, or electronic to transmit the information. Based on the 
reviews, the contractor will calculate State-specific error rates which 
will serve as the basis for calculating national Medicaid and SCHIP 
error rates. Each State reviewed also will submit a corrective action 
plan to CMS that outlines its plans to develop, implement and monitor 
corrective actions designed to address error causes for purposes of 
reducing the State's error rate. Frequency: Reporting--On occasion and 
quarterly; Affected Public: State, Local or Tribal Government; Number 
of Respondents: 36; Total Annual Responses: 5076; Total Annual Hours: 
58,680.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS Web 
site address at http://www.cms.hhs.gov/regulations/pra/, or E-mail your 
request, including your address, phone number, OMB number, and CMS 
document identifier, to [email protected], or call the Reports 
Clearance Office on (410) 786-1326.
    Written comments and recommendations for the proposed information 
collections must be mailed within 30 days of this notice directly to 
the OMB desk officer: OMB Human Resources and Housing Branch, 
Attention: Katherine Astrich, New Executive Office Building, Room 
10235, Washington, DC 20503.


[[Page 50358]]


    Dated: August 24, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-17100 Filed 8-25-05; 8:45 am]
BILLING CODE 4120-01-P