[Federal Register Volume 72, Number 115 (Friday, June 15, 2007)]
[Notices]
[Page 33230]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-11467]



[[Page 33230]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10117, 10118, 10119, 10135, 10136, 10214, and 
CMS-10216]


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

AGENCY: Centers for Medicare & Medicaid Services, Department of Health 
and Human Services.
    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: Extension without change 
of a currently approved collection; Title of Information Collection: 
Medicare Advantage Applications: Medicare Advantage (MA) Application 
Coordinated Care Plans (CMS-10117), Medicare Advantage (MA) Application 
Private Fee-For-Service Plans (CMS-10118); Medicare Advantage (MA) 
Application Regional PPO Plans (CMS-10119); Medicare Advantage (MA) 
Application Service Area Expansion (SAE) for Coordinated Care Plans: 
Private Fee For Service Plans (CMS-10135); Medical Savings Account 
Plans (CMS-10136), and Employer Group Waiver Plans (CMS-10214); Form 
Number: CMS-10117, 10118, 10119, 10135, 10136 and 10214 (OMB: 
0938-0935); Use: An entity seeking a contract as an MA organization 
must be able to provide Medicare's basic benefits plus meet the 
organizational requirements set out under the regulations at 42 CFR 
Part 422. An applicant must demonstrate that it can meet the benefit 
and other requirements within the specific geographic area it is 
requesting. The application forms are designed to give CMS the 
information needed to determine a health plan's compliance with the 
regulations at 42 CFR Part 422. The MA application forms will be used 
by CMS to determine whether an entity is eligible to enter into a 
contract to provide services to Medicare beneficiaries; Frequency: 
Reporting--Once; Affected Public: Business or other for-profit and not-
for-profit institutions; Number of Respondents: 220; Total Annual 
Responses: 220; Total Annual Hours: 5580.
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Alternative Benefits State Plan Amendment Health Opportunity Accounts 
(HOA) Demonstration Program; Use: The DRA provides States with numerous 
flexibilities in operating their State Medicaid programs. For example, 
Section 6082 of the DRA allows up to 10 States to operate Medicaid 
demonstrations to test alternative systems for delivering their 
Medicaid benefits. Under these demonstrations, States would have the 
flexibility to deliver their Medicaid benefits to volunteer 
beneficiaries through a program that is comprised of an HOA and a High 
Deductible Health Plan (HDHP). Under the DRA, States can submit a State 
Plan Pre-print to CMS to effectuate this change to their Medicaid 
programs. CMS will provide a State Medicaid Director letter providing 
guidance on this provision and the implementation of the DRA and the 
associated State Plan Amendment template for use by States to modify 
their Medicaid State Plans if they choose to implement this 
flexibility; Form Number: CMS-10216 (OMB: 0938-1007); 
Frequency: Reporting: One-time; Affected Public: State, Local or Tribal 
Government; Number of Respondents: 56; Total Annual Responses: 10; 
Total Annual Hours: 10.
    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/PaperworkReductionActof1995, 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 or faxed within 30 days of this notice 
directly to the OMB desk officer: OMB Human Resources and Housing 
Branch, Attention: Carolyn Lovett, New Executive Office Building, Room 
10235, Washington, DC 20503, Fax Number: (202) 395-6974.

    Dated: June 8, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E7-11467 Filed 6-14-07; 8:45 am]
BILLING CODE 4120-01-P