[Federal Register Volume 72, Number 235 (Friday, December 7, 2007)]
[Notices]
[Pages 69218-69219]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-23746]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10232, CMS-10120, CMS-10241, CMS-370, 377 and 
378]


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: State Plan Pre-print for Integrated Medicare 
and Medicaid Programs; Use: Information submitted via the State Plan 
Amendment (SPA) pre-print will be used by CMS Central and Regional 
Offices to analyze a State's proposal to implement integrated Medicare 
and Medicaid programs. The pre-print is an optional document for use by 
States to highlight the arrangements between a State and Medicare 
Advantage Special Needs Plans that are also providing Medicaid 
services. State Medicaid Agencies will complete the SPA pre-print and 
submit it to CMS for a comprehensive analysis. The pre-print provides 
the opportunity for States to confirm that their integrated care model 
complies with both federal statutory and regulatory requirements. The 
pre-print contains assurances, check-off items, and areas for States to 
describe policies and procedures for subjects such as enrollment, 
marketing and quality assurance. Form Numbers: CMS-10251 (OMB: 
0938-NEW); Frequency: Reporting--Once; Affected Public: State, Local, 
or Tribal Governments; Number of Respondents: 56; Total Annual 
Responses: 30; Total Annual Hours: 600.
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
1932 State Plan Amendment Template, State Plan Requirements and 
Supporting Regulations in 42 CFR 438.50; Form No.: CMS-10120 
(OMB: 0938-0933); Use: The State Medicaid Agencies will 
complete the template. CMS will review the information to determine if 
the State has met all the requirements under Section 1932(l)(1)(A) of 
the Social Security Act and 42 CFR 438.50. Once all requirements are 
met, the State will be allowed to enroll Medicaid beneficiaries on a 
mandatory basis into managed care entities without section 1115 or 
1915(b) waiver authority; Frequency: On occasion; Affected Public: 
State, local, or tribal government; Number of Respondents: 56; Total 
Annual Responses: 10; Total Annual Hours: 100.
    3. Type of Information Collection Request: New Collection; Title of 
Information Collection: Annual State Report and Annual State 
Performance Rankings; Use: The Deficit Reduction Act of 2005 (DRA) 
requires CMS to contract with a vendor to conduct a monthly national 
survey of retail prescription drug prices and to report the prices to 
the States. These national average prices will be used as a benchmark 
by the States for the management of their prescription drug programs. 
The law also requires that States report their drug utilization rates 
for non-innovator multiple source drugs, their payment rates under 
their State plan, and their dispensing fees. A template will be used to 
facilitate data collection. The States' rankings are to be presented to 
the Congress and the States. Form Number: CMS-10241 (OMB: 
0938-NEW); Frequency: Reporting--Yearly; Affected Public: States, Local 
or Tribal Governments; Number of Respondents: 51; Total Annual 
Responses: 51; Total Annual Hours: 765.
    4. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Health Insurance Benefit Agreement, Ambulatory Surgical Centers (ASC) 
Request for Certification in the Medicare Program, ASC Survey Report 
Form and ASC Conditions of Coverage; Use: The Health Insurance Benefit 
Agreement is utilized for the purpose of establishing for payment under 
Title XVIII of the Social Security Act. The ASC Request for 
Certification form is utilized as an application for facilities wishing 
to participate in the Medicare program as an ASC. This form initiates 
the process of obtaining a decision as to whether the conditions for 
coverage are met. It also promotes data retrieval from the Online Data 
Input Edit (ODIE system, a subsystem of the Online Survey Certification 
and Report (OSCAR) system by CMS Regional Offices (ROs). The ASC Report 
Form is an instrument used by the State survey agency to record data 
collection in order to determine supplier compliance with individual 
conditions for coverage and report it to the Federal Government. The 
form is primarily a coding worksheet designed to facilitate data 
reduction and retrieval into the ODIE/OSCAR system at the CMS ROs. This 
form includes basic information on compliance (i.e., met, not met and 
explanatory statements) and does not require any descriptive 
information regarding the survey activity itself. Form Numbers: CMS-
370, 377, 378 (OMB: 0938-0266); Frequency: Reporting--
Occasionally (initially and then every 3 years); Affected Public: 
States, Local or Tribal Governments; Number of Respondents: 5123; Total 
Annual Responses: 1707; Total Annual Hours: 2,787.
    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.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on January 7, 2008.
    OMB Human Resources and Housing Branch, Attention: Katherine 
Astrich, New Executive Office Building, Room 10235, Washington, DC 
20503, Fax Number: (202) 395-6974.


[[Page 69219]]


    Dated: November 30, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.

[FR Doc. E7-23746 Filed 12-6-07; 8:45 am]
BILLING CODE 4120-01-P