[Federal Register Volume 74, Number 195 (Friday, October 9, 2009)]
[Notices]
[Pages 52236-52238]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-24236]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-10142, CMS-R-262, CMS-10300, CMS-10298 and
CMS-10294]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid 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) 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 functions; (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: Revision of a currently
approved collection; Title of Information Collection: CY 2011 Bid
Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription
Drug Plans (PDP); Use: Under the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), and implementing
regulations at 42 CFR, Medicare Advantage organizations (MAO) and
Prescription Drug Plans are required to submit an actuarial pricing
``bid'' for each plan offered to Medicare beneficiaries for approval
CMS.
MAOs and PDPs use the Bid Pricing Tool (BPT) software to develop
their actuarial pricing bid. The information provided in the BPT is the
basis for the plan's enrollee premiums and CMS payments for each
contract year. The tool collects data such as medical expense
development (from claims data and/or manual rating), administrative
expenses, profit levels, and projected plan enrollment information. By
statute, completed BPTs are due to CMS by the first Monday of June each
year.
CMS reviews and analyzes the information provided on the Bid
Pricing Tool. Ultimately, CMS decides whether to approve the plan
pricing (i.e., payment and premium) proposed by each organization.
Refer to the supporting document attachment ``C'' for a list of
changes. Form Number: CMS-10142 (OMB: 0938-0944); Frequency:
Reporting--Yearly; Affected Public: Business or other for-profit and
not-for-profit institutions; Number of Respondents: 550; Total Annual
Responses: 6,050; Total Annual Hours: 42,350. (For policy questions
regarding this collection contact Diane Spitalnic at 410-786-5745. For
all other issues call 410-786-1326.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: CY 2011 Plan
Benefit Package (PBP) Software and Formulary Submission Use: Under the
Medicare Modernization Act (MMA), Medicare Advantage (MA) and
Prescription Drug Plan (PDP) organizations are required to submit plan
benefit packages for all Medicare beneficiaries residing in their
service area. The plan benefit package submission consists of the PBP
software, formulary file, and supporting documentation, as necessary.
MA and PDP organizations use the PBP software to describe their
organization's plan benefit packages, including information on
premiums, cost sharing, authorization rules, and supplemental benefits.
They also generate a formulary to describe their list of drugs,
including information on prior authorization, step therapy, tiering,
and quantity limits. Additionally, CMS uses the PBP and formulary data
to review and approve the plan benefit packages proposed by each MA and
PDP organization.
CMS requires that MA and PDP organizations submit a completed PBP
and formulary as part of the annual bidding process. During this
process, organizations prepare their proposed plan benefit packages for
the upcoming contract year and submit them to CMS for review and
approval. Based on operational changes and policy clarifications to the
Medicare program and continued input and feedback by the industry, CMS
has made the necessary changes to the plan benefit package submission.
Refer to the supporting document ``Appendix B'' for
[[Page 52237]]
a list of changes. Form Number: CMS-R-262 (OMB: 0938-0763);
Frequency: Reporting--Yearly; Affected Public: Business or other for-
profit and not-for-profit institutions; Number of Respondents: 475;
Total Annual Responses: 4988; Total Annual Hours: 12,113. (For policy
questions regarding this collection contact Sara Walters at 410-786-
3330. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: New collection; Title of
Information Collection: State Plan Amendment Templates for Additional
State Plan Option for Providing Premium Assistance under Title XIX and
XXI; Use: Section 301 of the Children's Health Insurance Program
Reauthorization Act of 2009 (CHIPRA), Public Law 111-3, adds Section
2105(c)(10) of the Social Security Act effective April 1, 2009, to
offer States a new option to provide premium assistance subsidies to
enroll targeted low-income individuals under age 19, and their parents
in qualified employer-sponsored coverage. To elect this option, a State
Children's Health Insurance Program agency will complete the template
pages and submit it for approval as part of a State plan amendment.
Form Number: CMS-10300 (OMB: 0938-New); Frequency: Reporting--
Once and On occasion; Affected Public: State, Local or Tribal
Government; Number of Respondents: 51; Total Annual Responses: 51;
Total Annual Hours: 255. (For policy questions regarding this
collection contact Stacey Green at 410-786-6102. For all other issues
call 410-786-1326.)
4. Type of Information Collection Request: New collection; Title of
Information Collection: Data Collection For Developing Outpatient
Therapy Payment Alternatives (DOTPA) ; Use: In Section 545 of the
Benefits Improvement and Protection Act (BIPA) of 2000, the Congress
required the Secretary of the Department of Health and Human Services
to report on the development of standardized assessment instruments for
outpatient therapy. Currently, CMS does not collect these data. The
purposes of this project are to identify, collect, and analyze therapy-
related information tied to beneficiary need and the effectiveness of
outpatient therapy services that is currently unavailable to CMS. The
ultimate goal is to develop payment method alternatives to the current
financial cap on Medicare outpatient therapy services. Form Number:
CMS-10298 (OMB: 0938-New); Frequency: Reporting--Yearly;
Affected Public: Business or other for-profit and not-for-profit
institutions; Number of Respondents: 190; Total Annual Responses:
38,632; Total Annual Hours: 13,658. (For policy questions regarding
this collection contact David Bott at 410-786-0249. For all other
issues call 410-786-1326.)
5. Type of Information Collection Request: New collection; Title of
Information Collection: Program Evaluation of the Eighth and Ninth
Scope of Work Quality Improvement Organization Program; Use: The
statutory authority for the Quality Improvement Organization (QIO)
Program is found in Part B of Title XI of the Social Security Act, as
amended by the Peer Review Improvement Act of 1982. The Social Security
Act established the Utilization and Quality Control Peer Review
Organization Program, now known as the QIO Program. The statutory
mission of the QIO Program, as set forth in Title XVIII--Health
Insurance for the Aged and Disabled, Section 1862(g) of the Social
Security Act--is to improve the effectiveness, efficiency, economy, and
quality of services delivered to Medicare beneficiaries. The quality
strategies of the Medicare QIO Program are carried out by specific QIO
contractors working with health care providers in their state,
territory, or the District of Columbia. The QIO contract contains a
number of quality improvement initiatives that are authorized by
various provisions in the Act. As a general matter, Section 1862(g) of
the Act mandates that the secretary enter into contracts with QIOs for
the purpose of determining that Medicare services are reasonable and
medically necessary and for the purposes of promoting the effective,
efficient, and economical delivery of health care services and of
promoting the quality of the type of services for which payment may be
made under Medicare. CMS interprets the term ``promoting the quality of
services'' to involve more than QIOs reviewing care on a case-by-case
basis, but to include a broad range of proactive initiatives that will
promote higher quality. CMS has, for example, included in the SOW tasks
in which the QIO will provide technical assistance to Medicare-
participating providers and practitioners in order to help them improve
the quality of the care they furnish to Medicare beneficiaries.
Additional authority for these activities appears in Section 1154(a)(8)
of the Act, which requires that QIOs perform such duties and functions,
assume such responsibilities, and comply with such other requirements
as may be required by the Medicare statute. CMS regards survey
activities as appropriate if they will directly benefit Medicare
beneficiaries. In addition, Section 1154(a)(10) of the Act specifically
requires that the QIOs ``coordinate activities, including information
exchanges, which are consistent with economical and efficient operation
of programs among appropriate public and private agencies or
organizations, including other public or private review organizations
as may be appropriate.'' CMS regards this as specific authority for
QIOs to coordinate and operate a broad range of collaborative and
community activities among private and public entities, as long as the
predicted outcome will directly benefit the Medicare program.
The purpose of the study is to design and conduct an analysis
evaluating the impact on national and regional health care processes
and outcomes of the Ninth Scope of Work QIO Program. The QIO Program is
national in scope and scale and affects the quality of healthcare of 43
million elderly and disabled Americans. CMS will conduct an impact and
process analysis using data from multiple sources: (1) Primary data
collected via in-depth interviews, focus groups, and surveys of QIOs,
health care providers, and other stakeholders; (2) secondary data
reported by QIOs through CMS systems; and (3) CMS administrative data.
The findings will be presented in a final report as well as in other
documents and reports suitable for publication in peer-review journals.
This request relates to the following data collections: (1) Survey of
QIO directors and theme leaders; (2) Survey of hospital QI directors
and nursing home administrators; (3) focus groups with Medicare
beneficiaries; and (4) in-person and telephone discussions with QIO
staff, partner organizations, health care providers, and community
health leaders. Form Number: CMS-10294 (OMB 0938-New);
Frequency: Occasionally; Affected Public: Business or other for-
profits, and Medicare beneficiaries; Number of Respondents: 3,343;
Total Annual Responses: 3,343; Total Annual Hours: 1,707. (For policy
questions regarding this collection contact Robert Kambic at 410-786-
1515. For all other issues call 410-786-1326.)
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web Site 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
[[Page 52238]]
Reports Clearance Office on (410) 786-1326.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by December 8, 2009:
1. Electronically. You may submit your comments electronically to
http://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: October 1, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-24236 Filed 10-8-09; 8:45 am]
BILLING CODE 4120-01-P