[Federal Register Volume 76, Number 195 (Friday, October 7, 2011)]
[Notices]
[Pages 62414-62415]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-26026]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10340, CMS-10237, CMS-10137, and CMS-265-11 
and CMS-265-94]


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: Collection of Encounter Data from Medicare 
Advantage Organizations; Use: The Centers for Medicare and Medicaid 
Services (CMS) intends to collect encounter data, or data on each item 
or service delivered to an enrollee, from Medicare Advantage 
Organizations. Medicare Advantage organizations will obtain this data 
from providers. CMS would collect the data electronically from Medicare 
Advantage Organizations via the Health Insurance Portability and 
Accountability Act (HIPAA) compliant standard Health Care Claims 
transactions for professional data and institutional data. The 
information is used to submit health care claims or equivalent health 
encounter information, carry out health plan enrollments and 
disenrollments, determine health plan eligibility, send and receive 
health care payment and remittance advices, transmit health plan 
premium payments, determine health care claim status, provide referral 
certifications and authorizations, and coordinate the benefits for 
individuals who have more than one health plan. Form Number: CMS-10340 
(OMB: 0938-New); Frequency: Weekly; Affected Public: Private 
Sector; Businesses or other for-profits; Number of Respondents: 827; 
Total Annual Responses: 517,793,438; Total Annual Hours: 34,520. (For 
policy questions regarding this collection contact Sean Creighton at 
410-786-9302 or Deondra Moseley at 410-786-4577. For all other issues 
call 410-786-1326.)
    2. Type of Information Collection Request: Revision of a currently 
approved collection;
    Title of Information Collection: Part C Medicare Advantage and 1876 
Cost Plan Expansion Application; Use: Collection of this information is 
mandated in Part C of the Medicare Prescription Drug, Improvement and 
Modernization Act of 2003 (MMA) in Subpart K of 42 CFR part 422 
entitled Contracts with Medicare Advantage Organizations. In addition, 
the Medicare Improvements for Patients and Providers Act of 2008 
(MIPPA) amended titles XVII and XIX of the Social Security Act to 
improve the Medicare program.
    In general, coverage for the prescription drug benefit is provided 
through prescription drug plans (PDPs) that offer drug-only coverage or 
through Medicare Advantage (MA) organizations that offer integrated 
prescription drug and health care products (MA-PD plans). PDPs must 
offer a basic drug benefit. Medicare Advantage Coordinated Care Plans 
(MA-CCPs) either must offer a basic benefit or may offer broader 
coverage for no additional cost. Medicare Advantage Private Fee for 
Service Plans (MA-PFFS) may choose to offer enrollees a Part D benefit. 
Employer Group Plans may also provide Part D benefits. If any of the 
contracting organizations meet basic requirements, they may also offer 
supplemental benefits through enhanced alternative coverage for an 
additional premium.
    Organizations wishing to provide healthcare services under MA and/
or MA-PD plans must complete an application, file a bid, and receive 
final approval from CMS. Existing MA plans may request to expand their 
contracted service area by completing the Service Area Expansion (SAE) 
application. Applicants may offer a local MA plan in a county, a 
portion of a county (i.e., a partial county) or multiple counties. 
Applicants may offer a MA regional plan in one or more of the 26 MA 
regions.
    This clearance request is for the information collected to ensure 
applicant compliance with CMS requirements and to gather data used to 
support determination of contract awards. The information will be 
collected under the solicitation of Part C application from MA, EGWP 
Plan, and Cost Plan applicants. The collection information will be used 
by CMS to: (1) Ensure that applicants meet CMS requirements, (2) 
support the determination of contract awards. Participation in all 
Programs is voluntary in nature. Only organizations that are interested 
in participating in the program will respond to the solicitation. MA-
PDs that voluntarily participate in the Part C program must submit a 
Part D application and successful bid. Form Number: CMS-10237 (OMB 
 0938-0935); Frequency: Yearly; Affected Public: Private 
Sector; Number of Respondents: 378; Total Annual Responses: 378; Total 
Annual Hours:

[[Page 62415]]

13,296. (For policy questions regarding this collection contact 
Letticia Ramsey at 410-786-5262. For all other issues call 410-786-
1326.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Application for 
Prescription Drug Plans (PDP); Application for Medicare Advantage 
Prescription Drug (MA-PD); Application for Cost Plans to Offer 
Qualified Prescription Drug Coverage; Application for Employer Group 
Waiver Plans to Offer Prescription Drug Coverage; Service Area 
Expansion Application for Prescription Drug Coverage; Use: The Medicare 
Prescription Drug Benefit program was established by section 101 of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(MMA) and is codified in section 1860D of the Social Security Act (the 
Act). Section 101 of the MMA amended Title XVIII of the Social Security 
Act by redesignating Part D as Part E and inserting a new Part D, which 
establishes the voluntary Prescription Drug Benefit Program (``Part 
D''). The MMA was amended on July 15, 2008 by the enactment of the 
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), 
on March 23, 2010 by the enactment of the Patient Protection and 
Affordable Care Act and on March 30, 2010 by the enactment the Health 
Care and Education Reconciliation Act of 2010 (collectively the 
Affordable Care Act).
    Coverage for the prescription drug benefit is provided through 
contracted prescription drug plans (PDPs) or through Medicare Advantage 
(MA) plans that offer integrated prescription drug and health care 
coverage (MA-PD plans). Cost Plans that are regulated under Section 
1876 of the Social Security Act, and Employer Group Waiver Plans (EGWP) 
may also provide a Part D benefit. Organizations wishing to provide 
services under the Prescription Drug Benefit Program must complete an 
application, negotiate rates, and receive final approval from CMS. 
Existing Part D Sponsors may also expand their contracted service area 
by completing the Service Area Expansion (SAE) application.
    Effective January 1, 2006, the Part D program established an 
optional prescription drug benefit for individuals who are entitled to 
Medicare Part A or enrolled in Part B. In general, coverage for the 
prescription drug benefit is provided through PDPs that offer drug-only 
coverage, or through MA organizations that offer integrated 
prescription drug and health care coverage (MA-PD plans). PDPs must 
offer a basic drug benefit. Medicare Advantage Coordinated Care Plans 
(MA-CCPs) must offer either a basic benefit or may offer broader 
coverage for no additional cost. Medicare Advantage Private Fee for 
Service Plans (MA-PFFS) may choose to offer a Part D benefit. Cost 
Plans that are regulated under Section 1876 of the Social Security Act, 
and Employer Group Plans may also provide a Part D benefit. If any of 
the contracting organizations meet basic requirements, they may also 
offer supplemental benefits through enhanced alternative coverage for 
an additional premium.
    Applicants may offer either a PDP or MA-PD plan with a service area 
covering the nation (i.e., offering a plan in every region) or covering 
a limited number of regions. MA-PD and Cost Plan applicants may offer 
local plans. There are 34 PDP regions and 26 MA regions in which PDPs 
or regional MA-PDs may be offered respectively. The MMA requires that 
each region have at least two Medicare prescription drug plans from 
which to choose, and at least one of those must be a PDP. Requirements 
for contracting with Part D Sponsors are defined in part 423 of 42 CFR.
    This clearance request is for the information collected to ensure 
applicant compliance with CMS requirements and to gather data used to 
support determination of contract awards.; Form Number: CMS-10137 (OMB 
 0938-0936); Frequency: Occasionally; Affected Public: State, 
Local, or Tribal Governments; Number of Respondents: 178; Total Annual 
Responses: 178; Total Annual Hours: 2,322. (For policy questions 
regarding this collection contact Linda Anders at 410-786-0459. For all 
other issues call 410-786-1326.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Independent Renal 
Dialysis Facility Cost Report; Use: Form CMS-265-94 has not been 
revised and will be used for cost reporting periods ending on or before 
December 31, 2010. Form CMS-265-11 is a new form that incorporates 
portions of CMS-265-94 and CMS-339. It is effective for cost reporting 
that begins or overlaps January 1, 2011. Providers of services 
participating in the Medicare program are required under sections 
1815(a), 1833(e), 1861(v)(1)(A) and 1881(b)(2)(B) of the Social 
Security Act (42 U.S.C. 1395g) to submit annual information to achieve 
settlement of costs for health care services rendered to Medicare 
beneficiaries. The Form CMS-265-11 cost report is needed to determine 
the amount of reasonable cost due to the providers for furnishing 
medical services to Medicare beneficiaries; Form Numbers: CMS-265-11 
and CMS-265-94 (OMB: 0938-0236); Frequency: Yearly; Affected 
Public: Business or other for-profits and Not-for-profit institutions; 
Number of Respondents: 5,654 Total Annual Responses: 5,654; Total 
Annual Hours: 367,510 (For policy questions regarding this collection 
contact Gail Duncan at 410-786-7278. 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 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 November 7, 2011.
    OMB, Office of Information and Regulatory Affairs,
    Attention: CMS Desk Officer.
    Fax Number: (202) 395-6974.
    E-mail: [email protected].

    Dated: October 4, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-26026 Filed 10-6-11; 8:45 am]
BILLING CODE 4120-01-P