[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