[Federal Register Volume 76, Number 242 (Friday, December 16, 2011)]
[Notices]
[Pages 78265-78267]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32290]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-10180, CMS-R-199, CMS-10379 and CMS-10418]


Agency Information Collection Activities: Proposed Collection; 
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) 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: Extension of a currently 
approved collection; Title of Information Collection: Children's Health 
Insurance Program (CHIP) Report on Payables and Receivables; Use: 
Collection of CHIP data and the calculation of the CHIP Incurred But 
Not Reported (IBNR) estimate are pertinent to CMS' financial audit. The 
CFO auditors have reported the lack of an estimate for CHIP IBNR 
payables and receivables as a reportable condition in the FY 2005 audit 
of CMS's financial statements. It is essential that CMS

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collect the necessary data from State agencies in FY 2006, so that CMS 
continues to receive an unqualified audit opinion on its financial 
statements. Program expenditures for the CHIP have increased since its 
inception; as such, CHIP receivables and payables may materially impact 
the financial statements. The CHIP Report on Payables and Receivables 
will provide the information needed to calculate the CHIP IBNR. Form 
Number: CMS-10180 (OMB: 0938-0988); Frequency: Reporting--
Annually; Affected Public: State, Local or Tribal governments; Number 
of Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 
392. (For policy questions regarding this collection contact Michele 
Myers at (410) 786-7911. For all other issues call (410) 786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Report 
on Payables and Receivables; Use: The Chief Financial Officers (CFO) 
Act of 1990, as amended by the Government Management Reform Act (GMRA) 
of 1994, requires government agencies to produce auditable financial 
statements. Because the Centers for Medicare & Medicaid Services (CMS) 
fulfills its mission through its contractors and the States; these 
entities are the primary source of information for the financial 
statements. There are three basic categories of data: expenses, 
payables, and receivables. The CMS-64 is used to collect data on 
Medicaid expenses. The CMS-R-199 collects Medicaid payable and 
receivable accounting data from the States. Form Number: CMS-R-199 
(OMB: 0938-0697); Frequency: Reporting--Annually; Affected 
Public: State, Local or Tribal governments; Number of Respondents: 56; 
Total Annual Responses: 56; Total Annual Hours: 336. (For policy 
questions regarding this collection contact Michele Myers at (410) 786-
7911. For all other issues call (410) 786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Rate Increase 
Disclosure and Review Reporting Requirements (45 CFR Part 154). Use: 
Under the Section 1003 of the Affordable Care Act (Section 2794 of the 
Public Health Service Act), The Secretary, in conjunction with the 
States, is required to establish a process for the annual review, 
beginning with the 2010 plan year, of unreasonable increases in 
premiums for health insurance coverage. Section 2794 directs the 
Secretary to ensure the public disclosure of information of 
unreasonable rate increases and justification for those increases.
    On December 23, 2010, CMS published a proposed rate review 
regulation in the Federal Register for public comment (Rate Increase 
Disclosure and Review Rule, 75 FR 81004). CMS revised the proposed rule 
based on the public comments and published the final rate review 
regulation in the Federal Register on May 19, 2011. The final rule 
defines the unreasonable rate review process and issuer reporting and 
disclosure requirements (Rate Increase Disclosure and Review Rule, 76 
FR 29964). The regulation establishes the following reporting 
requirements:
     The Preliminary Justification: This data collection is 
required of all health insurance issuers for all rate increases that 
exceed the ``subject to review''' reporting threshold as defined in the 
rule. This information will be posted on an HHS Web site.
     Rate Review Final Determination: This data collection 
requires States with effective rate review programs and CMS to report 
their review findings and unreasonable rate increase determinations on 
all rate increases that are subject to review. This information will be 
posted on an HHS Web site.
     The Final Justification for an Unreasonable Rate Increase: 
This data collection is required of health insurance issuers that elect 
to implement a rate increase that is determined to be unreasonable 
based on State or CMS review. This information will be posted on the 
Health Insurance Issuer's Web site and on a CMS Web site.

1. Preliminary Justification

    The Preliminary Justification consists of three parts, Part I: Rate 
Increase Summary, Part II: Written Explanation of the Rate Increase, 
and Part III: Rate Filing Documentation. Issuers must complete Parts I 
and II for all rate increases that exceed the reporting threshold as 
defined in the rule. As described in the preamble of the rule, this 
information would be collected to provide consumers with basic 
information on all rate increases that are subject to review under the 
rate review program.
    Under the rule, ``subject to review'' rate increases would be 
reviewed by either States or CMS, depending on whether a State has an 
effective rate review program. Issuers would only be required to submit 
Part III of the Preliminary Justification when CMS is conducting the 
review of a rate increase that is ``subject to review.'' Accordingly, 
Part III requires health insurance issuers to provide detailed rate 
data that would be used for the purposes of conducting thorough 
actuarial reviews and for making determinations about whether rate 
increases are unreasonable.
    This Notice contains the following information about the 
Preliminary Justification:
     Preliminary Justification Issuer Instructions: health 
insurance issuer instructions for completing all three parts of the 
Preliminary Justification.
     Part I Worksheet: a standardized Excel worksheet that must 
be used to complete Part I of the Preliminary Justification.
     Sample Internet display of the Rate Review Consumer 
Disclosure: Information provided in the Preliminary Justification would 
be posted on an HHS Web site. This sample display shows how the 
information contained in the Part I Worksheet would be displayed to 
consumers.

2. Rate Review Final Determination

    Under the rule, States and CMS would have to provide a Rate Review 
Final Determination at the close of their review of all ``subject to 
review'' rate increases. The Rate Review Final Determination must 
provide the State's or CMS' determination on whether a rate increase is 
``unreasonable.'' Section 154.301(a)(3) of the rule provides a list of 
actuarial review elements that must be taken into account as part of 
the rate review process. The Final Determination must provide a brief 
statement explaining how the review of elements set forth in Sec.  
154.301(a)(3) caused the State or CMS to arrive at its determination 
that the rate is unreasonable.
    The Rate Review Final Determination will be entered into a data 
entry text box in the Rate Review Data Collection System. CMS is 
estimating that this statement would be approximately a paragraph in 
length. There is no specific form or set of instructions associated 
with this reporting requirement, apart from the reporting requirements 
provided in the rule. The information provided in the Rate Review Final 
Determination will be posted as part of the rate review consumer 
disclosure information on an HHS Web site.

3. Final Justification for an Unreasonable Rate Increase

    The rule states that if a health insurance issuer implements a rate 
increase determined by CMS or a State to be unreasonable, the health 
insurance issuer must provide a Final Justification for an Unreasonable 
Rate Increase. In the Final Justification, issuers would

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have to provide a short statement about why they are electing to 
implement an unreasonable rate increase. This statement would be 
entered into a data entry text box in the Rate Review Data Collection 
System and would not need to be more than a paragraph or two in length. 
There is no form or instructions associated with this statement apart 
from the requirements provided in the regulation.
    The Final Justification Statement will be posted on an HHS Web site 
in the same location as the Preliminary Justification and Rate Review 
Final Determination. Additionally, health insurance issuers 
implementing rate increases that were determined to be unreasonable, 
must post all of this information--the Preliminary Justification, the 
Rate Review Final Determination, and the Final Justification Statement 
on their Web sites for a period of 3 years.
    In addition to the aforementioned requirements, we revised the 
information collection request as a result of an amendment to the 
regulation discussed in the final rule that published September 6, 2011 
(76 FR 54969). The amendment to the rate review final rule updated the 
applicability of the rate review requirements to include products that 
would be considered part of the individual or small group market had 
they not been sold through associations, including those that are 
consider to be large group products under State law or have been 
otherwise excluded from State's existing definitions for individual and 
small group products. This change resulted in an increase in the total 
number of rate increases that are subject to the rate review reporting 
requirements. The amendment did not propose any changes to the 
information that issuers must submit for each rate increase. Thus, 
burden associated with each rate increase submission remains unchanged 
from the final rate review rule. The revised association product 
reporting requirements took effect on November 1, 2011. CMS received a 
6 month Emergency PRA approval for the revised association reporting 
requirements on October 31, 2011 (OMB-0938-1141). CMS is now requesting 
a 3-year OMB approval of these collection requirements. Form Number: 
CMS-10379 (OCN: 0938-1141); Frequency: Annually; Affected Public: 
Private Sector and States; Number of Respondents: 452; Number of 
Responses: 3,571; Total Annual Hours: 14,630. (For policy questions 
regarding this collection, contact Sally McCarty at (301) 492-4489. For 
all other issues call (410) 786-1326.)
    4. Type of Information Collection Request: New information 
collection; Title of Information Collection: Medical Loss Ratio Annual 
Reporting and Rebate Calculation; Use: Under Section 2718 of the 
Affordable Care Act and implementing regulations at 45 CFR Part 158 (75 
FR 74864, December 1, 2010 (Interim Final Rule); 75 FR 82277, December 
30, 2010 (Technical Correction); and 76 FR 76574, December 7, 2011 
(Final Rule with comment period)), a health insurance issuer (issuer) 
offering group or individual health insurance coverage must submit a 
report to the Secretary concerning the amount the issuer spends each 
year on claims, quality improvement expenses, non-claims costs, Federal 
and State taxes and licensing and regulatory fees, and the amount of 
earned premium. An issuer must provide an annual rebate to enrollees if 
the amount it spends on certain costs compared to its premium revenue 
(excluding Federal and States taxes and licensing and regulatory fees) 
does not meet a certain ratio, referred to as the medical loss ratio 
(MLR). An interim final rule (IFR) implementing the MLR was published 
on December 1, 2010 (75 FR 74865) and modified by technical corrections 
on December 30, 2010 (75 FR 82277), which added Part 158 to Title 45 of 
the Code of Federal Regulations. The IFR is effective January 1, 2011. 
A final rule regarding selected provisions of the interim final rule 
was published on December 7, 2011 (76 FR 76574) and an interim final 
rule regarding an issue not included in issuers' reporting requirements 
(distribution of rebates by non-federal governmental plans) was also 
published on December 7, 2011 (76 FR 76596). Each issuer is required to 
submit MLR data annually, including information about any rebates it 
must provide, on a form prescribed by CMS for each large group market, 
small group market, and individual market within each State in which 
the issuer conducts business. Data is to be submitted electronically 
through CMS' Health Insurance Oversight System (HIOS). Additionally, 
each issuer is required to maintain for a period of seven years all 
documents, records and other evidence that support the data included in 
each issuer's annual report to the Secretary. Form Number: CMS-10418; 
Frequency: Annually; Affected Public: Private Sector: Business or other 
for-profits and not-for-profit institutions; Number of Respondents: 
527; Number of Responses: 5,530; Total Annual Hours: 352,563. (For 
policy questions regarding this collection, contact Carol Jimenez at 
(301) 492-4457. 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 Email 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.
    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 February 14, 2012:
    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: December 13, 2011.
Martique Jones,
Director, Regulations Development Group, Division B Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2011-32290 Filed 12-15-11; 8:45 a.m.]
BILLING CODE 4120-01-P