[Federal Register Volume 77, Number 2 (Wednesday, January 4, 2012)]
[Notices]
[Pages 291-292]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-33752]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-74 and CMS-10338]


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 without change 
of a currently approved collection; Title of Information Collection: 
Income and Eligibility Verification System (IEVS) Reporting and 
Supporting Regulations Contained in 42 CFR 431.17, 431.306, 435.910, 
435.920, and 435.940-960; Use: The information collected is used to 
verify the income and eligibility of Medicaid applicants and 
recipients, as required by Section 1137 of the Social Security Act. 
Final regulations to implement Section 1137 of the Act were published 
February 28, 1986. Subsequent final amendments to the regulations were 
published on February 27, 1987; March 2, 1989; October 7, 1992; and 
January 31, 1994. These regulations provide the standards States use to 
determine which recipient and applicant records to match, the frequency 
of the match, due process protections for individuals whose records are 
matched, and those

[[Page 292]]

circumstances which permit exceptions from conducting verifications; 
Form Number: CMS-R-74 (OCN 0938-0467); Frequency: Monthly; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 50; 
Total Annual Responses: 8,520,000; Total Annual Hours: 124,054. (For 
policy questions regarding this collection contact Barbara Washington 
at (410) 786-9964. For all other issues call (410) 786-1326.)
    2. Type of Information Collection Request: Type of Information 
Collection Request: Extension of a currently approved collection; Title 
of Information Collection: Affordable Care Act Internal Claims and 
Appeals and External Review Procedures for Non-grandfathered Group 
Health Plans and Issuers and Individual Market Issuers; Use: The 
Patient Protection and Affordable Care Act, Public Law 111-148, (the 
Affordable Care Act) was enacted on March 23, 2010. As part of the Act, 
Congress added PHS Act section 2719, which provides rules relating to 
internal claims and appeals and external review processes. On July 23, 
2010 (75 FR 43330), interim final regulations (IFR) set forth rules 
implementing PHS Act section 2719 for internal claims and appeals and 
external review processes. With respect to internal claims and appeals 
processes for group health coverage, PHS Act section 2719 and our 
regulations provide that group health plans and health insurance 
issuers offering group health insurance coverage must comply with the 
internal claims and appeals processes set forth in 29 CFR 2560.503-1 
(the DOL claims procedure regulation) and update such processes in 
accordance with standards established by the Secretary of Labor. The 
DOL claims procedure regulation requires an employee benefit plan to 
provide third-party notices and disclosures participants and 
beneficiaries of the plan. In addition, our regulations add an 
additional requirement that non-grandfathered group health plans and 
issuers of non-grandfathered health policies provide to the claimant, 
free of charge, any new or additional evidence considered, or generated 
by the plan or issuer in connection with the claim.
    The IFR also requires issuers offering coverage in the individual 
health insurance market to also generally comply with the DOL claims 
procedure regulation as updated by the Secretary of HHS in the IFR for 
their internal claims and appeals processes.
    Furthermore, PHS Act section 2719 and the IFR provide that non-
grandfathered group health plans, issuers offering group health 
insurance coverage, and self-insured nonfederal governmental plans 
(through the IFR amendment dated June 24, 2011) must comply either with 
a State external review process or a Federal review process. The IFR 
provides a basis for determining when such plans and issuers must 
comply with an applicable State external review process and when they 
must comply with the Federal external review process. Plans and issuers 
that are required to participate in the Federal external review process 
must electronically elect either the HHS-administered process or the 
private accredited IRO process by January 1, 2012. The election 
requirements associated with this ICR are articulated through guidance 
published June 22, 2011 at http://cciio.cms.gov/resources/files/hhs_srg_elections_06222011.pdf. The election requirements are necessary 
for the Federal external review process to provide an independent 
external review as requested by claimants. Form Number: CMS-10338 (OCN: 
0938-1099); Frequency: Occasionally; Affected Public: State, Local, 
Tribal Governments; Business or other for-profit; Not-for-profit 
institutions. Number of Respondents: 46,773; Number of Responses: 
218,657,161; Total Annual Hours: 930,267. (For policy questions 
regarding this collection, contact Colin McVeigh at (301) 492-4263. 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 March 5, 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 23, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-33752 Filed 1-3-12; 8:45 am]
BILLING CODE 4120-01-P