[Federal Register Volume 78, Number 71 (Friday, April 12, 2013)]
[Notices]
[Pages 21956-21957]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-08676]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-460 and CMS-10469]


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: Medicare 
Participating Physician or Supplier Agreement. Use: Section 1842(h) of 
the Social Security Act permits physicians and suppliers to voluntarily 
participate in Medicare Part B by agreeing to take assignment on all 
claims for services to Medicare beneficiaries. The law also requires 
that the Secretary provide specific benefits to the physicians, 
suppliers and other persons who choose to participate. The CMS-460 is 
the agreement by which the physician or supplier elects to participate 
in Medicare. The information is used by: Medicare contractors to 
provide the benefits the law provides for participating entities and to 
enable contractors to enforce the Medicare limiting charge for 
physicians, suppliers and other persons who do not participate; 
Medicare beneficiaries to assist them in locating physicians who will 
accept Medicare assignment on claims for services and therefore save 
them money; and CMS to gauge the effectiveness of our and contractors 
efforts to increase participation in Medicare. Form Number: CMS-460 
(OCN: 0938-0373). Frequency: Yearly. Affected Public: Private sector 
(business or other for-profits). Number of Respondents: 120,000. Total 
Annual Responses: 120,000. Total Annual Hours: 30,000. (For policy 
questions regarding this collection contact April Billingsley at 410-
786-0140. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: New collection; Title of 
Information Collection: Issuer Reporting Requirements for Selecting a 
Cost-Sharing Reductions Reconciliation Methodology; Use: Under 
established Department of Health and Human Services (HHS) regulations, 
qualified health plan (QHP) issuers will receive advance payments of 
the cost-sharing reductions throughout the year. Each issuer will then 
be subject to one of two reconciliation processes after the year to 
ensure that HHS reimbursed each issuer the correct advance cost-sharing 
amount. This information collection request establishes the data 
collection requirements for a QHP issuer to report to HHS which 
reconciliation reporting option the issuer will be subject to for a 
given benefit year.
    On March 23, 2010, the President signed into law H.R. 3590, the 
Patient Protection and Affordable Care Act (Affordable Care Act), 
Public Law 111-148. Sections 1402 and 1412 of the Affordable Care Act 
provide for reductions in cost sharing on essential health benefits for 
low- and moderate-income enrollees in silver level qualified health 
plans on individual market Exchanges. It also provides for reductions 
in cost sharing for Indians enrolled in QHPs at any metal level. These 
cost-sharing reductions will help eligible individuals and families 
afford the out-of-pocket spending associated with health care services 
provided through Exchange-based QHP coverage.
    The law directs QHP issuers to notify the Secretary of HHS of cost-
sharing reductions made under the statute for qualified individuals, 
and directs the Secretary to make periodic and timely payments to the 
QHP issuer equal to the value of those reductions. Further, the law 
permits advance payment of the cost-sharing reduction amounts to QHP 
issuers based upon amounts specified by the Secretary.

[[Page 21957]]

    On December 7, 2012, HHS published a proposed rule (77 FR 73118) 
entitled ``HHS Notice of Benefit and Payment Parameters for 2014.'' 
This rule proposed a payment approach under which CMS would make 
monthly advance payments to issuers to cover projected cost-sharing 
reduction amounts, and then reconcile those advance payments after the 
end of the benefit year to the actual cost-sharing reduction amounts. 
The reconciliation process described in the rule would require that QHP 
issuers provide CMS the amount of cost-sharing paid by each enrollee, 
as well as the level of cost-sharing that enrollee would have paid 
under a standard plan without cost-sharing reductions. To determine the 
amount of cost-sharing an enrollee receiving cost-sharing reductions 
would have paid under a standard plan, QHP issuers would need to re-
adjudicate each claim for these enrollees under a standard plan 
structure. HHS finalized the proposed notice of benefit and payment 
parameters for 2014 and this approach on March 11, 2013 (78 FR 15410).
    During the comment period to the proposed rule, HHS received 
numerous comments suggesting that the reporting requirements of the 
reconciliation process for QHP issuers would be operationally 
challenging for some issuers. In response to these comments, HHS issued 
an interim final rule (CMS-9964-IFC) with comment period on March 11, 
2013 (78 FR 15541) entitled ``Amendments to the HHS Notice of Benefit 
and Payment Parameters for 2014,'' which laid out an alternative 
approach that QHP issuers may elect to pursue with respect to the 
reporting requirements. This alternative approach would allow a QHP 
issuer to estimate the amount of cost-sharing an enrollee receiving 
cost-sharing reductions would have paid under a standard plan in the 
Exchange, rather than re-adjudicating each of the enrollee's claims. 
This approach is intended to permit a reasonable transitional period in 
which QHP issuers will be allowed to choose the methodology that best 
aligns with their operational practices, which should reduce the 
administrative burden on issuers in the initial years of the Exchanges. 
The interim final rule describes the estimation methodology in 
sufficient detail to allow QHP issuers to make an informed decision of 
which reporting approach to pursue.
    Prior to the start of each coverage year, QHP issuers must notify 
HHS of the methodology it is selecting for the benefit year. QHP 
issuers will provide information on which option they choose via the 
Health Insurance Oversight System (HIOS), a web-based data collection 
system that is already being used by issuers to provide information for 
the healthcare.gov Web site. All submissions will be made 
electronically and no paper submissions are required. The QHP issuer 
must select the same methodology for all plan variations it offers on 
the Exchange for a benefit year. Moreover, as the estimated methodology 
is intended as a transition to the actual methodology, the QHP issuer 
may not select the estimated methodology if it selected the actual 
methodology for the prior benefit year. Form Number: CMS-10469 (OCN: 
0938-NEW); Frequency: Annually; Affected Public: Private Sector 
(business or other for-profits); Number of Respondents: 1,200; Total 
Annual Responses: 1,200; Total Annual Hours: 13,200. (For policy 
questions regarding this collection contact Chris Weiser at 410-786-
0650. 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 June 11, 2013:
    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: April 9, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-08676 Filed 4-11-13; 8:45 am]
BILLING CODE 4120-01-P