[Federal Register Volume 78, Number 129 (Friday, July 5, 2013)]
[Notices]
[Pages 40482-40484]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-16085]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10171, CMS-10207, CMS-10476 and CMS-855(C)]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (PRA), federal agencies are required to publish notice in 
the Federal Register concerning each proposed collection of information 
(including each proposed extension or reinstatement of an existing 
collection of information) and to allow 60 days for public comment on 
the proposed action. Interested persons are invited to send comments 
regarding our burden estimates 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.

DATES: Comments must be received by September 3, 2013.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number (OCN). To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send 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) that are 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.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.

SUPPLEMENTARY INFORMATION: 

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).
    CMS-10171 Coordination of Benefits Between Part D Plans and Other 
Prescription Coverage Providers.
    CMS-10207 Physician Self-Referral Exceptions for Electronic 
Prescribing and Electronic Health Records.
    CMS-10476 Medical Loss Ratio (MLR) Report for Medicare Advantage 
(MA) Plans and Prescription Drug Plans (PDP).
    CMS-855(C) Medicare Enrollment Application for Registration of 
Eligible Entities That Provide Health Insurance Coverage Complementary 
to Medicare Part B
    Under the Paperwork Reduction Act (PRA) (44 U.S.C. 3501-3520), 
federal agencies must obtain approval from the Office of Management and 
Budget (OMB) for each collection of information they conduct or 
sponsor. The term ``collection of information'' is defined in 44 U.S.C. 
3502(3) and 5 CFR 1320.3(c) and includes agency requests or 
requirements that members of the public submit reports, keep records, 
or provide information to a third party. Section 3506(c)(2)(A) of the 
PRA requires federal agencies to publish a 60-day notice in the Federal 
Register concerning each proposed collection of information, including 
each proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice.

Information Collections

    1. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Coordination of 
Benefits Between Part D Plans and Other Prescription Coverage 
Providers; Use: We will use the information along with Part D plans, 
other health insurers or payers, and pharmacies to coordinate 
prescription drug benefits provided to the Medicare beneficiary. Form 
Number: CMS-10171 (OCN: 0938-0978): Frequency: Occasionally; Affected 
Public: Private sector--Business or other for-profits; Number of 
Respondents: 57,116; Total Annual Responses: 2,402,582; Total Annual 
Hours: 5,205,128. (For policy questions regarding this collection 
contact Heather Rudo at 410-786-7627.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Physician Self-Referral Exceptions for Electronic 
Prescribing and Electronic Health Records; Use: The collected 
information would be used for enforcement purposes. Specifically, if we 
were investigating the financial relationships between donors and 
physicians to determine whether the provisions in the exceptions at 42 
CFR 411.357(v) and (w) were met, first, we would review the written 
agreements that indicate what items and services each entity intended 
to provide. Form Number: CMS-10207 (OCN: 0938-1009); Frequency: 
Monthly; Affected Public: Private sector--Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 9,409; Total 
Annual Responses: 17,744; Total Annual Hours: 1,896. (For policy 
questions regarding this collection contact Michael Zleit at 410-786-
2050.)
    3. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Medical 
Loss Ratio (MLR) Report for Medicare Advantage (MA) Plans and 
Prescription Drug Plans (PDP); Use: We will use the data collection of 
annual reports provided by plan sponsors for each contract to ensure 
that beneficiaries are receiving value for their premium dollar by 
calculating each contract's medical loss ratio (MLR) and any 
remittances due for the respective MLR reporting year. The 
recordkeeping requirements will be used to determine plan sponsors' 
compliance with the MLR requirements, including compliance with how 
plan sponsors' experience is to be reported, and how their MLR and any 
remittances are calculated. Form Number: CMS-10476 (OCN: 0938-New); 
Frequency: Yearly; Affected Public: Private sector--Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
616; Total Annual Responses: 616; Total Annual Hours: 28,980. (For 
policy questions regarding this collection contact Ilina Chaudhuri at 
410-786-8628.)
    4. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Medicare Enrollment Application for Registration of Eligible Entities 
That Provide Health Insurance Coverage Complementary to Medicare Part 
B; Use: The primary

[[Page 40484]]

function of a Medicare enrollment application is to gather information 
from a provider, supplier or other entity that tells us who it is, 
whether it meets certain qualifications to be a health care provider, 
supplier or entity, where it practices or renders its services, the 
identity of the owners of the enrolling entity, and information 
necessary to establish correct claims payments. We are adding a new 
CMS-855 Medicare Registration Application, the CMS-855C: Medicare 
Enrollment Application for Registration of Eligible Entities That 
Provide Health Insurance Coverage Complementary to Medicare Part B. 
This Medicare registration application is to be completed by all 
entities that provide a complimentary health benefit plan and intend to 
bill Medicare as an indirect payment procedure (IPP) biller and the 
entity or health plan meets all Medicare requirements to submit claims 
for indirect payments. The entity must furnish the name of at least one 
authorized official, preferably the administrator of the health plan, 
who must sign this registration application attesting that the 
registering entity meets the requirements to register as an indirect 
payment procedure biller and will also abide by the requirements stated 
in the Certification & Attestation Statement in Section 10 of the 
application.
    The CMS-855C will be submitted at the time the applicant first 
requests a Medicare identification number for the sole purpose of 
submitting claims under the ``Indirect Payment Procedure (IPP)'' for 
reimbursement, and when necessary to report any changes to information 
previously submitted. The application will be used by Medicare 
contractors to collect data to ensure the applicant has the necessary 
credentials to submit Medicare claims for reimbursement, including 
information that allows Medicare contractors to ensure that the entity 
and its owners and administrators are not sanctioned from the Medicare 
program, or debarred, suspended or excluded from any other Federal 
agency or program. Form Number: CMS-855(C) (OCN: 0938-New); Frequency: 
Occasionally; Affected Public: Private sector--Business or other for-
profits and Not-for-profit institutions; Number of Respondents: 440; 
Total Annual Responses: 440; Total Annual Hours: 500. (For policy 
questions regarding this collection contact Kim McPhillips at 410-786-
5374.)

    Dated: June 28, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-16085 Filed 7-3-13; 8:45 am]
BILLING CODE 4120-01-P