[Federal Register Volume 78, Number 144 (Friday, July 26, 2013)]
[Notices]
[Pages 45203-45205]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18004]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers CMS-R-13, CMS-R-297, CMS-10088, CMS-10293, CMS-
10477, CMS-855(POH), CMS-2552-10, CMS-10185 and CMS-10463]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

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 a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the 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.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by August 26, 2013:

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974 OR Email: [email protected].
    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: Under the Paperwork Reduction Act of 1995 
(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 (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-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 that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Conditions of Coverage for Organ Procurement Organizations 
and Supporting Regulations; Use: Section 1138(b) of the Social Security 
Act, as added by section 9318 of the Omnibus Budget Reconciliation Act 
of 1986 (Pub. L. 99-509), sets forth the statutory qualifications and 
requirements that organ procurement organizations (OPOs) must meet in 
order for the costs of their services in procuring organs for 
transplant centers to be reimbursable under the Medicare and Medicaid 
programs. An OPO must be certified and designated by the Secretary as 
an OPO and must meet performance-related standards prescribed by the 
Secretary. The corresponding regulations are found at 42 CFR Part 486 
(Conditions for Coverage of Specialized Services Furnished by 
Suppliers) under subpart G (Requirements for Certification and 
Designation and Conditions for Coverage: Organ Procurement 
Organizations).
    Since each OPO has a monopoly on organ procurement within its 
designated service area (DSA), we must hold OPOs to high standards. 
Collection of this information is necessary for us to assess the 
effectiveness of each OPO and determine whether it should continue to 
be certified as an OPO and designated for a particular donation service 
area by the Secretary or replaced by an OPO that can more effectively 
procure organs within that DSA. Form Number: CMS-R-13 (OCN: 0938-0688); 
Frequency: Occasionally; Affected Public: Private sector--Not-for-
profit institutions; Number of Respondents: 58; Total Annual Responses: 
58; Total Annual Hours: 14,453. (For policy questions regarding this 
collection contact Diane Corning at 410-786-8486.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Request for Employment Information; Use: The Social Security 
Administration uses this form to obtain information from employers 
regarding whether a Medicare beneficiary's coverage under a group 
health plan is based on current employment status. Form Number: CMS-R-
297 (OCN: 0938-0787); Frequency: Once; Affected Public: Private 
sector--Business or other for-profit and Not-for-profit institutions; 
Number of Respondents: 15,000; Total Annual Responses: 15,000; Total 
Annual Hours: 3,750. (For policy questions regarding this collection 
contact Lindsay Smith at 410-786-6843.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Notification of 
Fiscal Intermediaries (FIs) and CMS of Co-located Medicare Providers 
and Supporting Regulations; Use: Many long-term care hospitals (LTCHs) 
are co-located with other Medicare providers (acute care hospitals, 
inpatient rehabilitation facilities, skilled nursing facilities, and 
psychiatric facilities), which leads to potential gaming of the 
Medicare system based on patient shifting. We require that LTCHs notify 
FIs, Medicare administrative contractors (MACs), and CMS of co-located 
providers and establish policies to limit payment abuse that will be 
based on FIs and MACs tracking patient movement among these co-located 
providers under 42 CFR 412.22(e)(6) and (h)(5).

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    Based upon being able to identify co-located providers, FIs, MACs, 
and CMS will be able to track patient shifting between LTCHs and other 
in-patient providers which will lead to appropriate payments under 
Sec.  412.532. That section limits payments to LTCHs where over 5 
percent of admissions represent patients who had been sequentially 
discharged by the LTCH, admitted to an on-site provider, and 
subsequently readmitted to the LTCH. Since each discharge triggers a 
Medicare payment, we implemented this policy to discourage payment 
abuse. Form Number: CMS-10088 (OCN: 0938-0897); Frequency: 
Occasionally; Affected Public: Private sector--Business or other for-
profit and Not-for-profit institutions; Number of Respondents: 25; 
Total Annual Responses: 25; Total Annual Hours: 6. (For policy 
questions regarding this collection contact Judy Richter at 410-786-
2590.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Tribal 
Consultation State Plan Amendment Template; Use: Certain states utilize 
a process to seek advice on a regular ongoing basis from designees of 
the Indian Health Service (IHS) and Urban Indian Organizations 
concerning Medicaid and Children's Health Insurance Program (CHIP) 
matters having a direct effect on them. The consultation process is 
required for the 37 states in which 1 or more Indian Health Programs or 
Urban Indian Organizations furnish health care services. The states' 
Medicaid agency will complete the template page and submit it for 
approval as part of its state plan amendment. The purpose is to 
document how the state meets the tribal consultation requirements. Form 
Number: CMS-10293 (OCN: 0938-1098); Frequency: Occasionally; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 37; 
Total Annual Responses: 37; Total Annual Hours: 37. (For policy 
questions regarding this collection contact Lane Terwilliger at 410-
786-6618.)
    5. Type of Information Collection Request) New Collection (Request 
for a new control number); Title of Information Collection: Medicaid 
Incentives for Prevention of Chronic Disease (MIPCD) Demonstration; 
Use: Under section 4108(d)(1) of the Affordable Care Act, we are 
required to contract with an independent entity or organization to 
conduct an evaluation of the Medicaid Incentives for Prevention of 
Chronic Disease (MIPCD) demonstration. The contractor will conduct 
state site visits, two rounds of focus group discussions, interviews 
with key program stakeholders, and field a beneficiary satisfaction 
survey. Both the state site visits and interviews with key program 
stakeholders will entail one-on-one interviews; however each set will 
have a unique data collection form. Thus, each evaluation task listed 
above has a separate data collection form and this proposed information 
collection encompasses four data collection forms. The purpose of the 
evaluation and assessment includes determining the following:
     The effect of such initiatives on the use of health care 
services by Medicaid beneficiaries participating in the program;
     The extent to which special populations (including adults 
with disabilities, adults with chronic illnesses, and children with 
special health care needs) are able to participate in the program;
     The level of satisfaction of Medicaid beneficiaries with 
respect to the accessibility and quality of health care services 
provided through the program; and
     The administrative costs incurred by state agencies that 
are responsible for administration of the program.
    Form Number: CMS-10477 (OCN: 0938-NEW); Frequency: Annually; 
Affected Public: Individuals and households, Business or other for-
profits and Not-for-profit institutions, State, Local or Tribal 
Governments; Number of Respondents: 4,524; Total Annual Responses: 
4,524; Total Annual Hours: 1,795. (For policy questions regarding this 
collection contact Jean Scott at 410-786-6327.)
    6. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Annual 
Report of Physician-Owned Hospital Ownership and/or Investment 
Interest; Use: Section 6001 of the Affordable Care Act (ACA) requires 
Medicare hospitals to report whether they have any physician owners 
including immediately family members of the physician. Currently the 
CMS 855A captures basic ownership and managerial information on 
providers. The CMS 855A was revised in July 2011 and a specific 
attachment designed to capture physician-owned hospital ownership and 
investment interest data was added to the form. The attachment is being 
removed from the CMS 855A application because the annual reporting 
requirement for physician-owned hospitals is not required for Medicare 
enrollment processing. This physician-owned hospital data collection is 
mandated to be reported on an annual basis. Additionally, the ACA 
prohibits the expansion of current physician-owned hospitals and banned 
the establishment of new ones making the CMS 855A the improper method 
to collect this required annual report.
    We are requesting the physician-owned hospital ownership 
information, investment information or both, previously collected in 
Attachment 1 of the CMS 855A enrollment application to become a stand-
alone form with a unique OMB number for the following reasons:
     The physician-owned data collection has a small targeted 
audience of approximately 140 physician-owned hospitals nationwide.
     The physician-owned data collection is required annually, 
as noted above.
     The data required under section 6001 is more specific than 
the data currently collected on the CMS-855A provider enrollment 
application.
     The data is not required for Medicare provider enrollment 
purposes.
    Form Number: CMS-855 (POH)(OCN: 0938-New); Frequency: Yearly; 
Affected Public: Private Sector--Business or other for-profits and Not-
for-profit institutions; Number of Respondents: 140; Total Annual 
Responses: 140; Total Annual Hours: 140. (For policy questions 
regarding this collection contact Kim McPhillips at 410-786-5374.)
    7. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Hospital and 
Health Care Complexes and Supporting Regulations in 42 CFR 413.20 and 
413.24; Use: Medicare Part A institutional providers must provide 
adequate cost data to receive Medicare reimbursement (42 CFR 
413.24(a)). Providers must submit the cost data to their Medicare 
Fiscal Intermediary (FI)/Medicare Administrative Contractor (MAC) 
through the Medicare cost report (MCR). We are submitting a revision of 
the Hospital and Hospital Health Care Complex Cost Report, Form CMS-
2552-10. Form CMS 2552-10 is used by hospitals participating in the 
Medicare program to report the health care costs to determine the 
amount of reimbursable costs for services rendered to Medicare 
beneficiaries. The revisions were caused by legislative requirements in 
the Patient Protection and Affordable Care Act of 2010 and the 
Temporary Payroll Tax Cut Continuation Act of 2011. Form Number: CMS-
2552-10 (OCN: 0938-0050); Frequency: Yearly; Affected Public: Private 
sector--Business or other for-profits and Not-for-profit institutions; 
Number of

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Respondents: 6,171; Total Annual Responses: 6,171; Total Annual Hours: 
4,153,083. (For policy questions regarding this collection contact 
Nadia Massuda at 410-786-5834.)
    8. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare Part D 
Reporting Requirements; Use: Title I, Part 423, Sec.  423.514 describes 
our regulatory authority to establish reporting requirements for Part D 
sponsors. It is noted that each Part D plan sponsor must have an 
effective procedure to develop, compile, evaluate, and report to us, to 
its enrollees, and to the general public, at the times and in the 
manner that we requires, statistics in the following areas: the cost of 
its operations; the patterns of utilization of its services; the 
availability, accessibility, and acceptability of its services; 
information demonstrating that the Part D plan sponsor has a fiscally 
sound operation; and other matters that we may require. CMS has 
identified the appropriate data needed to effectively monitor plan 
performance. Changes to the currently approved data collection 
instrument reflect new executive orders, legislation, as well as recent 
changes to Agency policy and guidance. Form Number: CMS-10185 (OCN: 
0938-0992); Frequency: Occasionally; Affected Public: Business and 
other for-profits; Number of Respondents: 690; Total Annual Responses: 
8,067; Total Annual Hours: 12,658. (For policy questions regarding this 
collection contact Latoyia Grant at 410-786-5434.)
    9. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Cooperative Agreement to Support Navigators in Federally-facilitated 
and State Partnership Exchanges; Use: Section 1311(i) of the Affordable 
Care Act requires Exchanges to establish a Navigator grant program as 
part of its function to provide consumers with assistance when they 
need it. Navigators will assist consumers by providing education about 
and facilitating selection of qualified health plans (QHPs) within 
Exchanges, as well as other required duties. Section 1311(i) requires 
that an Exchange operating as of January 1, 2014, must establish a 
Navigator Program under which it awards grants to eligible individuals 
or entities who satisfy the requirements to be Exchange Navigators. For 
Federally-facilitated Exchanges (FFE) and State Partnership Exchanges 
(SPEs), we will be awarding the grants. Navigator awardees must provide 
quarterly, bi-annual, and an annual progress report to us on the 
activities performed during the grant period and any sub-awardees 
receiving funds. The 60-day Federal Register notice was published on 
April 12, 2013 (78 FR 21957). Several commenters suggested changes to 
the reporting requirements which were incorporated where appropriate. 
Form Number: CMS-10463 (OCN: 0938-NEW); Frequency: Annually, Quarterly; 
Affected Public: Private sector; Number of Respondents: 264; Total 
Annual Responses: 1,848; Total Annual Hours: 308,352. (For policy 
questions regarding this collection contact Holly Whelan at 301-492-
4220.)

    Dated: July 23, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-18004 Filed 7-25-13; 8:45 am]
BILLING CODE 4120-01-P