[Federal Register Volume 78, Number 159 (Friday, August 16, 2013)]
[Notices]
[Pages 50057-50060]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-20023]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-301, CMS-317, CMS-319, CMS-8003, CMS-10219, 
CMS-10242, CMS-10178, CMS-2744, CMS-3070, CMS-10479, CMS-10371 and CMS-
R-137]


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 September 16, 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 of a 
previously approved collection; Title of Information Collection: 
Certification of Medicaid Eligibility Quality Control (MEQC) Payment 
Error Rates; Use: These reviews are conducted to determine whether or 
not the sampled cases meet applicable State Title XIX or XXI 
eligibility requirements when applicable. The reviews are also used to 
assess beneficiary liability, if any, and to determine the amounts paid 
to provide Medicaid services for these cases. In the Medicaid 
Eligibility Quality Control (MEQC) system, sampling is the only 
practical method of validating eligibility of the total caseload and 
determining the dollar value of eligibility liability errors. Any 
attempt to make such validations and determinations by reviewing every 
case would be an enormous and unwieldy undertaking. During each 6-month 
review period, states are required to collect data on eligibility 
payment error dollars and paid claims dollars for each case in the 
sample. States must also identify cases for which a review cannot be 
conducted. At the conclusion of the 6-month review period, states must 
complete the Payment Error Rate form which contains aggregate data on

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sample size, number of sampled cases dropped, and number of sampled 
cases listed in error.
     These data, along with the calculated eligibility payment error 
rate and lower limit are certified by the State Medicaid Director (or 
designee) and submitted to the Regional Office. The collection of 
information is also necessary to implement provisions from the 
Children's Health Insurance Program Reauthorization Act of 2009 
(CHIPRA) (Pub. L. 111-3) with regard to the MEQC and Payment Error Rate 
Measurement (PERM) programs. Form Number: CMS-301 (OCN: 0938-0246); 
Frequency: Semi-Annually; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 51; Total Annual Responses: 102; 
Total Annual Hours: 16,446. (For policy questions regarding this 
collection contact Monetha Dockery at 410-786-0155.)
    2. Type of Information Collection Request: Reinstatement of 
previously approved collection; Title of Information Collection: State 
Medicaid Eligibility Quality Control (MEQC) Sample Plans; Use: The 
Medicaid Eligibility Quality Control (MEQC) system is based on monthly 
state reviews of Medicaid and Medicaid expansion under Title XXI cases 
by states performing the traditional sampling process identified 
through statistically reliable statewide samples of cases selected from 
the eligibility files. These reviews are conducted to determine whether 
or not the sampled cases meet applicable state Title XIX or XXI 
eligibility requirements when applicable. The reviews are also used to 
assess beneficiary liability, if any, and to determine the amounts paid 
to provide Medicaid services for these cases. In the MEQC system, 
sampling is the only practical method of validating eligibility of the 
total caseload and determining the dollar value of eligibility 
liability errors. Any attempt to make such validations and 
determinations by reviewing every case would be an enormous and 
unwieldy undertaking. In 1993, we implemented MEQC pilots in which 
states could focus on special studies, targeted populations, geographic 
areas or other forms of oversight with our approval. States must submit 
a sampling plan, or pilot proposal for us to approve before 
implementing their pilot program. The Children's Health Insurance 
Program Reauthorization Act (CHIPRA) was enacted February 4, 2009. 
Sections 203 and 601 of the CHIPRA relate to MEQC. Section 203 of the 
CHIPRA establishes an error rate measurement with respect to the 
enrollment of children under the express lane eligibility option. The 
law directs states not to include children enrolled using the express 
lane eligibility option in data or samples used for purposes of 
complying with the MEQC requirements. Section 601 of the CHIPRA, among 
other things, requires a new final rule for the Payment Error Rate 
Measurement (PERM) program and aims to harmonize the PERM and MEQC 
programs and provides states with the option to apply PERM data 
resulting from its eligibility reviews for meeting MEQC requirements 
and vice versa, with certain conditions. We review, either directly or 
through its contractors, of the sampling plans helps to ensure states 
are using valid statistical methods for sample selection. Form Number: 
CMS-317 (OCN: 0938-0148); Frequency: Semi-Annually; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 10; Total 
Annual Responses: 20; Total Annual Hours: 480. (For policy questions 
regarding this collection contact Monetha Dockery at 410-786-0155.)
    3. Type of Information Collection Request: Reinstatement of a 
previously approved collection; Title of Information Collection: State 
Medicaid Eligibility Quality Control (MEQC) Sample Selection Lists; 
Use: The Medicaid Eligibility Quality Control (MEQC) system is based on 
monthly state reviews of Medicaid and Medicaid expansion under Title 
XXI cases by states performing the traditional sampling process 
identified through statistically reliable statewide samples of cases 
selected from the eligibility files. These reviews are conducted to 
determine whether or not the sampled cases meet applicable state Title 
XIX or XXI eligibility requirements when applicable. The reviews are 
also used to assess beneficiary liability, if any, and to determine the 
amounts paid to provide Medicaid services for these cases. In the MEQC 
system, sampling is the only practical method of validating eligibility 
of the total caseload and determining the dollar value of eligibility 
liability errors. Any attempt to make such validations and 
determinations by reviewing every case would be an enormous and 
unwieldy undertaking. At the beginning of each month, state agencies 
still performing the traditional sample are required to submit sample 
selection lists which identify all of the cases selected for review in 
the states' samples. The sample selection lists contain identifying 
information on Medicaid beneficiaries such as: state agency review 
number, beneficiary's name and address, the name of the county where 
the beneficiary resides, Medicaid case number, etc. The submittal of 
the sample selection lists is necessary for Regional Office validation 
of state reviews. Without these lists, the integrity of the sampling 
results would be suspect and the Regional Offices would have no data on 
the adequacy of the States' monthly sample draw or review completion 
status. The authority for collecting this information is Section 
1903(u) of the Social Security Act. The specific requirement for 
submitting sample selection lists is described in regulations at 42 CFR 
431.814(h). Regional Office staff review the sample selection lists to 
determine that states are sampling a sufficient number of cases for 
review. Form Number: CMS-319 (OCN: 0938-0147); Frequency: Monthly; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 10; Total Annual Responses: 120; Total Annual Hours: 960. 
(For policy questions regarding this collection contact Monetha Dockery 
at 410-786-0155.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: 1915(c) Home and Community Based Services (HCBS) Waiver; 
Use: We will use the web-based application to review and adjudicate 
individual waiver actions. The web-based application will also be used 
by states to submit and revise their waiver requests. Form Number: CMS-
8003 (OCN: 0938-0449); Frequency: Yearly; Affected Public: State, 
Local, or Tribal Governments; Number of Respondents: 47; Total Annual 
Responses: 71; Total Annual Hours: 6,005. (For policy questions 
regarding this collection contact Kathy Poisal at 410-786-5940.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Healthcare 
Effectiveness Data and Information Set (HEDIS[supreg]) Data Collection 
for Medicare Advantage; Use: We use the data in the Healthcare 
Effectiveness Data and Information Set (HEDIS[supreg]) to: monitor 
Medicare Advantage organization performance, inform audit strategies, 
and inform beneficiary choice through their display in our consumer-
oriented public compare tools and Web sites. Medicare Advantage 
organizations use the data for quality assessment and as part of their 
quality improvement programs and activities. Quality Improvement 
Organizations and our contractors use HEDIS[supreg] data in conjunction 
with their statutory authority to improve quality of care, and 
consumers who are making informed health care choices. In addition, we

[[Page 50059]]

make health plan level HEDIS[supreg] data available to researchers and 
others as public use files at www.cms.hhs.gov. Form Number: CMS-10219 
(OCN: 0938-1028); Frequency: Yearly; Affected Public: Private sector--
Business or other for-profit and Not-for-profit institutions; Number of 
Respondents: 576; Total Annual Responses: 576; Total Annual Hours: 
184,320. (For policy questions regarding this collection contact Lori 
Teichman at 410-786-6684.)
    6. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Emergency and Non-Emergency Ambulance Transports and 
Beneficiary Signature Requirements in 42 CFR 424.36(b); Use: Ambulance 
providers and suppliers are the primary information users. 
Specifically, when ambulance providers and suppliers sign claims on 
behalf of beneficiaries they are required by Sec.  424.36(b)(6) to keep 
certain documentation in their files for at least four years from the 
date of service. The purpose of this information collection is to 
document emergency and nonemergency ambulance transports where the 
beneficiary was incapable of signing the claim and the ambulance 
provider or supplier signed the claim on the beneficiary's behalf. The 
information may also be used by: (1) Our Part A and Part B Medicare 
Administrative Contractors that process and pay ambulance claims; (2) 
our staff who review and audit claims for medical necessity; (3) our 
staff who review claims for overpayments; and (4) by others who 
investigate ambulance billing practices to ensure compliance under the 
False Claims Act and anti-kickback statute. Therefore, besides 
ambulance providers and suppliers, the information collected may be 
used by CMS, the Office of the General Counsel, the Office of the 
Inspector General, the Department of Justice, and the Federal Bureau of 
Investigations. Form Number: CMS-10242 (OCN: 0938-1049). Frequency: 
Occasionally; Affected Public: Private sector--Business or other for-
profit and not-for-profit institutions; Number of Respondents: 11,564; 
Total Annual Responses: 15,633,781; Total Annual Hours: 1,303,857. (For 
policy questions regarding this collection contact David Walczak at 
410-786-4475.)
    7. Type of Information Collection Request: Reinstatement of a 
previously approved collection; Title of Information Collection: 
Medicaid and Children's Health Insurance (CHIP) Managed Care Claims and 
Related Information; Use: The Payment Error Rate Measurement (PERM) 
program measures improper payments for Medicaid and the State 
Children's Health Insurance Program (SCHIP). The program was designed 
to comply with the Improper Payments Information Act (IPIA) of 2002 and 
the Office of Management and Budget (OMB) guidance. Although OMB 
guidance requires error rate measurement for SCHIP, 2009 SCHIP 
legislation temporarily suspended PERM measurement for this program and 
changed to Children's Health Insurance Program (CHIP) effective April 
01, 2009. See Children's Health Insurance Program Reauthorization Act 
of 2009 (CHIPRA) Public Law 111-3 for more details. There are two 
phases of the PERM program, the measurement phase and the corrective 
action phase. PERM measures improper payments in Medicaid and CHIP and 
produces state and national-level error rates for each program. The 
error rates are based on reviews of Medicaid and CHIP fee-for-service 
(FFS) and managed care payments made in the Federal fiscal year under 
review. States conduct eligibility reviews and report eligibility 
related payment error rates also used in the national error rate 
calculation. We created a 17 state rotation cycle so that each state 
will participate in PERM once every three years. We need to collect 
capitation payment information from the selected states so that the 
federal contractor can draw a sample and review the managed care 
capitation payments. We will also collect state managed care contracts, 
rate schedules and updates to the contracts and rate schedules. This 
information will be used by the Federal contractor when conducting the 
managed care claims reviews. Sections 1902(a)(6) and 2107(b)(1) of the 
Social Security Act grants us authority to collect information from the 
States. The IPIA requires us to produce national error rates in 
Medicaid and CHIP fee-for-service, including the managed care 
component. The state-specific Medicaid managed care and CHIP managed 
care error rates will be based on reviews of managed care capitation 
payments in each program and will be used to produce national Medicaid 
managed care and CHIP managed care error rates. Form Number: CMS-10178 
(OCN: 0938-0994); Frequency: Occasionally; Affected Public: State, 
Local, or Tribal Governments; Number of Respondents: 34; Total Annual 
Responses: 2040; Total Annual Hours: 28,050. (For policy questions 
regarding this collection contact Monetha Dockery at 410-786-0155.)
    8. Type of Information Collection Request: Revision of a previously 
approved collection; Title of Information Collection: End Stage Renal 
Disease (ESRD) Medical Information Facility Survey; Use: The End Stage 
Renal Disease (ESRD) Medical Information Facility Survey form (CMS-
2744) is completed annually by Medicare-approved providers of dialysis 
and transplant services. The CMS-2744 is designed to collect 
information concerning treatment trends, utilization of services and 
patterns of practice in treating ESRD patients. The information is used 
to assess and evaluate the local, regional and national levels of 
medical and social impact of ESRD care and is used extensively by 
researchers and suppliers of services for trend analysis. The 
information is available on our Dialysis Facility Compare Web site and 
will enable patients to make informed decisions about their care by 
comparing dialysis facilities in their area. Form Number: CMS-2744 
(OCN: 0938-0447); Frequency: Yearly; Affected Public: Business or other 
for-profit and Not-for-profit institutions; Number of Respondents: 
5,964; Total Annual Responses: 5,964; Total Annual Hours: 47,712. (For 
policy questions regarding this collection contact Michelle Tucker at 
410-786-0736.)
    9. Type of Information Collection Request: Reinstatement with 
change of a currently approved collection; Title of Information 
Collection: Intermediate Care Facility (ICF) for the Mentally Retarded 
(MR) or Persons with Related Conditions Survey Report Form; Use: This 
survey form is needed to ensure intermediate care facility (ICF) for 
the mentally retarded (MR) provider and client characteristics are 
available and updated annually for the federal government's Online 
Survey Certification and Reporting (OSCAR) system. It is required for 
the provider to fill out at the time of the annual recertification or 
initial certification survey conducted by the state Medicaid agency. 
The team leader for the state survey team must review and approve the 
completed form before completion of the survey. The state Medicaid 
survey agency is responsible for transferring the 3070 information into 
OSCAR. Form Number: CMS-3070 (OCN: 0938-0062); Frequency: Reporting--
Yearly; Affected Public: Private Sector: Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 6,446; Total 
Annual Responses: 6,446; Total Annual Hours: 19,388. (For policy 
questions regarding this collection contact Adrienne Rogers at 410-786-
3411.)
    10. Type of Information Collection Request: New Collection (Request 
for a new OMB control number); Title of

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Information Collection: Evaluation of the Multi-Payer Advanced Primary 
Care Practice (MAPCP) Demonstration Focus Group Protocols; Use: On 
September 16, 2009, the Department of Health and Human Services 
announced the establishment of the Multi-payer Advanced Primary Care 
Practice (MAPCP) Demonstration, under which Medicare joined Medicaid 
and private insurers as a payer participant in state-sponsored patient-
centered medical home (PCMH) initiatives. We selected eight states to 
participate in this demonstration: Maine, Vermont, Rhode Island, New 
York, Pennsylvania, North Carolina, Michigan, and Minnesota. We are 
proposing to conduct in-person focus groups with Medicare and Medicaid 
beneficiaries and their caregivers to more thoroughly understand 
patients' experiences with their PCMHs and how well their PCMHs are 
serving their needs.
    The focus groups will provide us with answers to fundamental 
``what, how, and why'' questions about beneficiaries' experiences with 
care and access to and coordination of care. We will use the 
information obtained via in-person, focus groups for the evaluation of 
the MAPCP Demonstration. The focus group data will be collected to 
supplement other qualitative and quantitative analyses from primary and 
secondary data sources by providing data on context, structure, and 
process, as well as select aspects of the key outcomes. The data 
gathered from the interviews will allow for more complete 
interpretation of the quantitative claims and other data analysis by 
taking into account the unique perspectives of beneficiaries. 
Subsequent to the publication of the 60-day Federal Register notice 
(April 29, 2013; 78 FR 25089), the protocols have been revised by 
adding, revising and/or deleting questions. Form Number: CMS-10479 
(OCN: 0938-NEW); Frequency: Annually; Affected Public: Individuals and 
households; Number of Respondents: 768; Total Annual Responses: 384; 
Total Annual Hours: 1,152. (For policy questions regarding this 
collection contact Suzanne Wensky at 410-786-0226.)
    11. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Cooperative 
Agreement to Support Establishment of State-Operated Health Insurance 
Exchanges; Use: All states (including the 50 states, consortia of 
states, Territories, and the District of Columbia herein referred to as 
States) that received a State Planning and Establishment Grant for 
Affordable Care Act's (ACA) Exchanges are eligible for the Cooperative 
Agreement to Support Establishment of State Operated Insurance 
Exchanges. Section 1311 of the Affordable Care Act offers the 
opportunity for each State to establish an Exchange [now referred to as 
Marketplace], and provides for grants to States for the planning and 
establishment of these Exchanges. Given the innovative nature of 
Exchanges and the statutorily-prescribed relationship between the 
Secretary and States in their development and operation, it is critical 
that the Secretary work closely with States to provide necessary 
guidance and technical assistance to ensure that States can meet the 
prescribed timelines, Federal requirements, and goals of the statute.
    In order to provide appropriate and timely guidance and technical 
assistance, the Secretary must have access to timely, periodic 
information regarding State progress. Consequently, the information 
collection associated with these grants is essential to facilitating 
reasonable and appropriate federal monitoring of funds, providing 
statutorily-mandated assistance to States to implement Exchanges in 
accordance with Federal requirements, and to ensure that States have 
all necessary information required to proceed, such that retrospective 
corrective action can be minimized.
    The submitted revision adds sets of Outcomes and Operational 
Metrics to States' data collection requirements; we will use the 
resulting data to evaluate Marketplace performance and overall 
effectiveness of the ACA. Key areas of measurement are the 
effectiveness of eligibility determination and enrollment processes, 
impact on affordability for consumers, and the effect of Marketplace 
participation on health insurances markets. Furthermore, these metrics 
facilitate actionable feedback and technical assistance to States for 
quality improvement efforts during the critical early period of 
operations. This funding opportunity was first released on January 20, 
2011. Form Number: CMS-10371 (OCN: 0938-0119); Frequency: Occasionally; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 40; Total Annual Responses: 1,475; Total Annual Hours: 
64,695. (For policy questions regarding this collection contact 
Christina Daw at 301-492-4181.)
    12. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Internal Revenue Service (IRS)/Social Security 
Administration (SSA)/Centers for Medicare and Medicaid Services (CMS) 
Data Match and Supporting Regulations; Use: Medicare Secondary Payer 
(MSP) is essentially the same concept known in the private insurance 
industry as coordination of benefits; it refers to those situations 
where Medicare assumes a secondary payer role to certain types of 
private insurance for covered services provided to a Medicare 
beneficiary.
    Congress sought to reduce the losses to the Medicare program by 
requiring in 42 U.S.C. 1395y(b)(5) that the Internal Revenue Service 
(IRS), the Social Security Administration (SSA), and we perform an 
annual data match (the IRS/SSA/CMS Data Match, or ``Data Match'' for 
short). We use the information obtained through Data Match to contact 
employers concerning possible application of the MSP provisions by 
requesting information about specifically identified employees (either 
a Medicare beneficiary or the working spouse of a Medicare 
beneficiary). This statutory data match and employer information 
collection activity enhances our ability to identify both past and 
present MSP situations. Form Number: CMS-R-137 (OCN: 0938-0565); 
Frequency: Annually; Affected Public: Business or other for-profit and 
Not-for-profit institutions, State, Local or Tribal Governments; Number 
of Respondents: 280,028; Total Annual Responses: 280,028; Total Annual 
Hours: 1,629,763. (For policy questions regarding this collection 
contact Rick Mazur at 410-786-1418.)

    Dated: August 13, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-20023 Filed 8-15-13; 8:45 am]
BILLING CODE 4120-01-P