[Federal Register Volume 78, Number 169 (Friday, August 30, 2013)]
[Notices]
[Pages 53766-53769]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-21257]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-4040, CMS-10174, CMS-R-285, CMS-10166, CMS-
10184, CMS-1572, CMS-10175, CMS-379 and CMS-10336)]


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 30, 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.

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    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 without 
change of a previously approved collection; Title of Information 
Collection: Request for Enrollment in Supplementary Medical Insurance; 
Use: Form CMS-4040 (and CMS-4040SP) is used to establish entitlement to 
and enrollment in Medicare Part B for beneficiaries who file for Part B 
only. The collected information is used to determine entitlement for 
individuals who meet the requirements in section 1836(2) of the Social 
Security Act as well as the entitlement of the applicant or their 
spouses to an annuity paid by OPM for premium deduction purposes. Form 
Number: CMS-4040 (OCN: 0938-0245); Frequency: Once; Affected Public: 
Individuals or households; Number of Respondents: 10,000; Total Annual 
Responses: 10,000; Total Annual Hours: 2,500. (For policy questions 
regarding this collection contact Lindsay Smith at 410-786-6843.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Collection of Prescription Drug Event Data from Contracted 
Part D Providers for Payment; Use: The information users would include 
Pharmacy Benefit Managers, third party administrators and pharmacies 
and prescription drug plans, Medicare Advantage plans that offer 
integrated prescription drug and health care coverage, Fallbacks and 
other plans that offer coverage of outpatient prescription drugs under 
the Medicare Part D benefit to Medicare beneficiaries. The data is used 
primarily for payment, but is also used for claim validation as well as 
for other legislated functions such as quality monitoring, program 
integrity, and oversight. Form Number: CMS-10174 (OCN: 0938-0982); 
Frequency: Monthly; Affected Public: Private sector (business or other 
for-profits and not-for-profit institutions); Number of Respondents: 
747; Total Annual Responses: 947,881,770; Total Annual Hours: 1,896. 
(For policy questions regarding this collection contact Ivan Iveljic at 
410-786-3312.)
    3. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Request for Retirement Benefit Information; Use: Section 
1818(d)(5) of the Social Security Act provides that former state and 
local government employees (who are age 65 or older, have been entitled 
to Premium Part A for at least 7 years, and did not have the premium 
paid for by a state, a political subdivision of a state, or an agency 
or instrumentality of one or more states or political subdivisions) may 
have the Part A premium reduced to zero. These individuals must also 
have 10 years of employment with the state or local government employer 
or a combination of 10 years of employment with a state or local 
government employer and a non-government employer. Form CMS-R-285 is an 
essential part of the process of determining whether an individual 
qualifies for the premium reduction. The Social Security Administration 
will use this information to help determine whether a beneficiary meets 
the requirements for reduction of the Part A premium. Form Number: CMS-
R-285 (OCN: 0938-0769); Frequency: Once; Affected Public: State, Local, 
or Tribal Governments; Number of Respondents: 500; Total Annual 
Responses: 500; Total Annual Hours: 125. (For policy questions 
regarding this collection contact Lindsay Smith at 410-786-6843.)
    4. Type of Information Collection Request: Reinstatement of a 
previously approved collection; Title of Information Collection: 
Payment Error Rate Measurement in Medicaid & Children's Health 
Insurance Program (CHIP); Use: The Improper Payments Information Act 
(IPIA) of 2002 as amended by the Improper Payments Elimination and 
Recovery Improvement Act (IPERIA) of 2012 requires CMS to produce 
national error rates for Medicaid and Children's Health Insurance 
Program (CHIP). To comply with the IPIA, we will engage a Federal 
contractor to produce the error rates in Medicaid and CHIP. The error 
rates for Medicaid and CHIP are calculated based on the reviews on 
three components of both Medicaid and CHIP program. They are: Fee-for-
service claims medical reviews and data processing reviews, managed 
care claims data-processing reviews, and eligibility reviews. Each of 
the review components collects different types of information, and the 
state-specific error rates for each of the review components will be 
used to calculate an overall state-specific error rate, and the 
individual state-specific error rates will be used to produce a 
national error rate for Medicaid and CHIP. The states will be requested 
to submit, at their option, test data which include full claims details 
to the contractor prior to the quarterly submissions to detect 
potential problems in the dataset to and ensure the quality of the 
data. These states will be required to submit quarterly claims data to 
the contractor who will pull a statistically valid random sample, each 
quarter, by strata, so that medical and data processing reviews can be 
performed. State-specific error rates will be based on these review 
results. We need to collect the fee-for-service claims data, medical 
policies, and other information from states as well as medical records 
from providers in order for the contractor to sample and review 
adjudicated claims in those states selected for medical reviews and 
data processing reviews. Based on the reviews, state-specific error 
rates will be calculated which will serve as part of the basis for 
calculating national Medicaid and CHIP error rates. Form Number: CMS-
10166 (OCN: 0938-0974); Frequency: Yearly, Quarterly; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 34; Total 
Annual Responses: 1650; Total Annual Hours: 56,100. (For policy 
questions regarding this collection contact Monetha Dockery at 410-786-
0155.)
    5. Type of Information Collection Request: Reinstatement with a 
change of a previously approved collection; Title of Information 
Collection: Eligibility Error Rate Measurement in Medicaid and the 
Children's Health Insurance Program; Use: The Improper Payments 
Information Act (IPIA) of 2002 requires CMS to produce national error 
rates for

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Medicaid and the Children's Health Insurance Program (CHIP). To comply 
with the IPIA, we will use a national contracting strategy to produce 
error rates for Medicaid and CHIP fee-for-service and managed care 
improper payments. The federal contractor will review States on a 
rotational basis so that each State will be measured for improper 
payments, in each program, once and only once every three years.
    Subsequent to the first publication, we determined that we will 
measure Medicaid and CHIP in the same State. Therefore, States will 
measure Medicaid and CHIP eligibility in the same year measured for 
fee-for-service and managed care. We believe this approach will 
advantage States through economies of scale (e.g. administrative ease 
and shared staffing for both programs reviews). We also determined that 
interim case completion timeframes and reporting are critical to the 
integrity of the reviews and to keep the reviews on schedule to produce 
a timely error rate. Lastly, the sample sizes were increased slightly 
in order to produce an equal sample size per strata each month. Each 
month States submit a monthly sample selection list, eligibility review 
findings for active and negative cases and claims review findings. At 
the end of the cycle, States would have submitted 48 forms. We are 
submitting a new instrument in which we compile all of the information 
from the 48 forms into a format that will allow States to submit 12 
forms for 12 months of eligibility data. This form will also serve 
either of the data substitution options. Periodically, we will conduct 
Federal re-reviews of States' PERM files to ensure the accuracy of 
States' review findings and the validity of the review process. We will 
select a random subsample of Medicaid and CHIP cases from the sample 
selection lists provided by each State. States will submit all 
pertinent information related to the review of each sampled case that 
is we select. Form Number: CMS-10184 (OCN: 0938-1012); Frequency: 
Yearly and Quarterly Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 34; Total Annual Responses: 120; 
Total Annual Hours: 15,755. (For policy questions regarding this 
collection contact Monetha Dockery at 410-786-0155.)
    6. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Home Health Agency Survey and Deficiencies Report; Use: In 
order to participate in the Medicare Program as a Home Health Agency 
(HHA) provider, the HHA must meet federal standards. This form is used 
to record information and patients' health and provider compliance with 
requirements and to report the information to the federal government. 
Form Number: CMS-1572 (OCN: 0938-0355); Frequency: Yearly; Affected 
Public: State, Local or Tribal Government; Number of Respondents: 
3,830; Total Annual Responses: 3,830; Total Annual Hours: 958. (For 
policy questions regarding this collection contact Patricia Sevast at 
410-786-8135.)
    7. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Certification Statement for Electronic File Interchange 
Organizations; Use: Health care providers can currently obtain a 
National Provider Identifier (NPI) via a paper application or over the 
Internet through the National Plan and Provider Enumeration System 
(NPPES). These applications must be submitted individually, on a per-
provider basis. The Electronic File Interchange (EFI) process allows 
provider-designated organizations (EFIOs) to capture multiple 
providers' NPI application information on a single electronic file for 
submission to NPPES. This process is also referred to as bulk 
enumeration. To ensure that the EFIO has the authority to act on behalf 
of each provider and complies with other federal requirements, an 
authorized official of the EFIO must sign a certification statement and 
mail it to us. Form Number: CMS-10175 (OCN: 0938-0984). Frequency: 
Occasionally; Affected Public: Private Sector; Number of Respondents: 
25; Total Annual Responses: 25; Total Annual Hours: 75. (For policy 
questions regarding this collection contact Leslie Jones at 410-786-
6599.).
    8. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Financial Statement of Debtor and Supporting Regulations; 
Use: The Form CMS-379 is used to collect financial information which is 
needed to evaluate requests from physicians and suppliers to pay 
indebtedness under an extended repayment schedule, or to compromise a 
debt less than the full amount. Normally, when a Medicare 
Administrative Contractor (MAC) overpays a physician or supplier, the 
overpayment is associated with a single claim, and the amount of the 
overpayment is moderate. In these cases, the physician/supplier usually 
refunds the overpaid amount in a lump sum. Alternatively, the MAC may 
recoup the overpaid amount against future payments. A recoupment is the 
recovery by Medicare of any outstanding Medicare debt by reducing 
present or future Medicare payments and applying the amount withheld to 
the indebtedness. The recoupment can be made only if the physician or 
supplier accepts assignment since the MAC makes payment to the 
physician or supplier only on assigned claims.
    Sometimes, however, an overpayment to a physician or supplier is 
exceptionally large, and it cannot be recovered in the normal fashion. 
The large overpayment usually results from aberrant billing practices, 
such as billing for more expensive services than were rendered. This 
could be discovered during routine review of a statistically valid 
sample of claims. The physician or supplier may be unable to refund a 
large overpaid amount in a single payment. The MAC cannot recover the 
overpayment by recoupment if the physician/supplier does not accept 
assignment of future claims, or is not expected to file future claims 
because of going out of business, illness or death. In these unusual 
circumstances, the MAC has authority to approve or deny extended 
repayment schedules up to 12 months, or may recommend to that we 
approve up to 60 months. Before the MAC takes these actions, the MAC 
will require full documentation of the physician's or supplier's 
financial situation. Thus, the physician or supplier must complete Form 
CMS-379. Form Number: CMS-379 (OCN: 0938-0270); Frequency: 
Occasionally; Affected Public: Private sector (business or other for-
profits); Number of Respondents: 500; Total Annual Responses: 500; 
Total Annual Hours: 1,000. (For policy questions regarding this 
collection contact Ronke Fabayo at 410-786-4460.)
    9. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Medicare and Medicaid Programs: Electronic Health Record 
Incentive Program; Use: The American Recovery and Reinvestment Act of 
2009 (Recovery Act) (Pub. L. 111-5) was enacted on February 17, 2009. 
The Recovery Act includes many measures to modernize our nation's 
infrastructure, and improve affordable health care. Expanded use of 
health information technology (HIT) and certified electronic health 
record (EHR) technology will improve the quality and value of America's 
health care. Title IV of Division B of the Recovery Act amends Titles 
XVIII and XIX of the Social Security Act (the Act) by establishing 
incentive payments to eligible professionals (EPs), eligible

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hospitals and critical access hospitals (CAHs), and Medicare Advantage 
(MA) organizations participating in the Medicare and Medicaid programs 
that adopt and successfully demonstrate meaningful use of certified EHR 
technology. These Recovery Act provisions, together with Title XIII of 
Division A of the Recovery Act, may be cited as the ``Health 
Information Technology for Economic and Clinical Health Act'' or the 
``HITECH Act.''
    The HITECH Act creates incentive programs for EPs and eligible 
hospitals, including CAHs, in the Medicare Fee-for-Service (FFS), MA, 
and Medicaid programs that successfully demonstrate meaningful use of 
certified EHR technology. In their first payment year, Medicaid EPs and 
eligible hospitals may adopt, implement or upgrade to certified EHR 
technology. It also, provides for payment adjustments in the Medicare 
FFS and MA programs starting in FY 2015 for EPs and eligible hospitals 
participating in Medicare that are not meaningful users of certified 
EHR technology. These payment adjustments do not pertain to Medicaid 
providers.
    The first final rule for the Medicare and Medicaid EHR Incentive 
Program, which was published in the Federal Register on July 28, 2010 
(CMS-0033-F), specified the initial criteria EPs, eligible hospitals 
and CAHs, and MA organizations must meet in order to qualify for 
incentive payments; calculation of incentive payment amounts; payment 
adjustments under Medicare for covered professional services and 
inpatient hospital services provided by EPs, eligible hospitals and 
CAHs failing to demonstrate meaningful use of certified EHR technology 
beginning in 2015; and other program participation requirements. On the 
same date, the Office of the National Coordinator of Health Information 
Technology (ONC) issued a closely related final rule (45 CFR part 170, 
RIN 0991-AB58) that specified the initial set of standards, 
implementation specifications, and certification criteria for certified 
EHR technology. ONC has also issued a separate final rule on the 
establishment of certification programs for health information 
technology (HIT) (45 CFR part 170, RIN 0991-AB59). The functionality of 
certified EHR technology should facilitate the implementation of 
meaningful use. Subsequently, final rules have been issued by CMS (77 
FR 53968) and ONC (77 FR 72985) to create a Stage 2 of meaningful use 
criteria and other changes to the CMS EHR Incentive Programs and the 
2014 Edition Certification Criteria for EHR technology.
    The information collection requirements contained in this 
information collection request are needed to implement the HITECH Act. 
In order to avoid duplicate payments, all EPs are enumerated through 
their National Provider Identifier (NPI), while all eligible hospitals 
and CAHs are enumerated through their CMS Certification Number (CCN). 
State Medicaid agencies and CMS use the provider's tax identification 
number and NPI or CCN combination in order to make payment, validate 
payment eligibility and detect and prevent duplicate payments for EPs, 
eligible hospitals and CAHs. Form Number: CMS-10336 (OCN: 0938-1158); 
Frequency: Occasionally; Affected Public: Private sector; Number of 
Respondents: 214,694; Total Annual Responses: 214,694; Total Annual 
Hours: 2,034,740. (For policy questions regarding this collection 
contact Travis Broome at 214-767-4450.)

    Dated: August 27, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-21257 Filed 8-29-13; 8:45 am]
BILLING CODE 4120-01-P