[Federal Register Volume 78, Number 193 (Friday, October 4, 2013)]
[Notices]
[Pages 61846-61848]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-24219]



[[Page 61846]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-2746, CMS-2728, CMS-P-0015A, CMS-43, CMS-
10137, CMS-10156, CMS-10170, CMS-10237, CMS-10261, CMS-10326, and CMS-
10493]


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 November 4, 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: Revision of a previously 
approved collection; Title of Information Collection: End Stage Renal 
Disease Death Notification; Use: The End Stage Renal Disease (ESRD) 
Death Notification (CMS-2746) is completed by all Medicare-approved 
ESRD facilities upon the death of an ESRD patient. Its primary purpose 
is to collect fact of death and cause of death of ESRD patients. 
Certain other identifying information (e.g., name, Medicare claim 
number, and date of birth) is required for matching purposes. federal 
regulations require that the ESRD Networks examine the mortality rates 
of every Medicare-approved facility within its area of responsibility. 
The death form provides the necessary data to assist the ESRD Networks 
in making decisions that result in improved patient care and in cost-
effective distribution of ESRD resources. The data is used by the ESRD 
Networks to verify facility deaths and to monitor facility performance. 
Form Number: CMS-2746 (OCN: 0938-0448); Frequency: On occasion; 
Affected Public: Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 5,964; Total Annual Responses: 
75,000; Total Annual Hours: 37,500. (For policy questions regarding 
this collection contact Michelle Tucker at 410-786-0736.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: End Stage Renal 
Disease Medical Evidence Report Medicare Entitlement and/or Patient 
Registration; Use: The End Stage Renal Disease (ESRD) Medical Evidence 
Report is completed for all ESRD patients either by the first treatment 
facility or by a Medicare-approved ESRD facility when it is determined 
by a physician that the patient's condition has reached that stage of 
renal impairment that a regular course of kidney dialysis or a kidney 
transplant is necessary to maintain life. The data reported on the CMS-
2728 is used by the Federal government, ESRD Networks, treatment 
facilities, researchers and others to monitor and assess the quality 
and type of care provided to end stage renal disease beneficiaries. The 
data collection captures the specific medical information required to 
determine the Medicare medical eligibility of End Stage Renal Disease 
claimants. Form Number: CMS-2728 (OCN: 0938-0046); Frequency: 
Occasionally; Affected Public: Individuals or households; Number of 
Respondents: 130,000; Total Annual Responses: 130,000; Total Annual 
Hours: 97,500. (For policy questions regarding this collection contact 
Michelle Tucker at 410-786-0736.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Current 
Beneficiary Survey; Use: We are the largest single payer of health care 
in the United States. With full implementation of the Affordable Care 
Act of 2010 (ACA), the agency will play a direct or indirect role in 
administering health insurance coverage for more than 120 million 
people across the Medicare, Medicaid, CHIP, and Exchange populations. 
One of our critical aims is to be an effective steward, major force, 
and trustworthy partner in leading the transformation of the health 
care system. We also aim to provide Americans with high quality care 
and better health at lower costs through improvement. At the forefront 
of these initiatives is the newly formed Center for Medicare and 
Medicaid Innovation (CMMI).
    The CMMI is authorized by Section 1115A of the Social Security Act, 
as established by section 3021 of the ACA and was established to ``test 
innovative payment and service delivery models to reduce program 
expenditures . . . while

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preserving or enhancing the quality of care furnished'' to Medicare, 
Medicaid and CHIP beneficiaries. Implicit across all of CMMI activities 
is an emphasis on diffusion--finding and validating innovative models 
that have the potential to scale, facilitating rapid adoption, and 
letting them take root in organizations, health systems, and 
communities across America.
    The Medicare Current Beneficiary Survey (MCBS) is the most 
comprehensive and complete survey available on the Medicare population 
and is essential in capturing data not otherwise collected through our 
operations. The MCBS is an in-person, nationally-representative, 
longitudinal survey of Medicare beneficiaries that we sponsor and is 
directed by the Office of Information Products and Data Analytics 
(OIPDA) in partnership with the CMMI. The survey captures beneficiary 
information whether aged or disabled, living in the community or 
facility, or serviced by managed care or fee-for-service. Data produced 
as part of the MCBS are enhanced with our administrative data (e.g. 
fee-for-service claims, prescription drug event data, enrollment, etc.) 
to provide users with more accurate and complete estimates of total 
health care costs and utilization. The MCBS has been continuously 
fielded for more than 20 years (encompassing over 1 million 
interviews), and consists of three annual interviews per survey 
participant.
    The MCBS continues to provide unique insight into the Medicare 
program and helps both us and our external stakeholders better 
understand and evaluate the impact of existing programs and significant 
new policy initiatives. In the past, MCBS data have been used to assess 
potential changes to the Medicare program. For example, the MCBS was 
instrumental in supporting the development and implementation of the 
Medicare prescription drug benefit by providing a means to evaluate 
prescription drug costs and out-of-pocket burden for these drugs to 
Medicare beneficiaries. Form Number: CMS-P-0015A (OCN: 0938-0568); 
Frequency: Occasionally; Affected Public: Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 16,550; Total 
Annual Responses: 49,650; Total Annual Hours: 58,450 (For policy 
questions regarding this collection contact William Long at 410-786-
7927.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Application for Hospital Insurance Benefits for Individuals 
with End Stage Renal Disease; Use: The CMS-43 application is used (in 
conjunction with CMS-2728) to establish entitlement to, and enrollment 
in, Medicare Part A (and Part B) for individuals with end stage renal 
disease. The application is completed by a Social Security 
Administration (SSA) claims representative or field representative 
using information provided by the individual during an interview. The 
CMS-43 application follows the questions and requirements used by SSA 
to determine Title II eligibility. This is done not only for 
consistency purposes, but because certain Title II and Title XVIII 
insured status and relationship requirements must be met in order to 
qualify for Medicare under the end stage renal disease provisions. Form 
Number: CMS-43 (OCN: 0938-0800); Frequency: Once; Affected Public: 
Individuals or households; Number of Respondents: 60,000; Total Annual 
Responses: 60,000; Total Annual Hours: 24,960. (For policy questions 
regarding this collection contact Lindsay Smith at 410-786-6843.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Solicitation for 
Applications for Medicare Prescription Drug Plan 2015 Contracts; Use: 
The information will be collected under the solicitation of proposals 
from prescription drug plans, Medicare Advantage (MA) plans that offer 
integrated prescription drug and health care coverage, Cost Plans, 
PACE, and EGWP applicants. We will use the information collected to 
ensure that applicants meet our requirements and to support the 
determination of contract awards. Form Number: CMS-10137 (OCN: 0938-
0936); Frequency: Yearly; Affected Public: Business or other for-
profits and Not-for-profits institutions; Number of Respondents: 254; 
Total Annual Responses: 254; Total Annual Hours: 2,319. (For policy 
questions regarding this collection contact Linda Anders at 410-786-
0459.)
    6. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Retiree Drug Subsidy (RDS) Applications and Instructions; 
Use: Under the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 and implementing regulations at 42 CFR part 
423, subpart R plan sponsors (e.g., employers, unions) who offer 
prescription drug coverage to their qualified covered retirees are 
eligible to receive a 28 percent tax-free subsidy for allowable drug 
costs. In order to qualify, plan sponsors must submit a complete 
application with a list of retirees for whom it intends to collect the 
subsidy. Once we review and analyze the information on the application 
and the retiree list, notification will be sent to the plan sponsor 
about its eligibility to participate in the RDS program. Form Number: 
CMS-10156 (OCN: 0938-0957); Frequency: Yearly and monthly; Affected 
Public: Business or other for-profits and Not-for-profit institutions; 
Number of Respondents: 4,500; Total Annual Responses: 4,500; Total 
Annual Hours: 288,000. (For policy questions regarding this collection 
contact John W. Campbell at 410-786-0542.)
    7. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Retiree Drug Subsidy (RDS) Payment Request and 
Instructions; Use: Under section 1860D-22 of the Social Security Act 
and implementing regulations at 42 CFR part 423 subpart R, plan 
sponsors (e.g., employers, unions) who offer prescription drug coverage 
meeting specified criteria to their qualified covered retirees are 
eligible to receive a 28 percent tax-free subsidy for allowable drug 
costs. Plan sponsors must submit required prescription drug cost data 
and other information in order to receive the subsidy. Subpart R 
stipulates that plan sponsors may elect to submit RDS payment requests 
on a monthly, quarterly, interim annual, or annual basis; once 
selected, the payment frequency may not be changed during the plan 
year. Form Number: CMS-10170 (OCN: 0938-0977); Frequency: Occasionally; 
Affected Public: Business or other for-profits and Not-for-profit 
institutions; Number of Respondents: 4,500; Total Annual Responses: 
4,500; Total Annual Hours: 679,500. (For policy questions regarding 
this collection contact John W. Campbell at 410-786-0542.)
    8. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Part C--Medicare 
Advantage and 1876 Cost Plan Expansion Application; Use: Organizations 
wishing to provide healthcare services under Medicare Advantage (MA), 
MA-PD or both that offer integrated prescription drug and health care 
products must complete an application, file a bid, and receive final 
approval from us. Existing MA plans may request to expand their 
contracted service area by completing the Service Area Expansion 
application. Any current 1876 Cost Plan Contractor that wants to expand 
its Medicare cost-based contract with us can complete the

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application. Information is collected to ensure applicant compliance 
with our requirements and to gather data used to support its 
determination of contract awards. Form Number: CMS-10237 (OCN 0938-
0935); Frequency: Yearly; Affected Public: Business or other for-
profits and Not-for-profits institutions; Number of Respondents: 566; 
Total Annual Responses: 566; Total Annual Hours: 22,955. (For policy 
questions regarding this collection contact Melissa Staud at 410-786-
3669.)
    9. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Part C Medicare 
Advantage Reporting Requirements and Supporting Regulations; Use: There 
are a number of information users of Part C reporting data, including 
our central and regional office staff that use this information to 
monitor health plans and to hold them accountable for their 
performance, researchers, and other government agencies such as the 
Government Accounting Office. Health plans can use this information to 
measure and benchmark their performance. We intend to make some of 
these data available for public reporting as ``display measures'' in 
2013. Form Number: CMS-10261 (OCN: 0938-1054); Frequency: Yearly and 
semi-annually; Affected Public: Business or other for-profits; Number 
of Respondents: 588; Total Annual Responses: 6,715; Total Annual Hours: 
174,785. (For policy questions regarding this collection contact Terry 
Lied at 410-786-8973.)
    10. Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Electronic Submission of Medicare Graduate Medical Education (GME) 
Affiliation Agreements; Use: We use the information contained in 
electronic affiliation agreements as documentation of the existence of 
Medicare GME affiliations, and to verify that the affiliations being 
formed by teaching hospitals for the purposes of sharing their Medicare 
Graduate Medical Education FTE cap slots are valid according to our 
regulations. The affiliation agreements are also used as reference 
materials when potential issues involving specific affiliations arise. 
Form Number: CMS-10326 (OCN: 0938-1111); Frequency: Yearly; Affected 
Public: Business or other for-profits and Not-for-profit institutions; 
Number of Respondents: 125; Total Annual Responses: 125; Total Annual 
Hours: 166. (For policy questions regarding this collection contact 
Tzvi Hefter at 410-786-0614.)
    11. Type of Information Collection Request: New collection (request 
for a new OMB control number); Title of Information Collection: 
Nationwide Consumer Assessment of Healthcare Providers and Systems 
(DCAHPS) Survey for Adults in Medicaid; Use: The goal of the survey is 
to obtain national and state-by-state estimates of adult Medicaid 
beneficiaries' access and experiences and satisfaction with care across 
different financing and delivery models (e.g., managed care and fee-
for-service) and population groups (e.g., beneficiaries with physical, 
mental or both physical and mental disabilities, dually eligible 
beneficiaries, all other beneficiaries). The survey will serve as 
baseline information on the experiences of low-income adults during the 
early stages of implementation of the Affordable Care Act provision 
that permits states to expand eligibility to adults with income below 
138 percent of the Federal poverty level who were not previously 
eligible. Along with states, we can use the survey information as one 
indicator of the quality of care within and across states. It also will 
be used to assist us along with the states in efforts to provide better 
care and more affordable care to Medicaid beneficiaries. Form Number: 
CMS-10493 (OCN: 0938-New); Frequency: Once; Affected Public: 
Individuals and households; Number of Respondents: 1,500,000; Total 
Annual Responses: 510,000; Total Annual Hours: 170,000. (For policy 
questions regarding this collection contact Marsha Lillie-Blanton at 
410-786-8856.)

    Dated: September 30, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-24219 Filed 10-3-13; 8:45 am]
BILLING CODE 4120-01-P