[Federal Register Volume 78, Number 212 (Friday, November 1, 2013)]
[Notices]
[Pages 65658-65660]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-26107]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10305, CMS-10488, CMS-R-71, CMS-R-10, CMS-
10220 and CMS-855C]


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 December 2, 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 currently 
approved collection; Title: Medicare Part C and Part D Data Validation 
(42 CFR 422.516(g) and 423.514(g)); Use: Data collected via the 
Medicare Part C and Part D Reporting Requirements Technical 
Specifications is an integral resource for oversight, monitoring, 
compliance and auditing activities necessary to ensure quality 
provision of the Medicare benefits to beneficiaries. We use the data 
collected through the Medicare Data Validation Program to substantiate 
the data collected via Medicare Part C and Part D Reporting 
Requirements Technical Specifications. If we detect data anomalies, the 
CMS division with primary responsibility for the applicable reporting 
requirement assists with determining a resolution. Form Number: CMS-
10305 (OCN: 0938-1115); Frequency: Yearly; Affected Public: Private 
sector--Business or other for-profit or Not-for-profit organizations; 
Number of Respondents: 208; Total Annual Responses: 657; Total Annual 
Hours: 179,301. (For policy questions regarding this collection contact 
Terry Lied at 410-786-8973.)
    2. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Health 
Insurance Marketplace Consumer Experience Surveys: Enrollee 
Satisfaction Survey and Marketplace Survey Data Collection; Use: 
Section 1311(c)(4) of the Affordable Care Act (ACA) requires the 
Department of Health and Human Services (HHS) to develop an enrollee 
satisfaction survey system that assesses consumer experience with 
qualified health plans (QHPs) offered through an Exchange. It also 
requires public display of enrollee satisfaction information by the 
Exchange to allow individuals to easily compare enrollee satisfaction 
levels between comparable plans. The HHS intends to establish two 
surveys that assess consumer experience with the Marketplaces and the 
QHPs offered through the Marketplaces. The surveys will include topics 
to assess consumer experience with the Marketplace such as enrollment 
and customer service, as well as experience with the health care system 
such as communication skills of providers and ease of access to health 
care services. We are considering using the Consumer Assessment of 
Health Providers and Systems (CAHPS[supreg]) principles (http://www.cahps.ahrq.gov/about.htm) for developing the surveys. We have 
proposed an application and approval process for enrollee satisfaction 
survey vendors who want to participate in collecting ESS data. The 
application form for survey vendors includes information regarding 
organization name and contact(s) as well as minimum business 
requirements such as relevant survey experience, organizational survey 
capacity, and quality control procedures.
    The Marketplace Survey will provide (1) Actionable information that 
the Marketplaces can use to improve performance, (2) information that 
CMS and state regulatory organizations can use for general oversight, 
and (3) a longitudinal database for future Marketplace research. The 
CAHPS[supreg] family of instruments does not have a survey that 
assesses entities similar to Marketplaces, so the Marketplace survey 
items were generated by the project team. The QHP Enrollee Experience 
survey will (1) help consumers choose among competing health plans, (2) 
provide actionable information that the QHPs can use to improve 
performance, (3) provide information that regulatory and accreditation 
organizations can use to regulate and accredit plans, and (4) provide a 
longitudinal database for consumer research. We plan to base the QHP 
survey on the CAHPS[supreg] Health Plan Survey.
    We are planning for two rounds of developmental testing for the 
Marketplace and QHP surveys. The 2014 survey field tests will help

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determine psychometric properties and provide an initial measure of 
performance for Marketplaces and QHPs to use for quality improvement. 
Based on field test results, there will be further refinement of the 
questionnaires and sampling designs to conduct the 2015 beta test of 
each survey. We plan to request clearance for two additional rounds of 
national implementation with reporting of scores for each survey in the 
future. A summary of findings from the testing rounds will be included 
when requesting clearance for the additional two rounds of national 
implementation in 2016 and 2017. In 2014, the total annual burden hours 
for the Marketplace and QHP Survey field tests are 34,668 hours with 
93,802 responses. In 2015, the total annual burden hours for the 
Marketplace and QHP Survey beta tests are 267,460 hours with 661,241 
responses. The total average annualized burden over three years for 
this requested information collection is 100,709 hours and the total 
average annualized number of responses is 251,681 responses. Form 
Number: CMS-10488 (OCN: 0938-NEW); Frequency: Annually; Affected 
Public: Public sector--Individuals and Households and Private sector--
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 251,681; Total Annual Responses: 251,681; Total Annual 
Hours: 100,709. (For policy questions regarding this collection contact 
Kathleen Jack at 410-786-7214.)
    3. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Quality Improvement Organization (QIO) Assumption of 
Responsibilities and Supporting Regulations; Use: The Peer Review 
Improvement Act of 1982 amended Title XI of the Social Security Act to 
create the Utilization and Quality Control Peer Review Organization 
(PRO) program which replaces the Professional Standards Review 
Organization (PSRO) program and streamlines peer review activities. The 
term PRO has been renamed Quality Improvement Organization (QIO). This 
information collection describes the review functions to be performed 
by the QIO. It outlines relationships among QIOs, providers, 
practitioners, beneficiaries, intermediaries, and carriers. Form 
Number: CMS-R-71 (OCN: 0938-0445); Frequency: Yearly; Affected Public: 
Private sector--Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 6,939; Total Annual Responses: 
50,377; Total Annual Hours: 158,993. (For policy questions regarding 
this collection contact Coles Mercier at 410-786-2112.)
    4. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Advance Directives (Medicare and Medicaid) and Supporting 
Regulations; Use: The advance directives requirement was enacted 
because Congress wanted individuals to know that they have a right to 
make health care decisions and to refuse treatment even when they are 
unable to communicate. Steps have been taken at both the federal and 
state level, to afford greater opportunity for the individual to 
participate in decisions made concerning the medical treatment to be 
received by an adult patient in the event that the patient is unable to 
communicate to others, a preference about medical treatment. The 
individual may make his preference known through the use of an advance 
directive, which is a written instruction prepared in advance, such as 
a living will or durable power of attorney. This information is 
documented in a prominent part of the individual's medical record. 
Advance directives as described in the Patient Self-Determination Act 
have increased the individual's control over decisions concerning 
medical treatment. Sections 4206 of the Omnibus Budget Reconciliation 
Act of 1990 defined an advance directive as a written instruction 
recognized under State law relating to the provision of health care 
when an individual is incapacitated (those persons unable to 
communicate their wishes regarding medical treatment).
    All states have enacted legislation defining a patient's right to 
make decisions regarding medical care, including the right to accept or 
refuse medical or surgical treatment and the right to formulate advance 
directives. Participating hospitals, skilled nursing facilities, 
nursing facilities, home health agencies, providers of home health 
care, hospices, religious nonmedical health care institutions, and 
prepaid or eligible organizations (including Health Care Prepayment 
Plans (HCPPs) and Medicare Advantage Organizations (MAOs) such as 
Coordinated Care Plans, Demonstration Projects, Chronic Care 
Demonstration Projects, Program of All Inclusive Care for the Elderly, 
Private Fee for Service, and Medical Savings Accounts must provide 
written information, at explicit time frames, to all adult individuals 
about: (a) The right to accept or refuse medical or surgical 
treatments; (b) the right to formulate an advance directive; (c) a 
description of applicable State law (provided by the State); and (d) 
the provider's or organization's policies and procedures for 
implementing an advance directive. Form Number: CMS-R-10 (OCN: 0938-
0610); Frequency: Yearly; Affected Public: Private sector--Business or 
other for-profits; Number of Respondents: 39,575; Total Annual 
Responses: 39,575; Total Annual Hours: 2,836,441. (For policy questions 
regarding this collection contact Sonia Swancy at 410-786-8445.)
    5. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Security Consent and Surrogate Authorization Form; Use: The 
primary function of the Medicare enrollment application is to obtain 
information about the Provider or supplier and whether they meet the 
Federal and/or State qualifications to participate in the Medicare 
program. In addition, the Medicare enrollment application gathers 
information regarding the provider or supplier's practice location, the 
identity of the owners of the enrolling organization, and information 
necessary to establish the correct claims payment.
    Enrollees have the option of submitting either a CMS 855 form, or 
submitting information via a web based process. In establishing a web 
based application process, we allow providers and suppliers the ability 
to enroll in the Medicare program, revalidate their enrollment and make 
changes to their enrollment information via Internet-based Provider 
Enrollment, Chain and Ownership System (PECOS). Individual providers/
suppliers (hereinafter referred to as ``Individual Providers'') log 
into Internet-based PECOS using their User IDs and passwords 
established when they applied on-line to the National Plan and Provider 
Enumeration System (NPPES) for their National Provider Identifiers 
(NPIs). Authorized Officials (AOs) of the provider or supplier 
organizations (hereinafter referred to as ``Organizational Providers'') 
must register for a user account and authenticate their identity and 
connection to the organization they represent before being able to log 
into Internet-based PECOS. Once authenticated, AOs for Organizational 
Providers, receive complete access to their enrollment information via 
Internet-based PECOS. Individuals and AOs of Organizational Providers 
are not required to submit a Security Consent and Surrogate 
Authorization Form to enroll, revalidate or make changes to their 
Medicare enrollment information.
    Individual and Organizational Providers may complete their Medicare 
enrollment responsibilities on their own

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or elect to delegate this task to a Surrogate. A Surrogate is an 
individual or organization identified by an Individual or 
Organizational Provider as someone authorized to access CMS computer 
systems, such as Internet-based PECOS, National Provider Plan and 
Enumeration System (NPPES) and the Medicare and Medicaid Electronic 
Health Records (EHR) Incentive Program Registration and Attestation 
System (HITECH), on their behalf and to modify or view any information 
contained therein that the Individual or Organizational Provider may 
have permission or right to access in accordance with Medicare 
statutes, regulations, policies, and usage guidelines for any CMS 
system. Surrogates may consist of administrative staff, independent 
contractors, 3rd party consulting companies or credentialing 
departments. In order for an Individual or Organizational Provider to 
delegate the Medicare credentialing process to a Surrogate to access 
and update their enrollment information in the above mentioned CMS 
systems on their behalf, it is required that a Security Consent and 
Surrogate Authorization Form be completed, or Individual and 
Organizational Providers use an equivalent online process via the PECOS 
Identity and Access Management (I&A) system. The Security Consent and 
Surrogate Authorization form replicates business service agreements 
between Medicare providers, suppliers or both and Surrogates providing 
enrollment services.
    We are proposing one version of the Security Consent and Surrogate 
Authorization Form. The form, once signed, mailed and approved, grants 
a Surrogate access to all current and future enrollment data for the 
Individual or Organization Provider. Form Number: CMS-10220 (OCN: 0938-
1035); Frequency: Occasionally; Affected Public: Individuals and 
Private Sector--Business or other for-profits and Not-for-profit 
institutions; Number of Respondents: 88,650; Total Annual Responses: 
88,650; Total Annual Hours: 22,162. (For policy questions regarding 
this collection contact Alisha Banks at 410-786-0671.)
    6. 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 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-855C (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: October 29, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-26107 Filed 10-31-13; 8:45 am]
BILLING CODE 4120-01-P