[Federal Register Volume 81, Number 68 (Friday, April 8, 2016)]
[Notices]
[Pages 20643-20646]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-08106]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-317, CMS-319, CMS-10166, CMS-10178, and CMS-
10184]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services.

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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 (the 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 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates 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 must be received by June 7, 2016.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) that are accepting comments.
    2. By regular mail. You may mail written comments to the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number ___, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.
    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:

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-317 State Medicaid Eligibility Quality Control Sampling Plan
CMS-319 State Medicaid Eligibility Quality Control Sample Selection 
Lists
CMS-10166 Payment Error Rate Measurement in Medicaid and the State 
Children's Health Insurance Program
CMS-10178 Medicaid and State Children's Health Insurance Plan (SCHIP) 
Managed Care
CMS-10184 Payment Error Rate Measurement--State Medicaid and SCHIP 
Eligibility

    Under the 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 requires federal agencies 
to publish a 60-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.
    1. Type of Information Collection Request: Extension of a currently 
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, CMS implemented MEQC pilots in which 
States could focus on special studies, targeted populations, geographic 
areas or other forms of oversight with CMS approval. States must submit 
a sampling plan, or pilot proposal to be approved by CMS 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. 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 Medicaid Eligibility 
Quality Control (MEQC) and Payment Error Rate Measurement (PERM) 
programs. Form Number: CMS-317 (OMB control number: 0938-0146); 
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 Bridgett Rider at 410-786-2602.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of

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Information Collection: State Medicaid Eligibility Quality Control 
(MEQC) Sample Selection Lists; Use: The 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 (OMB control number: 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 Bridgett Rider at 410-786-2602.)
    3. Type of Information Collection Request: Extension of a currently 
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, CMS 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 (OMB control number: 0938-
0974); Frequency: Annually, Quarterly; Affected Public: State, Local, 
or Tribal Governments; Number of Respondents: 34; Total Annual 
Responses: 34; Total Annual Hours: 56,100. (For policy questions 
regarding this collection contact Bridgett Rider at 410-786-2602.)
    4. Type of Information Collection Request: Extension of a currently 
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. 
The 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. Following is the list of 
States in which we will measure improper payments over the next three 
years in Medicaid. 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 
CMS 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 (OMB control number: 0938-0994); 
Frequency: Occasionally;  Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 34; Total Annual

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Responses: 28,050; Total Annual Hours: 28,050. (For policy questions 
regarding this collection contact Bridgett Rider at 410-786-2602.)
    5. Type of Information Collection Request: Extension of a currently 
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 Medicaid and the 
Children's Health Insurance Program (CHIP). To comply with the IPIA, 
CMS 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. Periodically, CMS will conduct 
Federal re-reviews of States' PERM files to ensure the accuracy of 
States' review findings and the validity of the review process. CMS 
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 selected by CMS. Form Number: CMS-10184 (OMB control number: 0938-
1012); Frequency: Annually, Quarterly Affected Public: State, Local, or 
Tribal Governments; Number of Respondents: 34; Total Annual Responses: 
1,583; Total Annual Hours: 946,164. (For policy questions regarding 
this collection contact Bridgett Rider at 410-786-2602.)

    Dated: April 5, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2016-08106 Filed 4-7-16; 8:45 am]
 BILLING CODE 4120-01-P