[Federal Register Volume 81, Number 141 (Friday, July 22, 2016)]
[Notices]
[Pages 47805-47807]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-17251]


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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: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

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 August 22, 2016.

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) 395-5806 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: Extension of a currently 
approved collection; Title of Information Collection: State Medicaid 
Eligibility Quality Control 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.)

[[Page 47806]]

    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: State Medicaid 
Eligibility Quality Control 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 (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 
State Children's Health Insurance Plan (SCHIP) Managed Care; 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.

[[Page 47807]]

Form Number: CMS-10178 (OMB control number: 0938-0994); Frequency: 
Occasionally; Affected Public: State, Local, or Tribal Governments; 
Number of Respondents: 34; Total Annual 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: Payment Error 
Rate Measurement--State Medicaid and SCHIP Eligibility; 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: July 18, 2016.
Martique Jones,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2016-17251 Filed 7-21-16; 8:45 am]
BILLING CODE 4120-01-P