[Federal Register Volume 82, Number 71 (Friday, April 14, 2017)]
[Notices]
[Pages 17997-17998]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-07568]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-1561/1561A, CMS-370 and CMS-377, CMS-10488, 
and CMS-10393]


Agency Information Collection Activities: Proposed Collection; 
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 (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 the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and 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 13, 2017.

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 https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    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: William Parham at (410) 786-4669.

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-1561/1561A Health Insurance Benefit Agreement
CMS-370 and CMS-377 ASC Forms for Medicare Program Certification
CMS-10488 Consumer Experience Survey Data Collection
CMS-10393 Beneficiary and Family Centered Data Collection

    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.

Information Collection

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Benefit Agreement; Use: Applicants to the Medicare program are required 
to agree to provide services in accordance with federal requirements. 
The CMS-1561/1561A is essential in that is allows us to ensure that 
applicants are in compliance with the requirements. Applicants will be 
required to sign the completed form and provide operational information 
to us to assure that they continue to meet the requirements after 
approval. Form Number: CMS-1561/1561A (OMB control number: 0938-0832); 
Frequency: Yearly; Affected Public: Private sector--(Business or other 
for-profits and Not-for-profit institutions); Number of Respondents: 
2,400; Total Annual Responses: 2,400; Total Annual Hours: 400. (For 
policy questions regarding this collection contact Shonte Carter at 
410-786-3532).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Titles of Information Collection: ASC Forms for 
Medicare Program Certification; Use: The CMS-370 is used to establish 
eligibility for payment. This agreement, upon submission by the 
ambulatory surgical center (ASC) and acceptance for filing by the 
Secretary of Health & Human Services, shall be binding on both the ASC 
and the Secretary. The agreement may be terminated by either party in 
accordance with regulations. In the event of termination, payment will 
not be available for ASC services furnished on or after the effective 
date of termination.
    The Request for Certification or Update of Certification 
Information in the Medicare Program Form (CMS-377)

[[Page 17998]]

is used by State agencies who conduct certification surveys on CMS' 
behalf to maintain information on the facility's characteristics that 
facilitate conducting surveys, e.g., determining the size and the 
composition of the survey team on the basis of the number of ORs/
procedure rooms and the types of surgical procedures performed in the 
ASC. Form Numbers: CMS-370 and CMS-377 (OMB control number: 0938-0266); 
Frequency: Occasionally; Affected Public: Private Sector--Business or 
other for-profit and Not-for-profit institutions; Number of 
Respondents: 5,694; Total Annual Responses: 1,898; Total Annual Hours: 
627. (For policy questions regarding this collection contact Erin McCoy 
at 410-786-2337.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Consumer 
Experience Survey Data Collection; Use: Section 1311(c)(4) of the 
Affordable Care Act 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. HHS 
established the QHP Enrollee Experience Survey (QHP Enrollee Survey) to 
assess consumer experience with the QHPs offered through the 
Marketplaces. The survey include topics to assess consumer experience 
with the health care system such as communication skills of providers 
and ease of access to health care services. CMS developed the survey 
using the Consumer Assessment of Health Providers and Systems 
(CAHPS[supreg]) principles (https://www.ahrq.gov/cahps/about-cahps/principles/index.html) and established an application and approval 
process for survey vendors who want to participate in collecting QHP 
enrollee experience data.
    The QHP Enrollee Survey, which is based on the CAHPS[supreg] Health 
Plan Survey, will be used to (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. CMS 
completed two rounds of developmental testing including 2014 
psychometric testing and 2015 beta testing of the QHP Enrollee Survey. 
The psychometric testing helped determine psychometric properties and 
provided an initial measure of performance for Marketplaces and QHPs to 
use for quality improvement. Based on psychometric test results, CMS 
further refined the questionnaire and sampling design to conduct the 
2015 beta test of the QHP Enrollee Survey. CMS previously obtained 
clearance for the 2016 and 2017 administrations of the QHP Enrollee 
Survey.
    At this time, CMS is requesting to renew approval for the 
information collection related to the QHP Enrollee Experience Survey in 
2018-2020. These activities are necessary to ensure that CMS fulfills 
legislative mandates established by section 1311(c)(4) of the 
Affordable Care Act to develop an ``enrollee satisfaction survey 
system'' and provide such information on Marketplace Web sites. CMS is 
also seeking approval to remove eight survey questions beginning with 
the 2018 survey administration. With the removal of these eight 
questions, the revised total estimated annual burden hours of national 
implementation of the QHP Enrollee Survey is 22,523 hours with 90,015 
responses. The revised total annualized burden over three years for 
this requested information collection is 67,569 hours and the total 
average annualized number of responses is 270,045 responses. Form 
Number: CMS-10488 (OMB Control Number: 0938-1221); Frequency: Annually; 
Affected Public: Public sector (Individuals and Households), Private 
sector (Business or other for-profits and Not-for-profit institutions); 
Number of Respondents: 90,015; Total Annual Responses: 90,015; Total 
Annual Hours: 22,523; (For policy questions regarding this collection 
contact Nidhi Singh-Shah at 301-492-5110.)
    4. Type of Information Collection Request: Revision of a previously 
approved collection; Title of Information Collection: Beneficiary and 
Family Centered Data Collection; Use: The CMS Quality Improvement 
Organization (QIO) Program includes Beneficiary and Family Centered 
Care (BFCC) QIOs whose functions, as set forth in Section 1862(g) of 
the Social Security Act, are to improve the effectiveness, efficiency, 
economy, and quality of services delivered to Medicare beneficiaries. 
To accomplish these goals, the QIOs review health care services funded 
under Medicare to determine whether those services are reasonable, 
medically necessary, furnished in the appropriate setting, and meet 
professionally recognized standards of quality. The QIOs also review 
health care services where the beneficiary or a representative has 
complained about the quality of those services or is appealing alleged 
premature discharge.
    Under the current 11th QIO Statement of Work (SOW), two 
organizations are providing services as BFCC QIOs across all of the 
United States. The QIO evaluation criteria have been revised to reflect 
this national regionalization and it is important for CMS to understand 
the impact on beneficiaries from this reorganization. The information 
will be used to evaluate the success of each QIO in meeting its 
contractual requirements and to understand the experience of Medicare 
beneficiaries and/or their representative with QIO contract mandated 
work. Form Number: CMS-10393 (OMB Control number: 0938-1177); 
Frequency: Once; Affected Public: Individuals or households; Number of 
Respondents: 24,970; Number of Responses: 24,970; Total Annual Hours: 
2,899. (For policy questions regarding this collection, contact David 
Russo at 617-565-1310.)

    Dated: April 11, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2017-07568 Filed 4-13-17; 8:45 am]
 BILLING CODE 4120-01-P