[Federal Register Volume 84, Number 132 (Wednesday, July 10, 2019)]
[Notices]
[Pages 32926-32927]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14719]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10003]


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 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 on the collection(s) of information must be received by 
the OMB desk officer by August 9, 2019.

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' website 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: 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: Revision with change of a 
currently approved collection; Title of Information Collection: Notice 
of Denial of Medical Coverage (or Payment) (NDMCP); Use: Section 
1852(g)(1)(B) of the Social Security Act (the Act) requires Medicare 
health plans to provide enrollees with a written notice in 
understandable language of the reasons for the denial and a description 
of the applicable appeals processes. Medicare health plans, including 
Medicare Advantage plans, cost plans, and Health Care Prepayment Plans 
(HCPPs), are required to issue the Notice of Denial of Medical Coverage 
(or Payment) (NDMCP) when a request for either a medical service or 
payment is denied, in whole or in part. Additionally, the notices 
inform Medicare enrollees of their right to file an appeal, outlining 
the steps and timeframes for filing. All Medicare health plans are 
required to use these standardized notices. In 2013, Medicaid appeal 
rights were integrated into form CMS-10003 for beneficiaries who are 
eligible for Medicare and full Medicaid benefits under a State Medicaid 
plan. These appeal rights are provided in instances where a Medicare 
health plan enrollee receives full benefits under a State Medical 
Assistance (Medicaid) program being managed by the plan and the plan 
denies a service or item that is also subject to Medicaid appeal 
rights.
    Changes to the collection from the 60-day package to the 30-day 
package include:
     Removal of language related to State Fair Hearings to 
comply with the change in Medicaid managed care rules at 42 CFR 
438.402(c)(1)(i), effective 2017, that all Medicaid managed care 
denials must now first have a plan-level review before a State Fair 
Hearing can be requested.
     Updates to comply with the Medicare Advantage final rule, 
published May 23, 2019, Federal Register, 84 FR 23832, effective 
January 1, 2020, regarding the change in timeframes for Medicare 
Advantage appeals related to Part B drugs.
     Removing the option to delete sections related to 
expedited payment requests (if applicable); plans are to leave all 
language regarding fast appeals. Text has been added to the notice 
informing enrollees they do not have a right to request an expedited 
appeal if they are asking to be paid back for an item or service 
already received (42 CFR 422.570(a)).
     The addition of language in the instructions that 
``applicable integrated plans'' should follow notification requirements 
under final rule published

[[Page 32927]]

April 16, 2019, Federal Register, 84 FR 15680, and amended May 23, 
2019, Federal Register, 84 FR 23832, effective January 1, 2021.
     The addition of instructions for MA-PDs to enter text in 
the free text field ``why did we deny your request?'' when they have 
determined that the requested drug being denied is covered under Part 
D.
    Form Number: CMS-10003 (OMB control number: 0938-0829); Frequency: 
Yearly; Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 694; Total Annual Responses: 9,373,200; Total Annual 
Hours: 1,561,575. (For policy questions regarding this collection 
contact Staci Paige at 410-786-1943.)

    Dated: July 5, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-14719 Filed 7-9-19; 8:45 am]
 BILLING CODE 4120-01-P