[Federal Register Volume 85, Number 247 (Wednesday, December 23, 2020)]
[Notices]
[Pages 83966-83967]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-28369]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-40B, CMS-R-285, CMS-10142 and CMS-10123/
10124]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
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 January 22, 2021.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
    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 website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    2. 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 Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Application for Enrollment in Medicare the Medical Insurance Program; 
Use: Section 1836 of the Act, and regulations at 42 CFR 407.10, provide 
the eligibility requirements for enrollment in Part B. Section 407.11 
lists the CMS-40B as the application to be used by individuals who wish 
to apply for Part B if they already have initial entitlement to 
premium-free Part A. Under the regulations, individuals may also enroll 
in Medicare Part B by signing a statement requesting Part B, if 
eligible for enrollment at that time. Individuals use the standardized 
Form CMS-40B to request enrollment.
    The CMS-40B provides the necessary information to determine 
eligibility and to process the beneficiary's request for enrollment for 
Medicare Part B coverage. This form is only used for enrollment by 
beneficiaries who already have Part A, but not Part B. Form CMS-40B is 
completed by the person with Medicare or occasionally by an SSA 
representative using information provided by the Medicare enrollee 
during an in-person interview. The form is owned by CMS, but not 
completed by CMS staff. SSA processes Medicare enrollments on behalf of 
CMS. Form Number: CMS-40B (OMB control number: 0938-1230); Frequency: 
Yearly; Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 400,000; Total Annual Responses: 400,000; Total Annual 
Hours: 100,000. (For policy questions regarding this collection contact 
Carla Patterson at 410-786-1000.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Request for Retirement Benefit Information; Use: Section 1818(d)(5) of 
the Social Security Act (the Act) provides that certain former State 
and local government employees (and their current or former spouses) 
may have the Part A premium reduced to zero.
    Form CMS-R-285, ``Request for Retirement Benefit Information,'' is 
used to obtain information regarding whether a beneficiary currently 
purchasing Medicare premium Part A coverage, is receiving retirement 
payments based on State or local government employment, how long the 
claimant worked for the State or local government employer, and whether 
the former employer or pension plan is subsidizing the individual's 
Part A premium.
    Form CMS-R-285 provides the necessary information regarding the 
prior state or local government employment to process the individual's 
request for premium Part A reduction based on their employment by a 
state or local government.
    The form is completed by the state or local government employer on 
behalf of the individual seeking the Medicare premium reduction. The 
SSA--CMS'

[[Page 83967]]

agent for processing Medicare enrollments and premium amount 
determinations will use this information to help determine whether a 
beneficiary meets the requirements for reduction of the Part A premium. 
The form is owned by CMS but not completed by CMS staff. Form Number: 
CMS-R-285 (OMB control number: 0938-0769); Frequency: Yearly; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 
500; Total Annual Responses: 500; Total Annual Hours: 125. (For policy 
questions regarding this collection contact Carla Patterson at 410-786-
1000.)
    3. Type of Information Collection Request: Revision with change of 
a currently approved collection; Title of Information Collection: Bid 
Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription 
Drug Plans (PDP); Use: This collection dates back to 2005. Under the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(MMA), and implementing regulations at 42 CFR, Medicare Advantage 
organizations (MAO) and Prescription Drug Plans (PDP) are required to 
submit an actuarial pricing ``bid'' for each plan offered to Medicare 
beneficiaries for approval by the Centers for Medicare & Medicaid 
Services (CMS). MAOs and PDPs use the Bid Pricing Tool (BPT) software 
to develop their actuarial pricing bid. The competitive bidding process 
defined by the ``The Medicare Prescription Drug, Improvement, and 
Modernization Act'' (MMA) applies to both the MA and Part D programs. 
It is an annual process that encompasses the release of the MA rate 
book in April, the bid's that plans submit to CMS in June, and the 
release of the Part D and RPPO benchmarks, which typically occurs in 
August. Form Number: CMS-10142 (OMB control number: 0938-0944); 
Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 555; Total Annual Responses: 4,995; 
Total Annual Hours: 149,850. (For policy questions regarding this 
collection contact Rachel Shevland at 410-786-3026.)
    4. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Fast Track Appeals Notices: NOMNC/DENC; Use: The purpose of the NOMNC 
is to help a beneficiary/enrollee decide whether to pursue a fast 
appeal by a Quality Improvement Organization (QIO) and how to file that 
request. Consistent with Sec. Sec.  405.1200 and 422.624, SNFs, HHAs, 
CORFs, and hospices must provide notice to all beneficiaries/enrollees 
whose Medicare-covered services are ending, no later than two days in 
advance of the proposed termination of service. This information is 
conveyed to the beneficiary/enrollee via the NOMNC.
    If a beneficiary/enrollee appeals the termination decision, the 
beneficiary/enrollee and the QIO, consistent with Sec. Sec.  
405.1200(b) and 405.1202(f) for Original Medicare, and Sec. Sec.  
422.624(b) and 422.626(e)(1)-(5) for Medicare health plans, will 
receive a detailed explanation of the reasons services should end. This 
detailed explanation is provided to the beneficiary/enrollee using the 
DENC, the second notice included in this renewal package. Form Number: 
CMS-10123/10124 (OMB control number: 0938-0953); Frequency: Yearly; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 24,915; Total Annual Responses: 5,314,194; Total Annual 
Hours: 1,142,749. (For policy questions regarding this collection 
contact Janet Miller at [email protected].)

    Dated: December 18, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2020-28369 Filed 12-22-20; 8:45 am]
BILLING CODE 4120-01-P