[Federal Register Volume 89, Number 108 (Tuesday, June 4, 2024)]
[Notices]
[Pages 47966-47968]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-12157]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-R-142 and CMS-10379]


Agency Information Collection Activities: Proposed Collection; 
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 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

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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 August 5, 2024.

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, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT: William N. 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-R-142 Examination and Treatment for Emergency Medical Conditions 
and Women in Labor (EMTALA)
CMS-10379 Rate Increase Disclosure and Review Requirements (45 CFR part 
154)

    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: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Examination and Treatment for Emergency Medical Conditions 
and Women in Labor (EMTALA); Use: Pursuant to section 1866(a)(1)(I) of 
the Act, Congress has mandated that the Secretary enforce section 1867 
of the Act. Under section 1867, effective August 1, 1986, hospitals may 
continue to participate in the Medicare program only if they are not 
out of compliance with its provisions. Continued Paperwork Reduction 
Act (PRA) approval of the regulation sections cited below will promote 
uniform and thorough application of the section 1866 and 1867 
requirements. They will also provide information when requested by 
Congress and other interested parties regarding the implementation of 
the statute. During 2004 through 2018, approximately 8,146 complaints 
were received, approximately 7,770 of those complaints were 
investigated, and approximately 3,567 EMTALA deficiencies were found. 
During Federal fiscal years 2001 through 2005 the Inspector General's 
Office imposed civil monetary penalties on hospitals in 105 cases, for 
a total of $2,645,750 in penalties. An audit completed by the Office of 
Inspector General (OIG) (entitled, Office of Inspector General: 
Implementation and Enforcement of the Examination and Treatment for 
Emergency Medical Conditions and Women in Labor by the Health Care 
Financing Administration, April 1995, A-06-93-00087) determined that 
CMS's implementation of the Act was generally effective, but Regional 
Offices (RO) were not consistent with conducting timely investigations, 
sending acknowledgments to complaints, ensuring that investigations 
were thorough, or ensuring that violations were referred to the OIG in 
accordance with CMS policy for possible civil monetary penalty action. 
OIG further concluded that without proper compliance, there is an 
increased risk that individuals with emergency medical conditions will 
not receive the treatment needed to stabilize their condition, which 
may place them in greater risk of death. Form Number: CMS-R-142 (OMB 
control number: 0938-0667); Frequency: Occasionally; Affected Public: 
Private Sector; Business or other for-profits, Not-for-profit 
institutions; Number of Respondents: 5,166; Total Annual Responses: 
5,166; Total Annual Hours: 5,166. (For policy questions regarding this 
collection contact Renate Dombrowski at (410) 786-4645.)
    2. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Rate Increase Disclosure and Review Requirements (45 CFR 
part 154); Use: 45 CFR part 154 implements the annual review of 
proposed increases in premiums for health insurance coverage called for 
by section 2794 of the Public Health Service Act (PHS Act). The 
regulation established a rate review program to ensure that all rate 
increases that meet or exceed an established threshold are reviewed by 
a state or the Centers for Medicare & Medicaid Services (CMS) to 
determine whether the proposed rate increases are unreasonable. Each 
state or CMS also reviews all proposed rate changes from issuers 
offering non-grandfathered health insurance coverage in the individual 
and/or small group markets for compliance with the Federal rating rules 
at sections 2701, 2705, 2717(c)(4), and 2753 of the PHS Act, section 
1312(c) of the Affordable Care Act, and 45 CFR 147.102, 147.110, 
148.180, and 156.80. Accordingly, issuers offering non-grandfathered 
health insurance coverage in the individual and/or small group markets 
are required to submit Rate Filing Justifications to CMS. 45 CFR 
154.103 exempts grandfathered health plan coverage as defined in 45 CFR 
147.140, excepted benefits as described in section 2791(c) of the PHS 
Act and student health insurance coverage, as defined in Sec.  147.145, 
from Federal rate review requirements.
    The Rate Filing Justification consists of three parts. All issuers 
must continue to submit a Uniform Rate Review Template (URRT) (Part I 
of the Rate Filing Justification) for all single risk pool plans. 45 
CFR 154.200(a)(1) establishes a 15 percent Federal default threshold 
for reasonableness review. Issuers that submit a rate filing that 
includes a plan with a proposed rate increase that meets or exceeds the 
threshold must include a written description justifying the rate 
increase,

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also known as the consumer justification narrative (Part II of the Rate 
Filing Justification). We note that the threshold set by CMS 
constitutes a minimum standard, and most states currently employ 
stricter rate review standards and may continue to do so. Issuers 
offering a QHP or any single risk pool submission containing a rate 
increase of any size must continue to submit an actuarial memorandum 
(Part III of the Rate Filing Justification). The actuarial memorandum 
is required whenever a state with an Effective Rate Review Program, as 
determined in accordance with 45 CFR 154.301, requires it to be 
submitted, and for all plans in states that do not have an Effective 
Rate Review Program. Form Number: CMS-10379 (OMB control number: 0938-
1141); Frequency: Annually; Affected Public: Private Sector; Businesses 
or other for-profits, Not-for-profit institutions, State, Local, or 
Tribal Governments; Number of Respondents: 620; Number of Responses: 
2,551; Total Annual Hours: 46,102. (For policy questions regarding this 
collection, contact Keith McNamara at 410-786-7010.)

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-12157 Filed 6-3-24; 8:45 am]
BILLING CODE 4120-01-P