[Federal Register Volume 90, Number 54 (Friday, March 21, 2025)]
[Notices]
[Pages 13367-13368]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-04890]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-276, CMS-10716 and CMS-10799]
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 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 May 20, 2025.
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-276 Prepaid Health Plan Cost Report
CMS-10716 Applicable Integrated Plan Coverage Decision Letter
CMS-10799 D-SNP Enrollee Advisory Committee
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.
[[Page 13368]]
Information Collections
1. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Prepaid Health
Plan Cost Report; Use: The Cost Report outlines the provisions for
implementing Sections 1876(h) and 1833(a)(1)(A) of the Social Security
Act (Act). Organizations contracting with the Secretary under the Act
provide health services on a prepayment basis to enrolled members and
are required to submit adequate cost and statistical data, based on
financial records, in order to be reimbursed on reasonable cost basis
by CMS. Organizations include Health Maintenance Organizations (HMOs)
and Competitive Medical Plans (CMPs) under Section 1876, in addition
to, Health Care Prepayment Plans (HCPPs) under Section 1833. These
entities may be collectively referred to as ``Managed Care
Organizations'' (MCOs).
Form CMS 276, provided by CMS as excel worksheets, covers the
prescribed format for the cost reports. The worksheets are designed to
be of sufficient flexibility to take into account the diversity of
operations, yet provide the necessary cost and statistical information
to enable CMS to determine the proper amount of payment to the Plan.
Cost-based MCOs must submit through HPMS an annual Budget Forecast,
semi-annual interim, and final cost report to CMS, all of which are
included in this collection. Additionally, HMOs/CMPs are required to
submit fourth quarter interim reports annually to CMS. Please note that
HCPPs are not required to submit fourth quarter interim reports. Form
Number: CMS-276 (OMB control number: 0938-0165); Frequency: Yearly,
semi-annually, and once; Affected Public: Private sector; Number of
Respondents: 16; Number of Responses: 36; Total Annual Hours: 1,128.
(For questions regarding this collection contact Frank Cisar at 410-
786-7553).
2. Type of Information Collection Request: Revision with change of
a currently approved collection; Title of Information Collection:
Applicable Integrated Plan Coverage Decision Letter; Use: Section
1859(f)(8) of the Act requires development of unified grievance and
appeals processes for D-SNPs, to the extent feasible. We finalized
regulations for integrated organization determinations at Sec.
422.631, affecting D-SNP administration for January 1, 2021 and beyond.
The rule requires applicable integrated plans to send an enrollee a
written notice of any adverse decision on an integrated organization
determination using a notice that is written in plain language and
contains the information detailed at Sec. 422.631(d)(1)(iii).
Applicable integrated plans as defined at Sec. 422.561 issue form
CMS-10716 when a request for either a medical service or payment is
denied in whole or in part after considering both the Medicare and
Medicaid benefit. Applicable integrated plans issue this form to
enrollees when the plan reduces, stops, suspends, changes, or denies,
in whole or in part, a request for a service or item (including a Part
B drug) or a request for payment of a service or item (including a Part
B drug) that the enrollee has already received. The form provides the
enrollee with information regarding their right to an appeal of the
applicable integrated plan's decision and the enrollee will use the
instructions to navigate the appeal process. Form Number: CMS-10716
(OMB control number 0938-1386); Frequency: Occasionally; Affected
Public: Private Sector and Business or other for-profits; Number of
Respondents: 129; Number of Responses: 10,468; Total Annual Hours:
1,745. (For questions regarding this collection contact Kristi Sugarman
at 415-744-3629.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: D-SNP Enrollee
Advisory Committee; Use: CMS established paragraph (f) at Sec. 422.107
under our authority at section 1856(b)(1) of the Act to establish in
regulation other standards not otherwise specified in statute that are
both consistent with Part C statutory requirements and necessary to
carry out the MA program and our authority at section 1857(e) of the
Act to adopt other terms and conditions not inconsistent with Part C as
the Secretary may find necessary and appropriate.
MA organizations with D-SNPs would use the information collected
from enrollees in the enrollee advisory committee to help identify and
address barriers to high-quality, coordinated care for enrollees. Any
collection of information directly from MA organizations offering a D-
SNPs regarding the enrollee advisory committee requirement Sec.
422.107(f) will be included in a separate PRA package. CMS is
collecting data on D-SNP enrollee advisory committees as part of the CY
2025 Part C Reporting Requirements. Form Number: CMS-10799 (OMB control
number 0938-1422); Frequency: Occasionally; Affected Public: Private
Sector and Business or other for-profits; Number of Respondents: 398;
Number of Responses: 398; Total Annual Hours: 15,920. (For questions
regarding this collection contact Melissa Maker at 212-616-2329.)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-04890 Filed 3-20-25; 8:45 am]
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