[Federal Register Volume 90, Number 97 (Wednesday, May 21, 2025)]
[Notices]
[Pages 21773-21775]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-09138]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-10305, CMS-1696, CMS-10468, and CMS-10338]
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
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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 July 21, 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-10305 Medicare Part C and Part D Data Validation (42 CFR 422.516(g)
and 423.514(j))
CMS-1696 Appointment of Representative
CMS-10468 Essential Health Benefits in Alternative Benefit Plans,
Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums
and Cost Sharing; Exchanges: Eligibility and Enrollment
CMS-10338 Affordable Care Act Internal Claims and Appeals and External
Review Procedures for Non-grandfathered Group Health Plans and Issuers
and Individual Market Issuers
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 Collections
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Part C
and Part D Data Validation (42 CFR 422.516(g) and 423.514(j)); Use:
This ``Medicare Part C and Part D Data Validation (42 CFR 422.516(g)
and 423.514(j))'' forms will be used by Data Validation Contractors
(DVCs) to evaluate the quality of data submitted by plans for the
Medicare Parts C and D Reporting Requirements. The Centers for Medicare
and Medicaid Services (CMS) established reporting requirements for
Medicare Part C and Part D sponsoring organizations (Medicare Advantage
Organizations [MAOs], Cost Plans, and Medicare Part D sponsors) under
the authority described in 42 CFR 422.516(a) and 423.514(a),
respectively. Under these reporting requirements, each sponsoring
organization must submit Medicare Part C, Medicare Part D, or Medicare
Part C and Part D data; Form Number: CMS-10305 (OMB control number:
0938-1115); Frequency: Yearly; Affected Public: Businesses or other
for-profits; Number of Respondents: 840; Total Annual Responses: 840;
Total Annual Hours: 10,920. (For policy questions regarding this
collection contact Bindu Aryal at 667-414-0889 or
[email protected].)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Appointment of
Representative; Use: The requirements for appointing representatives
for claims and appeals processed under 42 CFR part 405 subpart I were
codified into regulation at 42 CFR 405.910. In summary, section 405.910
states an individual or entity may appoint a representative to act on
their behalf in exercising their rights relative to an initial claim
determination or an appeal. The appointment of representation must be
in writing and must include all the required elements specified in
405.910(c). The burden associated with this requirement is the time and
effort of the individual or entity to prepare an appointment of
representation containing all the required information of this section.
This form would be completed by Medicare beneficiaries, providers,
and suppliers (typically their billing clerk, or billing company), and
any party who wish to appoint a representative to assist them with
their initial Medicare claims determinations and filing appeals on
Medicare claims. The information supplied on the form is reviewed by
Medicare claims and appeals adjudicators. The adjudicators make
determinations whether the form was completed accurately, and if the
form is correct and accepted, the form is appended to the claim or
appeal that it was filed with Form Number: CMS-1696 (OMB control
number: 0938-0950); Frequency: Occasionally; Affected Public:
Individuals and Households and Private Sector; Number of Respondents:
208,173 Total Annual Responses: 208,173; Total Annual Hours: 52,043.
(For policy questions regarding this collection contact Katherine Hosna
at (410) 786-4993 or [email protected].)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Essential Health
Benefits in Alternative Benefit Plans, Eligibility Notices, Fair
Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges:
Eligibility and Enrollment; Use: Information collected by the
Exchanges, Medicaid or CHIP agencies will be used to determine
eligibility for coverage through the Exchanges and insurance
affordability programs (i.e., Medicaid, CHIP, and advance payment of
the premium tax credits), and to assist consumers in enrolling in a QHP
if eligible.
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Applicants include anyone who may be eligible for coverage through any
of these programs. The Exchanges verify the information provided on the
application, communicate with the applicant or his/her authorized
representative and subsequently provide the information to the health
plan selected by the applicant so that it can enroll him/her in a QHP.
The Exchanges also use the information provided in support of its
ongoing operations, including activities such as verifying continued
eligibility for all programs, processing appeals, reporting on and
managing the insurance affordability programs for eligible individuals,
performing oversight and quality control activities, combating fraud,
and responding to any concerns about the security or confidentiality of
the information. Form Number: CMS-10468 (OMB control number: 0938-
1207); Frequency: Annually; Affected Public: Individuals, Households
and Private Sector; Number of Respondents: 20; Total Annual Responses:
20; Total Annual Hours: 25,614. (For policy questions regarding this
collection contact Angela Meadows at [email protected].)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Affordable Care
Act Internal Claims and Appeals and External Review Procedures for Non-
grandfathered Group Health Plans and Issuers and Individual Market
Issuers; Use: PHS Act section 2719 and paragraph (b)(2)(i) of the
Appeals regulation provide that group health plans and health insurance
issuers offering group health insurance coverage must comply with the
internal claims and appeals processes set forth in 29 CFR 2560.503-1 of
the Department of Labor (DOL) claims procedure regulation, and update
such processes in accordance with standards established by the
Secretary of Labor in paragraph (b)(2)(ii) of the regulation. Paragraph
(b)(3)(i) requires issuers offering coverage in the individual health
insurance market to also comply with the DOL claims procedure
regulation as updated by the Secretary of Health and Human Services
(HHS) in paragraph (b)(3)(ii) of the Appeals regulation for their
internal claims and appeals processes.
The information collection requirements included in the DOL claims
procedure regulation and the Appeals regulation ensure that claimants
receive clear and adequate information regarding the plan's claims
procedures and the plan's handling of specific benefit claims. This
transparency enables claimants to understand plan procedures and
decisions, allowing them to effectively request benefits and appeal
denied claims when necessary. The information collected in connection
with the HHS-administered federal external review process is collected
by HHS and is used to provide claimants with an independent external
review, ensuring a fair and impartial assessment of denied health
benefit claims. Form Number: CMS-10338 (OMB control number: 0938-1099);
Frequency: Occasionally; Affected Public: Private Sector (Business or
other for-profit and Not-for-profit institutions); Number of
Respondents: 91,355; Total Annual Responses: 375,202; Total Annual
Hours: 861,785. (For policy questions regarding this collection contact
Daniel Kidane at [email protected].)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-09138 Filed 5-20-25; 8:45 am]
BILLING CODE 4120-01-P