[Federal Register: December 7, 2007 (Volume 72, Number 235)]
[Notices]
[Page 69218-69219]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07de07-59]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10232, CMS-10120, CMS-10241, CMS-370, 377 and
378]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid
Services (CMS), Department of Health and Human Services, is publishing
the following summary of proposed collections for public comment.
Interested persons are invited to send comments regarding this burden
estimate or any other aspect of this collection of information,
including any of the following subjects: (1) The necessity and utility
of the proposed information collection for the proper performance of
the Agency's function; (2) the accuracy of the estimated burden; (3)
ways to enhance the quality, utility, and clarity of the information to
be collected; and (4) the use of automated collection techniques or
other forms of information technology to minimize the information
collection burden.
1. Type of Information Collection Request: New Collection; Title of
Information Collection: State Plan Pre-print for Integrated Medicare
and Medicaid Programs; Use: Information submitted via the State Plan
Amendment (SPA) pre-print will be used by CMS Central and Regional
Offices to analyze a State's proposal to implement integrated Medicare
and Medicaid programs. The pre-print is an optional document for use by
States to highlight the arrangements between a State and Medicare
Advantage Special Needs Plans that are also providing Medicaid
services. State Medicaid Agencies will complete the SPA pre-print and
submit it to CMS for a comprehensive analysis. The pre-print provides
the opportunity for States to confirm that their integrated care model
complies with both federal statutory and regulatory requirements. The
pre-print contains assurances, check-off items, and areas for States to
describe policies and procedures for subjects such as enrollment,
marketing and quality assurance. Form Numbers: CMS-10251 (OMB:
0938-NEW); Frequency: Reporting--Once; Affected Public: State, Local,
or Tribal Governments; Number of Respondents: 56; Total Annual
Responses: 30; Total Annual Hours: 600.
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
1932 State Plan Amendment Template, State Plan Requirements and
Supporting Regulations in 42 CFR 438.50; Form No.: CMS-10120
(OMB: 0938-0933); Use: The State Medicaid Agencies will
complete the template. CMS will review the information to determine if
the State has met all the requirements under Section 1932(l)(1)(A) of
the Social Security Act and 42 CFR 438.50. Once all requirements are
met, the State will be allowed to enroll Medicaid beneficiaries on a
mandatory basis into managed care entities without section 1115 or
1915(b) waiver authority; Frequency: On occasion; Affected Public:
State, local, or tribal government; Number of Respondents: 56; Total
Annual Responses: 10; Total Annual Hours: 100.
3. Type of Information Collection Request: New Collection; Title of
Information Collection: Annual State Report and Annual State
Performance Rankings; Use: The Deficit Reduction Act of 2005 (DRA)
requires CMS to contract with a vendor to conduct a monthly national
survey of retail prescription drug prices and to report the prices to
the States. These national average prices will be used as a benchmark
by the States for the management of their prescription drug programs.
The law also requires that States report their drug utilization rates
for non-innovator multiple source drugs, their payment rates under
their State plan, and their dispensing fees. A template will be used to
facilitate data collection. The States' rankings are to be presented to
the Congress and the States. Form Number: CMS-10241 (OMB:
0938-NEW); Frequency: Reporting--Yearly; Affected Public: States, Local
or Tribal Governments; Number of Respondents: 51; Total Annual
Responses: 51; Total Annual Hours: 765.
4. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Health Insurance Benefit Agreement, Ambulatory Surgical Centers (ASC)
Request for Certification in the Medicare Program, ASC Survey Report
Form and ASC Conditions of Coverage; Use: The Health Insurance Benefit
Agreement is utilized for the purpose of establishing for payment under
Title XVIII of the Social Security Act. The ASC Request for
Certification form is utilized as an application for facilities wishing
to participate in the Medicare program as an ASC. This form initiates
the process of obtaining a decision as to whether the conditions for
coverage are met. It also promotes data retrieval from the Online Data
Input Edit (ODIE system, a subsystem of the Online Survey Certification
and Report (OSCAR) system by CMS Regional Offices (ROs). The ASC Report
Form is an instrument used by the State survey agency to record data
collection in order to determine supplier compliance with individual
conditions for coverage and report it to the Federal Government. The
form is primarily a coding worksheet designed to facilitate data
reduction and retrieval into the ODIE/OSCAR system at the CMS ROs. This
form includes basic information on compliance (i.e., met, not met and
explanatory statements) and does not require any descriptive
information regarding the survey activity itself. Form Numbers: CMS-
370, 377, 378 (OMB: 0938-0266); Frequency: Reporting--
Occasionally (initially and then every 3 years); Affected Public:
States, Local or Tribal Governments; Number of Respondents: 5123; Total
Annual Responses: 1707; Total Annual Hours: 2,787.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS Web
Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995, or
E-mail your request, including your address, phone number, OMB number,
and CMS document identifier, to Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786-1326.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB desk
officer at the address below, no later than 5 p.m. on January 7, 2008.
OMB Human Resources and Housing Branch, Attention: Katherine
Astrich, New Executive Office Building, Room 10235, Washington, DC
20503, Fax Number: (202) 395-6974.
[[Page 69219]]
Dated: November 30, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E7-23746 Filed 12-6-07; 8:45 am]
BILLING CODE 4120-01-P