[Federal Register: October 10, 2008 (Volume 73, Number 198)]
[Notices]
[Page 60296-60297]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr10oc08-78]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-262, CMS-10142, CMS-10175 and CMS-R-218]
Agency Information Collection Activities: Proposed Collection;
Comment Request
Agency: Centers for Medicare & Medicaid Services.
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) 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 functions; (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: Revision of a currently
approved collection; Title of Information Collection: CY 2010 Plan
Benefit Package (PBP) and Formulary Submission for Medicare Advantage
(MA) Plans and Prescription Drug Plans (PDP) Use: Under the Medicare
Modernization Act (MMA), Medicare Advantage (MA) and Prescription Drug
Plan (PDP) organizations are required to submit plan benefit packages
for all Medicare beneficiaries residing in their service area. The plan
benefit package submission consists of the formulary file, Plan Benefit
Package (PBP) software, and supporting documentation as necessary. MA
and PDP organizations will generate a formulary to illustrate their
list of drugs, including information on prior authorization, step
therapy, tiering, and quantity limits. Additionally, the PBP software
will be used to describe their organization's plan benefit packages,
including information on premiums, cost sharing, authorization rules,
and supplemental benefits. CMS uses the formulary and PBP data to
review and approve the plan benefit packages proposed by each MA and
PDP organization.
CMS requires that MA and PDP organizations submit a completed
formulary and PBP as part of the annual bidding process. During this
process, organizations prepare their proposed plan benefit packages for
the upcoming contract year and submit them to CMS for review and
approval. Based on operational changes and policy clarifications to the
Medicare program and continued input and feedback by the industry, CMS
has made the necessary changes to the plan benefit package submission.
Form Number: CMS-R-262 (OMB 0938-0763); Frequency: Yearly;
Affected Public: Business or other for-profits b. Not-for-profit
institutions; Number of Respondents: 475; Total Annual Responses:
4987.5; Total Annual Hours: 12112.5.
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: CY 2010 Bid
Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription
Drug Plans (PDP). Use: 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 CMS. MAOs and PDPs use the Bid Pricing Tool (BPT) software
to develop their actuarial pricing bid. The information provided in the
BPT is the basis for the plan's enrollee premiums and CMS payments for
each contract year. The tool collects data such as medical expense
development (from claims data and/or manual rating), administrative
expenses, profit levels, and projected plan enrollment information. By
statute,
[[Page 60297]]
completed BPTs are due to CMS by the first Monday of June each year.
CMS reviews and analyzes the information provided on the Bid Pricing
Tool. Ultimately, CMS decides whether to approve the plan pricing
(i.e., payment and premium) proposed by each organization. Form Number:
CMS-10142 (OMB 0938-0944); Frequency: Yearly; Affected Public:
Business or other for-profits b. Not-for-profit institutions; Number of
Respondents: 550; Total Annual Responses: 6050; Total Annual Hours:
42,350.
3. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Certification Statement for Electronic File Interchange
Organizations (EFIOs) Use: Health care providers can currently obtain a
National Provider Identifier (NPI) via a paper application or over the
Internet through the National Plan and Provider Enumeration System
(NPPES). These applications must be submitted individually, on a per-
provider basis. The Electronic File Interchange (EFI) process allows
provider-designated electronic file interchange organizations (EFIOs)
to capture multiple providers' NPI application information on a single
electronic file for submission to NPPES. This process is also referred
to as ``bulk enumeration.'' To ensure that the EFIO has the authority
to act on behalf of each provider and complies with other Federal
requirements, an authorized official of the EFIO must sign a
certification statement and mail it to the Centers for Medicare and
Medicaid Services (CMS). Form Number: CMS-10175 (OMB 0938-
0984); Frequency: Once; Affected Public: Private Sector--Business or
other for-profits; Number of Respondents: 300; Total Annual Responses:
300; Total Annual Hours: 300.
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Information
Collection Requirements contained in 45 CFR Part 162; HIPAA Standards
for Electronic Transactions. Use: We are revising the currently
approved information collection request to include the information
collection requirements contained in CMS-0009-P (73 FR 49742). In the
aforementioned regulation, we update the adopted standards for
electronic transactions and propose the adoption of a new standard
transaction for Medicaid subrogation for retail pharmacy claims. The
use of these updated and additional standards would improve the
Medicare and Medicaid programs and other Federal health programs as
well as private health programs, and the effectiveness and efficiency
of the health care industry in general, by simplifying the
administration of the system and fostering and increase in EDI for
exchanging healthcare information. Increased advances in technology and
improvements in healthcare business processes have fostered development
of updated EDI standards to facilitate efficient and effective flow of
administrative operations. Adopting an updated version of the standards
and a new standard for Medicaid subrogation would greatly improve EDI
standardization for healthcare transactions. Form Number: CMS-R-218
(OMB 0938-0866); Frequency: Once; Affected Public: Private
Sector--Business or other for-profits and Not-for-profit institutions;
Number of Respondents: 696,026; Total Annual Responses: 696,026; Total
Annual Hours: 6,960,260.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web site 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by December 9, 2008:
1. Electronically. You may submit 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) 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.
Dated: October 2, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E8-24093 Filed 10-9-08; 8:45 am]
BILLING CODE 4120-01-P