[Federal Register Volume 75, Number 237 (Friday, December 10, 2010)]
[Notices]
[Pages 76988-76990]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-31071]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-21 and CMS-21B, CMS-37, CMS-64, CMS-10120,
CMS-10224, CMS-10098, CMS-10292 and CMS-10220]
Agency Information Collection Activities: Proposed Collection;
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) 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: Extension without change
of a currently approved collection; Title of Information Collection:
CMS-21 (Quarterly Children's Health Insurance Program (CHIP) Statement
of Expenditures for the Title XXI Program) and CMS-21B (State
Children's Health Insurance Program Budget Report for the Title XXI
Program State Plan Expenditures); Use: Forms CMS-21 and -21B provide
CMS with the information necessary to issue quarterly grant awards,
monitor current year expenditure levels, determine the allowability of
State claims for reimbursement, develop CHIP financial management
information, provide for State reporting of waiver expenditures, and
ensure that the Federally established allotment is not exceeded.
Further, these forms are necessary in the redistribution and
reallocation of unspent funds over the Federally mandated timeframes;
Form Numbers: CMS-21 and CMS-21B (OMB: 0938-0731); Frequency:
Quarterly; Affected Public: State, Local, or Tribal Governments; Number
of Respondents: 56; Total Annual Responses: 448; Total Annual Hours:
7,840. (For policy questions regarding this collection contact Jonas
Eberly at 410-786-6232. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Medicaid Program Budget Report; Use: Form CMS-37 is prepared and
submitted to the Centers for Medicare & Medicaid Services (CMS) by
State Medicaid agencies. Form CMS-37 is the primary document used by
CMS in developing the national Medicaid budget estimates that are
submitted to the Office of Management and Budget and the Congress; Form
Number: CMS-37 (OMB: 0938-0101); Frequency: Quarterly;
Affected Public: State, Local, or Tribal Governments; Number of
Respondents: 56; Total Annual Responses: 224; Total Annual Hours:
7,616. (For policy questions regarding this collection contact Jonas
Eberly at 410-786-6232. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Quarterly Medicaid Statement of Expenditures for the Medical Assistance
Program; Use: Form CMS-64 has been used since January 1980 by the
Medicaid State Agencies to report their actual program benefit costs
and administrative expenses to CMS. CMS uses this information to
compute the Federal financial participation (FFP) for the State's
Medicaid Program costs. Certain schedules of the CMS-64 form are used
by States to report budget, expenditure and related statistical
information required for implementation of the Medicaid portion of the
State Children's Health Insurance Programs; Form Number: CMS-64
(OMB: 0938-0067); Frequency: Quarterly; Affected Public:
State, Local, or Tribal Governments; Number of Respondents: 56; Total
Annual Responses: 224; Total Annual Hours: 16,464. (For policy
questions regarding this collection contact Jonas Eberly at 410-786-
6232. For all other issues call 410-786-1326.)
4. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
1932 State Plan Amendment Template; Use: Section 1932(a)(1)(A) of the
Social Security Act (the Act) grants states the authority to enroll
Medicaid beneficiaries on a mandatory basis into managed care entities,
managed care organizations (MCOs) and primary care case managers
(PCCMs). Under this authority, a state can amend its Medicaid state
plan to require certain categories of Medicaid beneficiaries to enroll
in managed care entities without being out of compliance. This template
may be used by states to easily modify their state plans if they choose
to implement the provisions of section 1932(a)(1)(A).
The State Medicaid Agencies will complete the template. CMS will
review the information to determine if the state has met all the
requirements of section 1932(a)(1)(A) and 42 CFR 438.50. If the
requirements are met, CMS will approve the amendment to the state's
title XIX plan giving the state the authority to enroll Medicaid
beneficiaries on a mandatory basis into managed care entities MCOs and
PCCMs. For a state to receive Medicaid funding, there must be an
approved title XIX state plan; Form Number: CMS-10120 (OMB:
[[Page 76989]]
0938-0933); Frequency: Occasionally; Affected Public: State, Local, or
Tribal Governments; Number of Respondents: 56; Total Annual Responses:
10; Total Annual Hours: 100. (For policy questions regarding this
collection contact Camille Dobson at 410-786-7065. For all other issues
call 410-786-1326.)
5. Type of Information Collection Request: Revision of currently
approved collection; Title of Information Collection: Healthcare Common
Procedure Coding System (HCPCS); Use: In October 2003, the Secretary of
Health and Human Services delegated the Center for Medicare and
Medicaid Services (CMS) authority to maintain and distribute HCPCS
Level II Codes. As a result, the National Panel was delineated and CMS
continued with the decision-making process under its current structure,
the CMS HCPCS Workgroup (herein referred to as ``the Workgroup''. CMS'
HCPCS Workgroup is an internal workgroup comprised of representatives
of the major components of CMS, and private insurers, as well as other
consultants from pertinent Federal agencies. Currently the application
intake is paper-based. However, the process has grown and the HCPCS
staff is exploring electronic processes for the collection and storage
of applications. We have received feedback on the nature of the
application; and have streamlined the form into a user-friendly
application. The content of the material is the same, but the questions
have been refined in accordance with comments received from industry
members; and the level of necessity of the information required to
render quality coding decision as determined by the CMS workgroup. The
information on the form is used to update the HCPCS code set. All
information is received and distributed to CMS' HCPCS workgroup and is
reviewed and discussed at workgroup meetings. In turn, CMS' HCPCS
workgroup reaches a decision as to whether a change should be made to
codes in the HCPCS code set. The respondent who submits the application
form can be anyone who has an interest in obtaining a code or modifying
an existing code. However, respondents are usually manufacturers of
products, or consultants on behalf of the manufacturer. Form Number:
CMS-10224 (OMB: 0938-1042; Frequency: Occasionally; Affected
Public: Private Sector, Business and other for-profit and not-for-
profit institutions; Number of Respondents: 300; Total Annual
Responses: 300; Total Annual Hours: 3300. (For policy questions
regarding this collection contact Felicia Eggleston at 410-786-9287 or
Lori Anderson at 410-786-6190. For all other issues call 410-786-1326.)
6. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Beneficiary Satisfaction Survey; Use: The Beneficiary
Satisfaction survey is performed to insure that the CMS 1-800-MEDICARE
Helpline contractor is delivering satisfactory service to the Medicare
beneficiaries. It gathers data on several Helpline operations such as
print fulfillment and websites tool hosted on http://www.medicare.gov.
Respondents to the survey are Medicare beneficiaries that have
contacted 1-800-MEDICARE for information on benefits and services. CMS
is seeking approval for additional questions to be added to the
original collection entitled 800-Medicare Beneficiary Satisfaction
survey. The original set of questions was used when placing outbound
calls to callers regarding the service they received when they called
the 800 Medicare Helpline with a Medicare question. The new expanded
collection will include multiple survey methods to measure customer
satisfaction not only with the Beneficiary Contact Center's (BCC's)
handling of issues via telephone, but also the service provided to
beneficiaries when they write a letter regarding their Medicare issue
or use the e-mail and/or web chat services provided by the BCC. The use
of Customer Satisfaction Surveys is critical to the CMS mission to
provide service to beneficiaries that is convenient, accessible,
accurate, courteous, professional and responsive to the needs of
diverse groups. Form Number: CMS-10098 (OMB: 0938-0919);
Frequency: Weekly, Monthly, and Yearly; Affected Public: Individuals
and Households; Number of Respondents: 36,144; Total Annual Responses:
36,144; Total Annual Hours: 6033. (For policy questions regarding this
collection contact Mark Broccolino at 410-786-6128. For all other
issues call 410-786-1326.)
7. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: State Medicaid
Health Information Technology Plan, Planning-Advance Planning Document
and Update, Implementation Advance Planning Document and Update, and
Annual Implementation of Advance Planning Document to Implement Section
4201 of the American Reinvestment and Recovery Act of 2009; Use:
Section 4201 of Recovery Act establishes 100 percent Federal Financial
Participation (FFP) as reimbursement to States for making incentive
payments to providers for meaningful use of certified electronic health
record technology and 90 percent FFP for administering these payments.
Additionally, States are required to conduct oversight of this program
and ensure no duplicate payments; thus, CMS is requiring States to
submit information to CMS for prior approval before drawing down
funding. These documents, if States choose to implement these
flexibilities, will require a collection of information to effectuate
these changes.
The State Medicaid agencies will complete the templates. CMS will
review the information to determine if the State has met all of the
requirements of the Recovery Act provisions the States choose to
implement. If the requirements are met, CMS will approve the amendments
giving the State the authority to implement their Health Information
Technology (HIT) strategy and implementation plans. For a State to
receive Medicaid Title XIX funding, there must be an approved State
Medicaid HIT Plan, Planning Advance Planning Document and
Implementation Advance Planning Document; Form Number: CMS-10292
(OMB: 0938-1088); Frequency: Yearly, Once, Occasionally;
Affected Public: State, Local, or Tribal Governments; Number of
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 56.
(For policy questions regarding this collection contact Sherry Armstead
at 410-786-4342. For all other issues call 410-786-1326.)
8. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Provider
Enrollment, Chain and Ownership System (PECOS) Security Consent Form;
Use: The primary function of the Medicare enrollment application is to
obtain information about the provider or supplier and whether the
provider or supplier meets Federal and/or State qualifications to
participate in the Medicare program. In addition, the Medicare
enrollment application gathers information regarding the provider or
supplier's practice location, the identity of the owners of the
enrolling organization, and information necessary to establish the
correct claims payment. In establishing a Web based application
process, we allow providers and suppliers the ability to enroll in the
Medicare program via the Internet. For these applicants, no security
consent form is needed to enroll or make a change in their Medicare
enrollment information. These applicants receive complete access to
their own
[[Page 76990]]
enrollments through Internet-based Provider Enrollment, Chain and
Ownership System (PECOS).
In order to allow a provider or supplier to delegate the Medicare
credentialing process to another individual or organization, it is
necessary to establish a Security Consent Form for those providers and
suppliers who choose to have another individual or organization access
their enrollment information and complete enrollments on their behalf.
These users could consist of administrative staff, independent
contractors, or credentialing departments and are represented as
Employer Organizations. Employer Organizations and its members must
request access to enrollment data through a Security Consent Form. The
security consent form replicates business service agreements between
Medicare applicants and organizations providing enrollment services.
We are proposing two different versions of the Security Consent
Form. The form, once signed, mailed and approved, grants an employer
organization or its members access to all current and future enrollment
data for the Medicare provider. Form Number: CMS-10220 (OMB:
0938-1035); Frequency: Occasionally; Affected Public: State, Local, or
Tribal Governments; Number of Respondents: 197,500; Total Annual
Responses: 197,500; Total Annual Hours: 49,375. (For policy questions
regarding this collection contact Alisha Banks at 410-786-0671. For all
other issues call 410-786-1326.)
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 [email protected], 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 February 8, 2011:
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: December 6, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2010-31071 Filed 12-9-10; 8:45 am]
BILLING CODE 4120-01-P