[Federal Register Volume 76, Number 34 (Friday, February 18, 2011)]
[Notices]
[Pages 9579-9581]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-3748]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-21 and -21B, CMS-37, CMS-64, CMS-10098, CMS-
10106, CMS-10120, CMS-10292, and CMS-10220]
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: Revision 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
[[Page 9580]]
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: Revision 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: Revision 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 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: 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 Web sites 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: 6,033. (For policy questions regarding this
collection contact Mark Broccolino at 410-786-6128. For all other
issues call 410-786-1326.)
5. Type of Information Collection Request: Revision of currently
approved collection; Title of Information Collection: Medicare
Authorization to Disclose Personal Health Information; Use: Unless
permitted or required by law, the Health Insurance Portability and
Accountability Act (HIPAA) prohibits Medicare (a HIPAA covered entity)
from disclosing an individual's protected health information without a
valid authorization. In order to be valid, an authorization must
include specified core elements and statements. Medicare will make
available to Medicare beneficiaries a standard, valid authorization to
enable beneficiaries to request the disclosure of their protected
health information. This standard authorization will simplify the
process of requesting information disclosure for beneficiaries and
minimize the response time for Medicare. The completed authorization
will allow Medicare to disclose an individual's personal health
information to a third party at the individual's request. Form Number:
CMS-10106 (OMB: 0938-0930); Frequency: Reporting--On occasion;
Affected Public: Individuals or households; Number of Respondents:
1,004,000; Total Annual Responses: 1,004,000; Total Annual Hours:
251,000. (For policy questions regarding this collection contact
Lindsay Dixon-Brown at 410-786-1178. For all other issues call 410-786-
1326.)
6. 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 organization (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:
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.)
7. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: State Medicaid
Health Information Technology (HIT) Plan (SMHP) and Model Checklist:
Health Information Technology (HIT) Planning-Advance Planning Document
(HIT P-APD); Use: Section 4201 of
[[Page 9581]]
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 without change
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 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 member's access to all current and future
enrollment data for the Medicare provider. Form Number: CMS-10220
(OMB: 0938-1035); Frequency: Occassionally; 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 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 [email protected], 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 March 21, 2011.
OMB, Office of Information and Regulatory Affairs, Attention: CMS
Desk Officer, Fax Number: (202) 395-6974, E-mail: [email protected].
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-3748 Filed 2-17-11; 8:45 am]
BILLING CODE 4120-01-P