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Respondents: 6,171; Total Annual Responses: 6,171; Total Annual Hours: 4,153,083. (For policy questions regarding this collection contact Nadia Massuda at 410–786–5834.)

8. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Medicare Part D Reporting Requirements; Use: Title I, Part 423, § 423.514 describes our regulatory authority to establish reporting requirements for Part D sponsors. It is noted that each Part D plan sponsor must have an effective procedure to develop, compile, evaluate, and report to us, to its enrollees, and to the general public, at
the times and in the manner that we requires, statistics in the following areas: the cost of its operations; the patterns of utilization of its services; the availability, accessibility, and acceptability of its services; information demonstrating that the Part D plan sponsor has a fiscally sound operation; and other matters that we may require. CMS has identified the appropriate data needed to effectively monitor plan performance. Changes to the currently approved data collection instrument reflect new executive orders, legislation, as well as recent changes to Agency policy and guidance. Form Number: CMS–10185 (OCN: 0938–0992); Frequency: Occasionally; Affected
Public: Business and other for-profits; Number of Respondents: 690; Total Annual Responses: 8,067; Total Annual

Hours: 12,658. (For policy questions regarding this collection contact Latoyia Grant at 410–786–5434.)

9. Type of Information Collection Request: New collection (Request for a new OMB control number); Title of Information Collection: Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges; Use: Section 1311(i) of the Affordable Care Act requires Exchanges to establish a Navigator grant program as part of its function to provide consumers with assistance when they need it. Navigators will assist consumers by providing education about and facilitating selection of qualified health plans (QHPs) within Exchanges, as well as other required duties. Section 1311(i) requires that an Exchange operating as of January 1, 2014, must establish a Navigator Program under which it awards grants to eligible individuals or entities who satisfy the requirements tobe Exchange Navigators. For Federallyfacilitated Exchanges (FFE) and State Partnership Exchanges (SPEs), we will be awarding the grants. Navigatorawardees must provide quarterly, biannual, and an annual progress report to us on the activities performed during the grant period and any sub-awardees receiving funds. The 60-day Federal Register notice was published on April 12, 2013 (78 FR 21957). Several commenters suggested changes to the reporting requirements which were incorporated where appropriate. Form
Number: CMS–10463 (OCN: 0938– NEW); Frequency: Annually, Quarterly; Affected Public: Private sector; Number of Respondents: 264; Total Annual Responses: 1,848; Total Annual Hours: 308,352. (For policy questions regarding this collection contact Holly Whelan at 301–492–4220.)

Dated: July 23, 2013.
Martique Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2013–18004 Filed 7–25–13; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[Document Identifiers: CMS–10326, CMS– 10487, CMS–P–0015A, CMS–R–10, CMS–R–**  **240, CMS–10282, CMS–R–65 and CMS– 10491]** 

**Agency Information Collection Activities: Proposed Collection;**  **Comment Request**

**AGENCY :**  Centers for Medicare & Medicaid Services, HHS.

**ACTION :**  Notice.

**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 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of 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 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.

**DATES :**  Comments must be received by September 24, 2013:

**ADDRESSES :**  When commenting, please
reference the document identifier or OMB control number (OCN). 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, you may make your request using one of following:

1. Access CMS’ Web site address at http://www.cms.hhs.gov/ PaperworkReductionActof1995.

2. Email your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@cms.hhs.gov.

3. Call the Reports Clearance Office at (410) 786–1326.

**FOR FURTHER INFORMATION CONTACT :**  Reports Clearance Office at (410) 786–

1326.

**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–10326 Electronic Submission of

Medicare Graduate Medical Education (GME) Affiliation Agreements CMS–10487 Medicaid Emergency

Psychiatric Demonstration (MEPD)
Evaluation
CMS–P–0015A Medicare Current

Beneficiary Survey CMS–R–10 Advance Directives (Medicare

and Medicaid) and Supporting Regulations


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CMS–R–240 Prospective Payments for

Hospital Outpatient Services and Supporting Regulations CMS–10282 Conditions of Participation for

Comprehensive Outpatient Rehabilitation Facilities (CORFs) and supporting regulations
CMS–R–65 Final Peer Review

Organizations Sanction Regulations in 42 CFR Sections 1004.40, 1004.50, 1004.60,
and 1004.70 CMS–10491 Enrollment Assistance Program

Under the Paperwork Reduction Act (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: Electronic
Submission of Medicare Graduate Medical Education (GME) Affiliation Agreements; Use: We use the
information contained in electronic affiliation agreements as documentation
of the existence of Medicare GME affiliations, and to verify that the affiliations being formed by teaching hospitals for the purposes of sharing
their Medicare Graduate Medical Education FTE cap slots are valid according to CMS regulations. The affiliation agreements are also used as reference materials when potential issues involving specific affiliations

arise. Form Number: CMS–10326 (OCN: 0938–1111); Frequency: Yearly; Affected
Public: Private sector—Business or other for-profits and Not-for-profit institutions; Number of Respondents:

125; Total Annual Responses: 125; Total
Annual Hours: 166. (For policy questions regarding this collection contact Tzvi Hefter at 410–786–0614.)

2. Type of Information Collection Request: New Collection (Request for a new OMBcontrol number); Title of Information Collection: Medicaid Emergency Psychiatric Demonstration (MEPD) Evaluation; Use: Since the inception of Medicaid, inpatient care provided to adults ages 21 to 64 in institutions for mental disease (IMDs)
has been excluded from federal matching funds. The Emergency
Medical Treatment and Active Labor Act (EMTALA), however, requires IMDs that participate in Medicare to provide treatment for psychiatric emergency medical conditions (EMCs), even for Medicaid patients for whose services
cannot be reimbursed. Section 2707 of the Affordable Care Act (ACA) directs the Secretary of Health and Human
Services to conduct and evaluate a demonstration project to determine the impact of providing payment under Medicaid for inpatient services provided by private IMDs to individuals with emergency psychiatric conditions between the ages of 21 and 64. We will
use the data to evaluate the Medicaid Emergency Psychiatric Demonstration (MEPD) in accordance with the ACA
mandates. This evaluation in turn will be used by Congress to determine whether to continue or expand the
demonstration. If the decision is made to expand the demonstration, the data collected will help to inform both CMS and its stakeholders about possible
effects of contextual factors and important procedural issues to consider in the expansion, as well as the
likelihood of various outcomes. Form
Number: CMS–10487 (OCN: 0938– NEW); Frequency: Annually; Affected
Public: Individuals and households; State, Local and Tribal governments;Business and other for-profits and Notfor-profits; Number of Respondents: 93; Total Annual Responses: 1,944; Total
Annual Hours: 2,046. (For policy questions regarding this collection contact Negussie Tilahun at 410–786– 2058.)

3. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Medicare Current Beneficiary Survey; Use: We are the largest single payer of health care in
the United States. With full implementation of the Affordable Care Act of 2010 (ACA), the agency will play a direct or indirect role in administering health insurance coverage for more than 120 million people across the Medicare, Medicaid, CHIP, and Exchange populations. One of our critical aims is to be an effective steward, major force, and trustworthy partner in leading the
transformation of the health care system. We also aim to provide Americans with high quality care and better health at lower costs through improvement. At the forefront of these initiatives is the newly formed Center for Medicare and Medicaid Innovation (CMMI).

CMMI is authorized by Section 1115A of the Social Security Act, as established by section 3021 of the ACA and was established to ‘‘test innovative payment and service delivery models to reduce program expenditures. . .while preserving or enhancing the quality of care furnished’’ to Medicare, Medicaid and CHIP beneficiaries. Implicit across all of CMMI activities is an emphasis on diffusion—finding and validating
innovative models that have the potential to scale, facilitating rapid adoption, and letting them take root in organizations, health systems, and

communities across America.

The Medicare Current Beneficiary Survey (MCBS) is the most comprehensive and complete survey available on the Medicare population and is essential in capturing data not otherwise collected through our operations. The MCBS is an in-person, nationally-representative, longitudinal survey of Medicare beneficiaries that we sponsor and is directed by the Office of
Information Products and Data Analytics (OIPDA) in partnership with the CMMI. The survey captures beneficiary information whether aged or disabled, living in the community or facility, or serviced by managed care or fee-for-service. Data produced as part of
the MCBS are enhanced with our administrative data (e.g. fee-for-service claims, prescription drug event data, enrollment, etc.) to provide users with more accurate and complete estimates of
total health care costs and utilization. The MCBS has been continuously fielded for more than 20 years (encompassing over 1 million interviews), and consists of three annual interviews per survey participant.

The MCBS continues to provide unique insight into the Medicare program and helps both us and our
external stakeholders better understand and evaluate the impact of existing programs and significant new policy initiatives. In the past, MCBS data have been used to assess potential changes to the Medicare program. For example, the MCBS was instrumental in supporting the development and implementation of the Medicare prescription drug benefit by providing a means to evaluateprescription drug costs and out-ofpocket burden for these drugs to
Medicare beneficiaries. Form Number: CMS–P–0015A (OCN: 0938–0568); Frequency: Occasionally; Affected
Public: Business or other for-profits and Not-for-profit institutions; Number of Respondents: 16,550; Total Annual Responses: 49,650; Total Annual Hours: 58,450 (For policy questions regarding


### 45207 Federal Register/ Vol. 78, No. 144 / Friday, July 26, 2013 / Notices

this collection contact William Long at 410–786–7927.)

4. Type of Information Collection Request: Reinstatement with change of a previously approved collection; Title of Information Collection: Advance Directives (Medicare and Medicaid) and Supporting Regulations; Use: The advance directives requirement was enacted because Congress wanted individuals to know that they have a right to make health care decisions and to refuse treatment even when they are unable to communicate. Steps have
been taken at both the federal and state level, to afford greater opportunity for the individual to participate in decisions made concerning the medical treatment to be received by an adult patient in the event that the patient is unable to communicate to others, a preference about medical treatment. The individual may make his preference known through the use of an advance directive, which is a written instruction prepared in advance, such as a living will or durable power of attorney. This
information is documented in a prominent part of the individual’s
medical record. Advance directives as
described in the Patient SelfDetermination Act have increased the
individual’s control over decisions concerning medical treatment. Sections 4206 of the Omnibus Budget
Reconciliation Act of 1990 defined an
advance directive as a written instruction recognized under State law relating to the provision of health care when an individual is incapacitated (those persons unable to communicate their wishes regarding medical treatment).

All states have enacted legislation defining a patient’s right to make decisions regarding medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. Participating hospitals, skilled nursing facilities, nursing facilities, home health agencies, providers of home health care, hospices, religious nonmedical health care institutions, and prepaid or eligible organizations (including Health Care Prepayment Plans (HCPPs) and Medicare Advantage Organizations (MAOs) such as Coordinated Care Plans, Demonstration Projects, Chronic Care Demonstration Projects, Program of All Inclusive Care for the Elderly, Private Fee for Service, and Medical Savings Accounts must provide written information, at explicit time frames, to all adult individuals about: a) the right to accept or refuse medical or surgical treatments; b) the right to formulate an advance directive; c) a description of applicable State law (provided by the State); and d) the provider’s or organization’s policies and procedures for implementing an advance directive.
Form Number: CMS–R–10 (OCN: 0938– 0610); Frequency: Yearly; Affected
Public: Business or other for-profits; Number of Respondents: 39,575; Total Annual Responses: 39, 575; Total
Annual Hours: 2,836,441. (For policy questions regarding this collection contact Sonia Swancy at 410–786– 8445.)

5. Type of Information Collection Request: Extension of a currently approved collection.

Title of Information Collection: Prospective Payments for Hospital Outpatient Services and Supporting Regulations; Use: The Secretary is required to establish a prospective payment system (PPS) for hospital outpatient services. Successful implementation of an outpatient PPS (OPPS) requires that we distinguish facilities or organizations that function as departments of hospitals from those that are freestanding. In this regard, we
will be able to determine: which services should be paid under the OPPS, the clinical laboratory fee schedule, or other payment provisions applicable to services furnished to hospital outpatients. Information from 42 CFR 413.65(b)(3) and (c) reports is needed to
make these determinations. Additionally, hospitals and other providers are authorized to impose deductible and coinsurance charges for facility services, but does not allow such charges by facilities or organizations which are not provider-based. This provision requires that we collect information from the required reports so
it can determine which facilities are provider-based. Form Number: CMS–R– 240 (OCN: 0938–0798). Frequency: Occasionally; Affected Public: Private sector—Business or other for-profits and Not-for-profit institutions; Number of Respondents: 905; Total Annual Responses: 500,405; Total Annual

Hours: 26,563. (For policy questions regarding this collection contact Daniel Schroder at 410–786–7452.)

6. Type of Information Collection Request: Reinstatement with change of a previously approved collection; Title of Information Collection: Conditions of Participation for Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Supporting Regulations;

Use: The Conditions of Participation (CoPs) and accompanying requirements specified in the regulations are used by our surveyors as a basis for determining whether a comprehensive outpatient rehabilitation facility (CORF) qualifies to be awarded a Medicare provider agreement. We believe the health care industry practice demonstrates that the patient clinical records and general content of records are necessary to ensure the well-being and safety of patients and that professional treatment and accountability are a normal part of industry practice. Form Number: CMS– 10282 (OCN: 0938–1091); Frequency: Yearly; Affected Public: Private sector—Business or other for-profit and Not-forprofit institutions; Number of Respondents: 314; Total Annual Responses: 314; Total Annual Hours: 8,076. (For policy questions regarding this collection contact Jacqueline Leach at 410–786–4282.)

7. Type of Information Collection Request: Reinstatement with change of a previously approved collection; Title of Information Collection: Final Peer Review Organizations Sanction Regulations in 42 CFR Sections 1004.40, 1004.50, 1004.60, and 1004.70; Use: The Peer Review Improvement Act of 1982 amended Title XI of the Social Security Act (the Act), creating the Utilization and Quality Control Peer Review Organization Program. Section 1156 of the Act imposes obligations on health care practitioners and others who
furnish or order services or items under Medicare. This section also provides for sanction actions, if the Secretary determines that the obligations as stated by this section are not met. Quality Improvement Organizations (QIOs) are responsible for identifying violations. The QIOs may allow practitioners or other entities, opportunities to submit relevant information before determining
that a violation has occurred. The information collection requirements
contained in this information collection request are used by the QIOs to collect the information necessary to make their
decision. Form Number: CMS–R–65 (OCN: 0938–0444); Frequency: On occasion; Affected Public: Private sector—Business or other for-profit and Not-for-profit institutions; Number of Respondents: 53; Total Annual Responses: 53; Total Annual Hours: 14,310. (For policy questions regarding
this collection contact Coles Mercier at 410–786–2112.)

8. Type of Information Collection Request: New collection (Request for a new OMBcontrol number); Title of Information Collection: Enrollment Assistance Program; Use: As required by the Affordable Care Act, CMS will implement a grant-based Navigator Program to provide support to targeted communities. However, there will also
be a need for broader based enrollment assistance in population centers that weidentify in states with Federallyfacilitated Marketplaces (FFMs) to provide Health Insurance Marketplace


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enrollment assistance to populations not covered or targeted by the Navigator Program. The target populations are
individual consumers and families eligible to enroll in Qualified Health Plans (QHPs) in population centers weidentify. Without such access to inperson enrollment assistance, millions of individuals who will be eligible for health insurance coverage in the Marketplaces might not have access to the direct assistance required to make
educated choices on available healthcare options and may therefore be unable to successfully enroll in the Marketplaces. To monitor program effectiveness, the Enrollment Assistance Program will provide weekly, monthly, quarterly and annual reports to us. Form
Number: CMS–10491 (OCN: 0938– NEW); Frequency: Weekly, Monthly, Quarterly, Yearly; Affected Public: Private Sector; Number of Respondents:

1; Number of Responses: 84; Total
Annual Hours: 554. (For policy questions regarding this collection contact Eliza Bangit at 301–492–4219.)

Dated: July 23, 2013.
Martique Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2013–17985 Filed 7–25–13; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[CMS–2388–N]**

**RIN 0938–AR79**

**Children’s Health Insurance Program (CHIP); Final Allotments to States, the**  **District of Columbia, and U.S.**
**Territories and Commonwealths for**

**Fiscal Year 2013**

**AGENCY :**  Centers for Medicare & Medicaid Services (CMS), HHS.

**ACTION :**  Notice.

**SUMMARY :**  This notice sets forth the final allotments of federal funding available to each State, the District of Columbia, and each U.S. Territory and Commonwealth for fiscal year 2013. Title XXI of the Social Security Act (the Act) authorizes payment of federal matching funds to States, the District of Columbia, and the U.S. Territories and Commonwealths to initiate and expand health insurance coverage to uninsured,
low-income children under the Children’s Health Insurance Program (CHIP). The fiscal year allotments contained in this notice were
determined in accordance with the funding provisions and final regulations published in the February 17, 2011 Federal Register (76 FR 9233).

**DATES :**  This notice is effective on August 26, 2013. Final allotments for fiscal year 2013 may be available for expenditure by states beginning with October 1, 2012.

**FOR FURTHER INFORMATION CONTACT :**  Richard Strauss, (410) 786–2019.

**SUPPLEMENTARY INFORMATION :** 
I. Purpose of This Notice

This notice sets forth the allotments available to each state, the District of Columbia, and each U.S. Territory and Commonwealth for fiscal year (FY) 2013 under title XXI of the Social Security Act (the Act). States may implement the Children’s Health Insurance Program (CHIP) through a separate state program under title XXI of the Act, an expansion of a State Medicaid program under title XIX of the Act, or a combination of both.
CHIP allotments for FY 2009 and subsequent fiscal years are available to match expenditures under an approved state child health plan for 2 fiscal years, including the year for which the allotments were provided. As specified by the Act, the allotments are available to states for FY 2013, and the unexpended amounts of such allotments for a state may be carried over to FY 2014 for use by the state. Federal funds appropriated for title XXI of the Act are limited, and the law specifies a methodology to divide the total fiscal year appropriation into individual allotments available for each state, the District of Columbia, and each U.S. Territory and Commonwealth with an approved child health plan.

Section 2104(b) of the Act requires states, the District of Columbia, and U.S.
Territories and Commonwealths to have an approved child health plan for the fiscal year in order for the Secretary to provide an allotment for that fiscal year. All states, the District of Columbia, and
U.S. Territories and Commonwealths have approved plans for FY 2013. Therefore, the FY 2013 allotments contained in this notice pertain to all states, the District of Columbia, and U.S.
Territories and Commonwealths.

In general, funding is appropriated under section 2104(a) of the Act for purposes of providing allotments to states under CHIP for each fiscal year. Section 2104(a) was amended by section 10203(d)(1) of the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111–148, enacted on March 23, 2010) (the Affordable Care Act) to extend appropriations for funding for CHIP fiscal year allotments through FY 2015.

II. Methodology for Determining CHIP
Fiscal Year Allotments for the 50 States, the District of Columbia, and the
U.S. Territories and Commonwealths

A. Funding Authority for the CHIP
Fiscal Year Allotments

Section 2104(a)(1) through (18) of the Act appropriates federal funds for providing states’ allotments for FYs 2009 through 2015. In particular, the appropriated amounts available for allotments for FYs 2009 through 2015, are as follows: $10,562,000,000 for FY 2009; 12,520,000,000 for FY 2010; $13,459,000,000 for FY 2011; $14,982,000,000 for FY 2012; $17,406,000,000 for FY 2013, $19,147,000,000 for FY 2014; and $2,850,000,000 for each of the first and second half of FY 2015. Also, section
108 of the Children’s Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111–3, enacted on February 4, 2009) (CHIPRA), as amended by section 10203(d) of the Affordable Care Act, provides for a one-time appropriation of $15,361,000,000 for allotments for the first half of FY 2015. Therefore, the total appropriation for providing allotments during FY 2015 is $21,061,000,000 (determined as the sum of $2,850,000,000, $15,361,000,000, and $2,850,000,000).

B. Methodology for Determining State’s
Fiscal Year Allotments

1. General

On September 16, 2009 we published a proposed rule in the Federal Register (74 FR 47517) and on February 17, 2011, we published the final rule in the Federal Register (76 FR 9233) to implement the methodologies and procedures to determine the fiscal year allotments of federal funds as specified under section 2104(m) of the Act for FY 2009 through FY 2015. In general, the States’ fiscal year allotments are provided from the appropriation for the respective fiscal year allotment, subject to a proration adjustment described in
section II.B.7 of this notice.

2. FY 2009 Through FY 2012 CHIP
Allotments

The final methodology is determined in accordance with the September 16,

2009 Federal Register (74 FR 47517)
which contained the FY 2009 CHIP allotments, the February 17, 2011 Federal Register (76 FR 9233) which
contained the FY 2010 and FY 2011 CHIP allotments, and the July 24, 2012 Federal Register (77 FR 43290) which
contained the FY 2012 CHIP allotments.