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[Federal Register Volume 78, Number 110 (Friday, June 7, 2013)]
[Notices]
[Pages 34387-34390]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-13578]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-8003, CMS-10166, CMS-10184, CMS-10219, CMS-
10242, CMS-2744, CMS-3070, CMS-10336, CMS-10220 and CMS-10175]

Agency Information Collection Activities; Proposed Collection; 
Comment Request

ACTION: Notice.

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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 (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 August 6, 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: This notice sets out a summary of the use 
and burden associated with the following information collections:
CMS-8003--1915(c) Home and Community Based Services (HCBS) Waiver
CMS-10166--Payment Error Rate Measurement in Medicaid & Children's 
Health Insurance Program (CHIP)
CMS-10184--Eligibility Error Rate Measurement in Medicaid and the 
Children's Health Insurance Program
CMS-10219--Healthcare Effectiveness Data and Information Set 
(HEDIS[supreg]) Data Collection for Medicare Advantage
CMS-10242--Emergency and Non-Emergency Ambulance Transports and 
Beneficiary Signature Requirements in 42 CFR 424.36(b)
CMS-2744--End Stage Renal Disease (ESRD) Medical Information Facility 
Survey
CMS-3070--Intermediate Care Facility (ICF) for the Mentally Retarded 
(MR) or Persons with Related Conditions Survey Report Form
CMS-10336--Medicare and Medicaid Programs: Electronic Health Record 
Incentive Program
CMS-10220--Security Consent and Surrogate Authorization Form
CMS-10175--Certification Statement for Electronic File Interchange 
Organizations
    More detailed information can be found in each collection's 
supporting statement and associated materials (see ADDRESSES).
    Under the Paperwork Reduction Act of 1995 (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

[[Page 34388]]

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.

Proposed Information Collections

    1. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: 1915(c) Home and Community Based Services (HCBS) Waiver; 
Use: The web-based application will be used by CMS to review and 
adjudicate individual waiver actions. The web-based application will 
also be used by states to submit and revise their waiver requests. Form 
Number: CMS-8003 (OCN: 0938-0449). Frequency: Yearly. Affected Public: 
State, Local, or Tribal Governments. Number of Respondents: 47. Total 
Annual Responses: 71. Total Annual Hours: 6,005. (For policy questions 
regarding this collection contact Kathy Poisal at 410-786-5940. For all 
other issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement of a 
previously approved collection; Title of Information Collection: 
Payment Error Rate Measurement in Medicaid & Children's Health 
Insurance Program (CHIP); Use: The Improper Payments Information Act 
(IPIA) of 2002 as amended by the Improper Payments Elimination and 
Recovery Improvement Act (IPERIA) of 2012 requires CMS to produce 
national error rates for Medicaid and Children's Health Insurance 
Program (CHIP). To comply with the IPIA, we will engage a federal 
contractor to produce the error rates in Medicaid and CHIP. The error 
rates for Medicaid and CHIP are calculated based on the reviews on 
three components of both Medicaid and CHIP program. They are: Fee-for-
service claims medical reviews and data processing reviews, managed 
care claims data-processing reviews, and eligibility reviews. Each of 
the review components collects different types of information, and the 
state-specific error rates for each of the review components will be 
used to calculate an overall state-specific error rate, and the 
individual state-specific error rates will be used to produce a 
national error rate for Medicaid and CHIP. The states will be requested 
to submit, at their option, test data which include full claims details 
to the contractor prior to the quarterly submissions to detect 
potential problems in the dataset to and ensure the quality of the 
data. These states will be required to submit quarterly claims data to 
the contractor who will pull a statistically valid random sample, each 
quarter, by strata, so that medical and data processing reviews can be 
performed. State-specific error rates will be based on these review 
results. We need to collect the fee-for-service claims data, medical 
policies, and other information from states as well as medical records 
from providers in order for the contractor to sample and review 
adjudicated claims in those states selected for medical reviews and 
data processing reviews. Based on the reviews, state-specific error 
rates will be calculated which will serve as part of the basis for 
calculating national Medicaid and CHIP error rates. Form Number: CMS-
10166 (OCN: 0938-0974); Frequency: Yearly, Quarterly; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 34; Total 
Annual Responses: 1650; Total Annual Hours: 56,100. (For policy 
questions regarding this collection contact Monetha Dockery at 410-786-
0155. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Reinstatement with a 
change of a previously approved collection; Title of Information 
Collection: Eligibility Error Rate Measurement in Medicaid and the 
Children's Health Insurance Program; Use: The Improper Payments 
Information Act (IPIA) of 2002 requires us to produce national error 
rates for Medicaid and the Children's Health Insurance Program (CHIP). 
To comply with the IPIA, we will use a national contracting strategy to 
produce error rates for Medicaid and CHIP fee-for-service and managed 
care improper payments. The federal contractor will review states on a 
rotational basis so that each state will be measured for improper 
payments, in each program, once and only once every three years.
    Subsequent to the first publication, we determined that we will 
measure Medicaid and CHIP in the same state. Therefore, states will 
measure Medicaid and CHIP eligibility in the same year measured for 
fee-for-service and managed care. We believe this approach will 
advantage states through economies of scale (e.g. administrative ease 
and shared staffing for both programs reviews). We also determined that 
interim case completion timeframes and reporting are critical to the 
integrity of the reviews and to keep the reviews on schedule to produce 
a timely error rate. Lastly, the sample sizes were increased slightly 
in order to produce an equal sample size per strata each month. Each 
month states submit a monthly sample selection list, eligibility review 
findings for active and negative cases and claims review findings. At 
the end of the cycle, states would have submitted 48 forms. We are 
submitting a new instrument in which we compile all of the information 
from the 48 forms into a format that will allow states to submit 12 
forms for 12 months of eligibility data. This form will also serve 
either of the data substitution options. Periodically, we will conduct 
federal re-reviews of states' PERM files to ensure the accuracy of 
states' review findings and the validity of the review process. We will 
select a random subsample of Medicaid and CHIP cases from the sample 
selection lists provided by each state. States will submit all 
pertinent information related to the review of each sampled case that 
we select. Form Number: CMS-10184 (OCN: 0938-1012); Frequency: Yearly, 
Quarterly Affected Public: State, Local, or Tribal Governments; Number 
of Respondents: 34; Total Annual Responses: 120; Total Annual Hours: 
15,755. (For policy questions regarding this collection contact Monetha 
Dockery at 410-786-0155. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection. Title of Information Collection: Healthcare 
Effectiveness Data and Information Set (HEDIS[supreg]) Data Collection 
for Medicare Advantage; Use: The data is used by CMS to: monitor 
Medicare Advantage organization performance, inform audit strategies, 
and inform beneficiary choice through their display in CMS' consumer-
oriented public compare tools and Web sites. Medicare Advantage 
organizations use the data for quality assessment and as part of their 
quality improvement programs and activities. Quality Improvement 
Organizations and CMS contractors use HEDIS[supreg] data in conjunction 
with their statutory authority to improve quality of care, and 
consumers who are making informed health care choices. In addition, we 
make health plan level HEDIS[supreg] data available to researchers and 
others as public use files at www.cms.hhs.gov. Form Number: CMS-10219 
(OCN: 0938-1028). Frequency: Yearly. Affected Public: Private sector 
(business or other for-profit and not-for-profit institutions); Number 
of Respondents: 576. Total Annual Responses: 576. Total Annual Hours: 
184,320. (For policy questions regarding this collection contact Lori 
Teichman at 410-786-6684. For all other issues call 410-786-1326.)

[[Page 34389]]

    5. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Emergency and Non-Emergency Ambulance Transports and 
Beneficiary Signature Requirements in 42 CFR 424.36(b); Use: Ambulance 
providers and suppliers are the primary information users. 
Specifically, when ambulance providers and suppliers sign claims on 
behalf of beneficiaries they are required by Sec.  424.36(b)(6) to keep 
certain documentation in their files for at least four years from the 
date of service. The purpose of this information collection is to 
document emergency and nonemergency ambulance transports where the 
beneficiary was incapable of signing the claim and the ambulance 
provider or supplier signed the claim on the beneficiary's behalf. The 
information may also be used by: (1) Our Part A and Part B Medicare 
Administrative Contractors that process and pay ambulance claims; (2) 
our staff who review and audit claims for medical necessity; (3) our 
staff who review claims for overpayments; and (4) by others who 
investigate ambulance billing practices to ensure compliance under the 
False Claims Act and anti-kickback statute. Therefore, besides 
ambulance providers and suppliers, the information collected may be 
used by CMS, the Office of the General Counsel, the Office of the 
Inspector General, the Department of Justice, and the Federal Bureau of 
Investigations. Form Number: CMS-10242 (OCN: 0938-1049). Frequency: 
Occasionally. Affected Public: Private sector (business or other for-
profit and not-for-profit institutions). Number of Respondents: 11,564. 
Total Annual Responses: 15,633,781. Total Annual Hours: 1,303,857. (For 
policy questions regarding this collection contact David Walczak at 
410-786-4475. For all other issues call 410-786-1326.)
    6. Type of Information Collection Request: Revision of a previously 
approved collection; Title of Information Collection: End Stage Renal 
Disease (ESRD) Medical Information Facility Survey; Use: The End Stage 
Renal Disease (ESRD) Medical Information Facility Survey form (CMS-
2744) is completed annually by Medicare-approved providers of dialysis 
and transplant services. The CMS-2744 is designed to collect 
information concerning treatment trends, utilization of services and 
patterns of practice in treating ESRD patients. The information is used 
to assess and evaluate the local, regional and national levels of 
medical and social impact of ESRD care and is used extensively by 
researchers and suppliers of services for trend analysis. The 
information is available on the CMS Dialysis Facility Compare Web site 
and will enable patients to make informed decisions about their care by 
comparing dialysis facilities in their area. Form Number: CMS-2744 
(OCN: 0938-0447); Frequency: Yearly; Affected Public: Business or other 
for-profit, Not-for-profit institutions; Number of Respondents: 5,964; 
Total Annual Responses: 5,964; Total Annual Hours: 47,712. (For policy 
questions regarding this collection contact Michelle Tucker at 410-786-
0736. For all other issues call 410-786-1326.)
    7. Type of Information Collection Request: Reinstatement with 
change of a currently approved collection; Title of Information 
Collection: Intermediate Care Facility (ICF) for the Mentally Retarded 
(MR) or Persons with Related Conditions Survey Report Form; Use: This 
survey form is needed to ensure intermediate care facility (ICF) for 
the mentally retarded (MR) provider and client characteristics are 
available and updated annually for the federal government's Online 
Survey Certification and Reporting (OSCAR) system. It is required for 
the provider to fill out at the time of the annual recertification or 
initial certification survey conducted by the state Medicaid agency. 
The team leader for the state survey team must review and approve the 
completed form before completion of the survey. The state Medicaid 
survey agency is responsible for transferring the 3070 information into 
OSCAR. Form Number: CMS-3070 (OCN: 0938-0062); Frequency: Reporting--
Yearly; Affected Public: Private Sector: Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 6,446; Total 
Annual Responses: 6,446; Total Annual Hours: 19,388. (For policy 
questions regarding this collection contact Adrienne Rogers at 410-786-
3411. For all other issues call 410-786-1326.)
    8. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Medicare and Medicaid Programs: Electronic Health Record 
Incentive Program; Use: The American Recovery and Reinvestment Act of 
2009 (Recovery Act) (Pub. L. 111-5) was enacted on February 17, 2009. 
The Recovery Act includes many measures to modernize our nation's 
infrastructure, and improve affordable health care. Expanded use of 
health information technology (HIT) and certified electronic health 
record (EHR) technology will improve the quality and value of America's 
health care. Title IV of Division B of the Recovery Act amends Titles 
XVIII and XIX of the Social Security Act (the Act) by establishing 
incentive payments to eligible professionals (EPs), eligible hospitals 
and critical access hospitals (CAHs), and Medicare Advantage (MA) 
organizations participating in the Medicare and Medicaid programs that 
adopt and successfully demonstrate meaningful use of certified EHR 
technology. These Recovery Act provisions, together with Title XIII of 
Division A of the Recovery Act, may be cited as the ``Health 
Information Technology for Economic and Clinical Health Act'' or the 
``HITECH Act.''
    The HITECH Act creates incentive programs for EPs and eligible 
hospitals, including CAHs, in the Medicare Fee-for-Service (FFS), MA, 
and Medicaid programs that successfully demonstrate meaningful use of 
certified EHR technology. In their first payment year, Medicaid EPs and 
eligible hospitals may adopt, implement or upgrade to certified EHR 
technology. It also, provides for payment adjustments in the Medicare 
FFS and MA programs starting in FY 2015 for EPs and eligible hospitals 
participating in Medicare that are not meaningful users of certified 
EHR technology. These payment adjustments do not pertain to Medicaid 
providers.
    The first final rule for the Medicare and Medicaid EHR Incentive 
Program, which was published in the Federal Register on July 28, 2010 
(CMS-0033-F), specified the initial criteria EPs, eligible hospitals 
and CAHs, and MA organizations must meet in order to qualify for 
incentive payments; calculation of incentive payment amounts; payment 
adjustments under Medicare for covered professional services and 
inpatient hospital services provided by EPs, eligible hospitals and 
CAHs failing to demonstrate meaningful use of certified EHR technology 
beginning in 2015; and other program participation requirements. On the 
same date, the Office of the National Coordinator of Health Information 
Technology (ONC) issued a closely related final rule (45 CFR part 170, 
RIN 0991-AB58) that specified the initial set of standards, 
implementation specifications, and certification criteria for certified 
EHR technology. ONC has also issued a separate final rule on the 
establishment of certification programs for health information 
technology (HIT) (45 CFR part 170, RIN 0991-AB59). The functionality of 
certified EHR technology should facilitate the implementation of 
meaningful use. Subsequently, final rules have been issued by CMS (77 
FR 53968) and ONC (77 FR 72985) to create a Stage 2 of meaningful use 
criteria and other

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changes to the CMS EHR Incentive Programs and the 2014 Edition 
Certification Criteria for EHR technology.
    The information collection requirements contained in this 
information collection request are needed to implement the HITECH Act. 
In order to avoid duplicate payments, all EPs are enumerated through 
their National Provider Identifier (NPI), while all eligible hospitals 
and CAHs are enumerated through their CMS Certification Number (CCN). 
State Medicaid agencies and CMS use the provider's tax identification 
number and NPI or CCN combination in order to make payment, validate 
payment eligibility and detect and prevent duplicate payments for EPs, 
eligible hospitals and CAHs. Form Number: CMS-10336 (OCN: 0938-1158). 
Frequency: Occasionally; Affected Public: Private sector. Number of 
Respondents: 214, 694; Total Annual Responses: 214,694. Total Annual 
Hours: 2,034,740.16. (For policy questions regarding this collection 
contact Travis Broome at 214-767-4450. For all other issues call 410-
786-1326.)
    9. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Security Consent and Surrogate Authorization Form; Use: The 
primary function of the Medicare enrollment application is to obtain 
information about the Provider or supplier and whether they meet the 
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.
    Enrollees have the option of submitting either a CMS 855 form, or 
submitting information via a web based process. In establishing a web 
based application process, we allow providers and suppliers the ability 
to enroll in the Medicare program, revalidate their enrollment and make 
changes to their enrollment information via Internet-based Provider 
Enrollment, Chain and Ownership System (PECOS). Individual providers/
suppliers (hereinafter referred to as ``Individual Providers'') log 
into Internet-based PECOS using their User IDs and passwords 
established when they applied on-line to the National Plan and Provider 
Enumeration System (NPPES) for their National Provider Identifiers 
(NPIs). Authorized Officials (AOs) of the provider or supplier 
organizations (hereinafter referred to as ``Organizational Providers'') 
must register for a user account and authenticate their identity and 
connection to the organization they represent before being able to log 
into Internet-based PECOS. Once authenticated, AOs for Organizational 
Providers, receive complete access to their enrollment information via 
Internet-based PECOS. Individuals and AOs of Organizational Providers 
are not required to submit a Security Consent and Surrogate 
Authorization Form to enroll, revalidate or make changes to their 
Medicare enrollment information.
    Individual and Organizational Providers may complete their Medicare 
enrollment responsibilities on their own or elect to delegate this task 
to a Surrogate. A Surrogate is an individual or organization identified 
by an Individual or Organizational Provider as someone authorized to 
access CMS computer systems, such as Internet-based PECOS, National 
Provider Plan and Enumeration System (NPPES) and the Medicare and 
Medicaid Electronic Health Records (EHR) Incentive Program Registration 
and Attestation System (HITECH), on their behalf and to modify or view 
any information contained therein that the Individual or Organizational 
Provider may have permission or right to access in accordance with 
Medicare statutes, regulations, policies, and usage guidelines for any 
CMS system. Surrogates may consist of administrative staff, independent 
contractors, 3rd party consulting companies or credentialing 
departments. In order for an Individual or Organizational Provider to 
delegate the Medicare credentialing process to a Surrogate to access 
and update their enrollment information in the above mentioned CMS 
systems on their behalf, it is required that a Security Consent and 
Surrogate Authorization Form be completed, or Individual and 
Organizational Providers use an equivalent online process via the PECOS 
Identity and Access Management (I&A) system. The Security Consent and 
Surrogate Authorization form replicates business service agreements 
between Medicare providers, suppliers or both and Surrogates providing 
enrollment services.
    We are proposing one version of the Security Consent and Surrogate 
Authorization Form. The form, once signed, mailed and approved, grants 
a Surrogate access to all current and future enrollment data for the 
Individual or Organization Provider. Form Number: CMS-10220 (OCN: 0938-
1035). Frequency: Occasionlly. Affected Public: Individuals and Private 
Sector; Number of Respondents: 88,650; Total Annual Responses: 88,650; 
Total Annual Hours: 22,162. (For policy questions regarding this 
collection contact Alisha Banks at 410-786-0671. For all other issues 
call 410-786-1326.)
    10. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Certification Statement for Electronic File Interchange 
Organizations; 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 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 us. Form Number: CMS-10175 (OCN: 0938-0984). Frequency: 
Occasionally. Affected Public: Private Sector; Number of Respondents: 
25; Total Annual Responses: 25; Total Annual Hours: 75. (For policy 
questions regarding this collection contact Leslie Jones at 410-786-
6599. For all other issues call 410-786-1326.)

    Dated: June 4, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-13578 Filed 6-6-13; 8:45 am]
BILLING CODE 4120-01-P
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