57932 Federal Register / Vol. 79, No. 187 / Friday, September 26, 2014 / Notices 

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 

November 25, 2014. 

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 llll, 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–10142 Bid Pricing Tool (BPT) for 

Medicare Advantage (MA) Plans and 

Prescription Drug Plans (PDP) 

CMS–R–262 CY 2016 Plan Benefit 

Package (PBP) Software and 

Formulary Submission 

Under the 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 Collection 

1. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Bid Pricing Tool 

(BPT) for Medicare Advantage (MA) 

Plans and Prescription Drug Plans 

(PDP); Use: We require that Medicare 

Advantage organizations and 

Prescription Drug Plans complete the 

Bid Pricing Tool (BPT) as part of the 

annual bidding process. During this 

process, organizations prepare their 

proposed actuarial bid pricing for the 

upcoming contract year and submit 

them to us for review and approval. The 

purpose of the BPT is to collect the 

actuarial pricing information for each 

plan. The BPT calculates the plan’s bid, 

enrollee premiums, and payment rates. 

We publish beneficiary premium 

information using a variety of formats 

(www.medicare.gov, the Medicare & You 

handbook, Summary of Benefits 

marketing information) for the purpose 

of beneficiary education and 

enrollment. Form Number: CMS–10142 

(OMB control number 0938–0944); 

Frequency: Yearly; Affected Public: 

Private sector (business or other forprofits and not-for-profit institutions); 

Number of Respondents: 555; Total 

Annual Responses: 4,995; Total Annual 

Hours: 149,850. (For policy questions 

regarding this collection contact Rachel 

Shevland at 410–786–3026). 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: CY 2016 Plan 

Benefit Package (PBP) Software and 

Formulary Submission; Use: We require 

that Medicare Advantage and 

Prescription Drug Plan organizations 

submit a completed PBP and formulary 

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 us for review and 

approval. We publish beneficiary 

education information using a variety of 

formats. The specific education 

initiatives that utilize PBP and 

formulary data include Web application 

tools on www.medicare.gov and the plan 

benefit insert in the Medicare & You 

handbook. In addition, organizations 

utilize the PBP data to generate their 

Summary of Benefits marketing 

information. Form Number: CMS–R–262 

(OMB control number 0938–0763); 

Frequency: Yearly; Affected Public: 

Private sector—Business or other forprofits and Not-for-profit institutions; 

Number of Respondents: 598; Total 

Annual Responses: 5,872; Total Annual 

Hours: 56,411. (For policy questions 

regarding this collection contact Kristy 

Holtje at 410–786–2209). 

Dated: September 23, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–22990 Filed 9–25–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10526 and 

CMS–10477] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

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 

(PRA), federal agencies are required to 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 187 / Friday, September 26, 2014 / Notices 57933 

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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the 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. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by October 27, 2014: 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 OR, Email: 

OIRA_submission@omb.eop.gov. 

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: 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 provide 

information to a third party. Section 

3506(c)(2)(A) of the PRA (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-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 that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Cost Sharing 

Reduction Reconciliation; Use: Under 

established Department of Health and 

Human Services (HHS) regulations, 

qualified health plan (QHP) issuers will 

receive estimated advance payments of 

cost-sharing reductions throughout the 

year. Each issuer will then be subject to 

a reconciliation process at the end of the 

benefit year to ensure that HHS 

reimburses each issuer only for actual 

cost sharing. This proposed collection 

establishes the data elements that a QHP 

issuer would be required to report to 

HHS in order to establish the costsharing reductions provided on behalf 

of enrollees for the benefit year. 

Comments were received and addressed 

in a Response to Comments document. 

Form Number: CMS–10526 (OMB 

control number: 0938–NEW); 

Frequency: Annually; Affected Public: 

Private sector—Business or other forprofits; Number of Respondents: 295; 

Total Annual Responses: 4 million; 

Total Annual Hours: 2,469. (For policy 

questions regarding this collection 

contact Patricia Meisol at 410–786– 

1917.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved information collection; Title 

of Information Collection: Medicaid 

Incentives for Prevention of Chronic 

Disease (MIPCD) Demonstration; Use: 

Under section 4108(d)(1) of the 

Affordable Care Act, we are required to 

contract with an independent entity or 

organization to conduct an evaluation of 

the Medicaid Incentives for Prevention 

of Chronic Disease (MIPCD) 

demonstration. The contractor will 

conduct state site visits, two rounds of 

focus group discussions, interviews 

with key program stakeholders, and 

field a beneficiary satisfaction survey. 

Both the state site visits and interviews 

with key program stakeholders will 

entail one-on-one interviews; however 

each set will have a unique data 

collection form. Thus, each evaluation 

task listed above has a separate data 

collection form and this proposed 

information collection encompasses six 

data collection forms. The purpose of 

the evaluation and assessment includes 

determining the following: 

• The effect of such initiatives on the 

use of health care services by Medicaid 

beneficiaries participating in the 

program; 

• The extent to which special 

populations (including adults with 

disabilities, adults with chronic 

illnesses, and children with special 

health care needs) are able to participate 

in the program; 

• The level of satisfaction of 

Medicaid beneficiaries with respect to 

the accessibility and quality of health 

care services provided through the 

program; and 

• The administrative costs incurred 

by state agencies that are responsible for 

administration of the program. 

Subsequent to the initial OMB 

approval issued January 23, 2014, we 

have added two Administrative Cost 

forms to the information collection. The 

burden estimates for this information 

collection have been revised to account 

for the burden associated with the new 

forms. Form Number: CMS–10477 

(OMB control number: 0938–1219); 

Frequency: Annually; Affected Public: 

Individuals and Households, Private 

sector—Business or other for-profits and 

Not-for-profit institutions, State, Local 

or Tribal Governments; Number of 

Respondents: 4,706; Total Annual 

Responses: 4,706; Total Annual Hours: 

2,236. (For policy questions regarding 

this collection contact Jean Scott at 410– 

786–6327.) 

Dated: September 23, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–22980 Filed 9–25–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4175–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2015 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

annual adjustment in the amount in 

controversy (AIC) threshold amounts for 

Administrative Law Judge (ALJ) 

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