Federal Register / Vol. 76, No. 242 / Friday, December 16, 2011 / Notices 78265 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, 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 14, 2012: 

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 9, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–32296 Filed 12–15–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10412] 

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: New collection; Title of 

Information Collection: Section 1115 

Demonstration: Long Term Services and 

Supports (LTSS) and Other Service 

Models for Individuals with Disabilities 

and Chronic Conditions; Use: Section 

1115 of the Social Security Act provides 

the Secretary of Health and Human 

Services broad authority to authorize 

experimental, pilot, or demonstration 

projects likely to assist in promoting the 

objectives of the Medicaid statute. 

Flexibility under Section 1115 is 

sufficiently broad to allow States to test 

substantially new ideas of policy merit. 

States seeking interventions for 

individuals needing LTSS to lower 

costs, improve care and improve health 

can utilize the 1115 demonstration to 

test and deliver innovative services and 

approaches to better and more 

efficiently meet the needs of this 

population. Section 1115 

demonstrations provide a vehicle for 

innovations in both care delivery and 

payment methodologies. 

Demonstrations must be ‘‘budget 

neutral’’ over the life of the project, 

meaning they cannot be expected to cost 

the Federal government more than it 

would cost without the waiver. State 

Medicaid agencies are responsible for 

developing section 1115 demonstration 

applications and submitting them to 

CMS; Form Number: CMS–10412 (OCN: 

0938–New); Frequency: Once; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 56; Total 

Annual Hours: 2,240. (For policy 

questions regarding this collection 

contact Adrienne Delozer at (410) 786– 

0278. 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 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, 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 January 17, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: December 9, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–32294 Filed 12–15–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10180, CMS–R– 

199, CMS–10379 and CMS–10418] 

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 of a currently 

approved collection; Title of 

Information Collection: Children’s 

Health Insurance Program (CHIP) Report 

on Payables and Receivables; Use: 

Collection of CHIP data and the 

calculation of the CHIP Incurred But 

Not Reported (IBNR) estimate are 

pertinent to CMS’ financial audit. The 

CFO auditors have reported the lack of 

an estimate for CHIP IBNR payables and 

receivables as a reportable condition in 

the FY 2005 audit of CMS’s financial 

statements. It is essential that CMS 


jlentini on DSK4TPTVN1PROD with NOTICES
78266 Federal Register / Vol. 76, No. 242 / Friday, December 16, 2011 / Notices 

collect the necessary data from State 

agencies in FY 2006, so that CMS 

continues to receive an unqualified 

audit opinion on its financial 

statements. Program expenditures for 

the CHIP have increased since its 

inception; as such, CHIP receivables and 

payables may materially impact the 

financial statements. The CHIP Report 

on Payables and Receivables will 

provide the information needed to 

calculate the CHIP IBNR. Form Number: 

CMS–10180 (OMB#: 0938–0988); 

Frequency: Reporting—Annually; 

Affected Public: State, Local or Tribal 

governments; Number of Respondents: 

56; Total Annual Responses: 56; Total 

Annual Hours: 392. (For policy 

questions regarding this collection 

contact Michele Myers at (410) 786– 

7911. For all other issues call (410) 786– 

1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid Report 

on Payables and Receivables; Use: The 

Chief Financial Officers (CFO) Act of 

1990, as amended by the Government 

Management Reform Act (GMRA) of 

1994, requires government agencies to 

produce auditable financial statements. 

Because the Centers for Medicare & 

Medicaid Services (CMS) fulfills its 

mission through its contractors and the 

States; these entities are the primary 

source of information for the financial 

statements. There are three basic 

categories of data: expenses, payables, 

and receivables. The CMS–64 is used to 

collect data on Medicaid expenses. The 

CMS–R–199 collects Medicaid payable 

and receivable accounting data from the 

States. Form Number: CMS–R–199 

(OMB#: 0938–0697); Frequency: 

Reporting—Annually; Affected Public: 

State, Local or Tribal governments; 

Number of Respondents: 56; Total 

Annual Responses: 56; Total Annual 

Hours: 336. (For policy questions 

regarding this collection contact 

Michele Myers at (410) 786–7911. For 

all other issues call (410) 786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Rate Increase 

Disclosure and Review Reporting 

Requirements (45 CFR Part 154). Use: 

Under the Section 1003 of the 

Affordable Care Act (Section 2794 of the 

Public Health Service Act), The 

Secretary, in conjunction with the 

States, is required to establish a process 

for the annual review, beginning with 

the 2010 plan year, of unreasonable 

increases in premiums for health 

insurance coverage. Section 2794 directs 

the Secretary to ensure the public 

disclosure of information of 

unreasonable rate increases and 

justification for those increases. 

On December 23, 2010, CMS 

published a proposed rate review 

regulation in the Federal Register for 

public comment (Rate Increase 

Disclosure and Review Rule, 75 FR 

81004). CMS revised the proposed rule 

based on the public comments and 

published the final rate review 

regulation in the Federal Register on 

May 19, 2011. The final rule defines the 

unreasonable rate review process and 

issuer reporting and disclosure 

requirements (Rate Increase Disclosure 

and Review Rule, 76 FR 29964). The 

regulation establishes the following 

reporting requirements: 

• The Preliminary Justification: This 

data collection is required of all health 

insurance issuers for all rate increases 

that exceed the ‘‘subject to review’’’ 

reporting threshold as defined in the 

rule. This information will be posted on 

an HHS Web site. 

• Rate Review Final Determination: 

This data collection requires States with 

effective rate review programs and CMS 

to report their review findings and 

unreasonable rate increase 

determinations on all rate increases that 

are subject to review. This information 

will be posted on an HHS Web site. 

• The Final Justification for an 

Unreasonable Rate Increase: This data 

collection is required of health 

insurance issuers that elect to 

implement a rate increase that is 

determined to be unreasonable based on 

State or CMS review. This information 

will be posted on the Health Insurance 

Issuer’s Web site and on a CMS Web 

site. 

1. Preliminary Justification 

The Preliminary Justification consists 

of three parts, Part I: Rate Increase 

Summary, Part II: Written Explanation 

of the Rate Increase, and Part III: Rate 

Filing Documentation. Issuers must 

complete Parts I and II for all rate 

increases that exceed the reporting 

threshold as defined in the rule. As 

described in the preamble of the rule, 

this information would be collected to 

provide consumers with basic 

information on all rate increases that are 

subject to review under the rate review 

program. 

Under the rule, ‘‘subject to review’’ 

rate increases would be reviewed by 

either States or CMS, depending on 

whether a State has an effective rate 

review program. Issuers would only be 

required to submit Part III of the 

Preliminary Justification when CMS is 

conducting the review of a rate increase 

that is ‘‘subject to review.’’ Accordingly, 

Part III requires health insurance issuers 

to provide detailed rate data that would 

be used for the purposes of conducting 

thorough actuarial reviews and for 

making determinations about whether 

rate increases are unreasonable. 

This Notice contains the following 

information about the Preliminary 

Justification: 

• Preliminary Justification Issuer 

Instructions: health insurance issuer 

instructions for completing all three 

parts of the Preliminary Justification. 

• Part I Worksheet: a standardized 

Excel worksheet that must be used to 

complete Part I of the Preliminary 

Justification. 

• Sample Internet display of the Rate 

Review Consumer Disclosure: 

Information provided in the Preliminary 

Justification would be posted on an 

HHS Web site. This sample display 

shows how the information contained in 

the Part I Worksheet would be displayed 

to consumers. 

2. Rate Review Final Determination 

Under the rule, States and CMS 

would have to provide a Rate Review 

Final Determination at the close of their 

review of all ‘‘subject to review’’ rate 

increases. The Rate Review Final 

Determination must provide the State’s 

or CMS’ determination on whether a 

rate increase is ‘‘unreasonable.’’ Section 

154.301(a)(3) of the rule provides a list 

of actuarial review elements that must 

be taken into account as part of the rate 

review process. The Final 

Determination must provide a brief 

statement explaining how the review of 

elements set forth in § 154.301(a)(3) 

caused the State or CMS to arrive at its 

determination that the rate is 

unreasonable. 

The Rate Review Final Determination 

will be entered into a data entry text box 

in the Rate Review Data Collection 

System. CMS is estimating that this 

statement would be approximately a 

paragraph in length. There is no specific 

form or set of instructions associated 

with this reporting requirement, apart 

from the reporting requirements 

provided in the rule. The information 

provided in the Rate Review Final 

Determination will be posted as part of 

the rate review consumer disclosure 

information on an HHS Web site. 

3. Final Justification for an 

Unreasonable Rate Increase 

The rule states that if a health 

insurance issuer implements a rate 

increase determined by CMS or a State 

to be unreasonable, the health insurance 

issuer must provide a Final Justification 

for an Unreasonable Rate Increase. In 

the Final Justification, issuers would 


jlentini on DSK4TPTVN1PROD with NOTICES
Federal Register / Vol. 76, No. 242 / Friday, December 16, 2011 / Notices 78267 

have to provide a short statement about 

why they are electing to implement an 

unreasonable rate increase. This 

statement would be entered into a data 

entry text box in the Rate Review Data 

Collection System and would not need 

to be more than a paragraph or two in 

length. There is no form or instructions 

associated with this statement apart 

from the requirements provided in the 

regulation. 

The Final Justification Statement will 

be posted on an HHS Web site in the 

same location as the Preliminary 

Justification and Rate Review Final 

Determination. Additionally, health 

insurance issuers implementing rate 

increases that were determined to be 

unreasonable, must post all of this 

information—the Preliminary 

Justification, the Rate Review Final 

Determination, and the Final 

Justification Statement on their Web 

sites for a period of 3 years. 

In addition to the aforementioned 

requirements, we revised the 

information collection request as a 

result of an amendment to the 

regulation discussed in the final rule 

that published September 6, 2011 (76 

FR 54969). The amendment to the rate 

review final rule updated the 

applicability of the rate review 

requirements to include products that 

would be considered part of the 

individual or small group market had 

they not been sold through associations, 

including those that are consider to be 

large group products under State law or 

have been otherwise excluded from 

State’s existing definitions for 

individual and small group products. 

This change resulted in an increase in 

the total number of rate increases that 

are subject to the rate review reporting 

requirements. The amendment did not 

propose any changes to the information 

that issuers must submit for each rate 

increase. Thus, burden associated with 

each rate increase submission remains 

unchanged from the final rate review 

rule. The revised association product 

reporting requirements took effect on 

November 1, 2011. CMS received a 6 

month Emergency PRA approval for the 

revised association reporting 

requirements on October 31, 2011 

(OMB–0938–1141). CMS is now 

requesting a 3-year OMB approval of 

these collection requirements. Form 

Number: CMS–10379 (OCN: 0938– 

1141); Frequency: Annually; Affected 

Public: Private Sector and States; 

Number of Respondents: 452; Number 

of Responses: 3,571; Total Annual 

Hours: 14,630. (For policy questions 

regarding this collection, contact Sally 

McCarty at (301) 492–4489. For all other 

issues call (410) 786–1326.) 

4. Type of Information Collection 

Request: New information collection; 

Title of Information Collection: Medical 

Loss Ratio Annual Reporting and Rebate 

Calculation; Use: Under Section 2718 of 

the Affordable Care Act and 

implementing regulations at 45 CFR Part 

158 (75 FR 74864, December 1, 2010 

(Interim Final Rule); 75 FR 82277, 

December 30, 2010 (Technical 

Correction); and 76 FR 76574, December 

7, 2011 (Final Rule with comment 

period)), a health insurance issuer 

(issuer) offering group or individual 

health insurance coverage must submit 

a report to the Secretary concerning the 

amount the issuer spends each year on 

claims, quality improvement expenses, 

non-claims costs, Federal and State 

taxes and licensing and regulatory fees, 

and the amount of earned premium. An 

issuer must provide an annual rebate to 

enrollees if the amount it spends on 

certain costs compared to its premium 

revenue (excluding Federal and States 

taxes and licensing and regulatory fees) 

does not meet a certain ratio, referred to 

as the medical loss ratio (MLR). An 

interim final rule (IFR) implementing 

the MLR was published on December 1, 

2010 (75 FR 74865) and modified by 

technical corrections on December 30, 

2010 (75 FR 82277), which added Part 

158 to Title 45 of the Code of Federal 

Regulations. The IFR is effective January 

1, 2011. A final rule regarding selected 

provisions of the interim final rule was 

published on December 7, 2011 (76 FR 

76574) and an interim final rule 

regarding an issue not included in 

issuers’ reporting requirements 

(distribution of rebates by non-federal 

governmental plans) was also published 

on December 7, 2011 (76 FR 76596). 

Each issuer is required to submit MLR 

data annually, including information 

about any rebates it must provide, on a 

form prescribed by CMS for each large 

group market, small group market, and 

individual market within each State in 

which the issuer conducts business. 

Data is to be submitted electronically 

through CMS’ Health Insurance 

Oversight System (HIOS). Additionally, 

each issuer is required to maintain for 

a period of seven years all documents, 

records and other evidence that support 

the data included in each issuer’s 

annual report to the Secretary. Form 

Number: CMS–10418; Frequency: 

Annually; Affected Public: Private 

Sector: Business or other for-profits and 

not-for-profit institutions; Number of 

Respondents: 527; Number of 

Responses: 5,530; Total Annual Hours: 

352,563. (For policy questions regarding 

this collection, contact Carol Jimenez at 

(301) 492–4457. 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 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, 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 14, 2012: 

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 llll, Room C4–26– 

05, 7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: December 13, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–32290 Filed 12–15–11; 8:45 a.m.] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9068–N] 

Medicare and Medicaid Programs; 

Quarterly Listing of Program 

Issuances—July Through September 

2011 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This quarterly notice lists 

CMS manual instructions, substantive 

and interpretive regulations, and other 

Federal Register notices that were 

published from July through September 

2011, relating to the Medicare and 


jlentini on DSK4TPTVN1PROD with NOTICES