50060 Federal Register / Vol. 78, No. 159 / Friday, August 16, 2013 / Notices 

Information Collection: Evaluation of 

the Multi-Payer Advanced Primary Care 

Practice (MAPCP) Demonstration Focus 

Group Protocols; Use: On September 16, 

2009, the Department of Health and 

Human Services announced the 

establishment of the Multi-payer 

Advanced Primary Care Practice 

(MAPCP) Demonstration, under which 

Medicare joined Medicaid and private 

insurers as a payer participant in statesponsored patient-centered medical 

home (PCMH) initiatives. We selected 

eight states to participate in this 

demonstration: Maine, Vermont, Rhode 

Island, New York, Pennsylvania, North 

Carolina, Michigan, and Minnesota. We 

are proposing to conduct in-person 

focus groups with Medicare and 

Medicaid beneficiaries and their 

caregivers to more thoroughly 

understand patients’ experiences with 

their PCMHs and how well their PCMHs 

are serving their needs. 

The focus groups will provide us with 

answers to fundamental ‘‘what, how, 

and why’’ questions about beneficiaries’ 

experiences with care and access to and 

coordination of care. We will use the 

information obtained via in-person, 

focus groups for the evaluation of the 

MAPCP Demonstration. The focus group 

data will be collected to supplement 

other qualitative and quantitative 

analyses from primary and secondary 

data sources by providing data on 

context, structure, and process, as well 

as select aspects of the key outcomes. 

The data gathered from the interviews 

will allow for more complete 

interpretation of the quantitative claims 

and other data analysis by taking into 

account the unique perspectives of 

beneficiaries. Subsequent to the 

publication of the 60-day Federal 

Register notice (April 29, 2013; 78 FR 

25089), the protocols have been revised 

by adding, revising and/or deleting 

questions. Form Number: CMS–10479 

(OCN: 0938–NEW); Frequency: 

Annually; Affected Public: Individuals 

and households; Number of 

Respondents: 768; Total Annual 

Responses: 384; Total Annual Hours: 

1,152. (For policy questions regarding 

this collection contact Suzanne Wensky 

at 410–786–0226.) 

11. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Cooperative 

Agreement to Support Establishment of 

State-Operated Health Insurance 

Exchanges; Use: All states (including 

the 50 states, consortia of states, 

Territories, and the District of Columbia 

herein referred to as States) that 

received a State Planning and 

Establishment Grant for Affordable Care 

Act’s (ACA) Exchanges are eligible for 

the Cooperative Agreement to Support 

Establishment of State Operated 

Insurance Exchanges. Section 1311 of 

the Affordable Care Act offers the 

opportunity for each State to establish 

an Exchange [now referred to as 

Marketplace], and provides for grants to 

States for the planning and 

establishment of these Exchanges. Given 

the innovative nature of Exchanges and 

the statutorily-prescribed relationship 

between the Secretary and States in 

their development and operation, it is 

critical that the Secretary work closely 

with States to provide necessary 

guidance and technical assistance to 

ensure that States can meet the 

prescribed timelines, Federal 

requirements, and goals of the statute. 

In order to provide appropriate and 

timely guidance and technical 

assistance, the Secretary must have 

access to timely, periodic information 

regarding State progress. Consequently, 

the information collection associated 

with these grants is essential to 

facilitating reasonable and appropriate 

federal monitoring of funds, providing 

statutorily-mandated assistance to States 

to implement Exchanges in accordance 

with Federal requirements, and to 

ensure that States have all necessary 

information required to proceed, such 

that retrospective corrective action can 

be minimized. 

The submitted revision adds sets of 

Outcomes and Operational Metrics to 

States’ data collection requirements; we 

will use the resulting data to evaluate 

Marketplace performance and overall 

effectiveness of the ACA. Key areas of 

measurement are the effectiveness of 

eligibility determination and enrollment 

processes, impact on affordability for 

consumers, and the effect of 

Marketplace participation on health 

insurances markets. Furthermore, these 

metrics facilitate actionable feedback 

and technical assistance to States for 

quality improvement efforts during the 

critical early period of operations. This 

funding opportunity was first released 

on January 20, 2011. Form Number: 

CMS–10371 (OCN: 0938–0119); 

Frequency: Occasionally; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

40; Total Annual Responses: 1,475; 

Total Annual Hours: 64,695. (For policy 

questions regarding this collection 

contact Christina Daw at 301–492– 

4181.) 

12. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Internal 

Revenue Service (IRS)/Social Security 

Administration (SSA)/Centers for 

Medicare and Medicaid Services (CMS) 

Data Match and Supporting Regulations; 

Use: Medicare Secondary Payer (MSP) is 

essentially the same concept known in 

the private insurance industry as 

coordination of benefits; it refers to 

those situations where Medicare 

assumes a secondary payer role to 

certain types of private insurance for 

covered services provided to a Medicare 

beneficiary. 

Congress sought to reduce the losses 

to the Medicare program by requiring in 

42 U.S.C. 1395y(b)(5) that the Internal 

Revenue Service (IRS), the Social 

Security Administration (SSA), and we 

perform an annual data match (the IRS/ 

SSA/CMS Data Match, or ‘‘Data Match’’ 

for short). We use the information 

obtained through Data Match to contact 

employers concerning possible 

application of the MSP provisions by 

requesting information about 

specifically identified employees (either 

a Medicare beneficiary or the working 

spouse of a Medicare beneficiary). This 

statutory data match and employer 

information collection activity enhances 

our ability to identify both past and 

present MSP situations. Form Number: 

CMS–R–137 (OCN: 0938–0565); 

Frequency: Annually; Affected Public: 

Business or other for-profit and Not-forprofit institutions, State, Local or Tribal 

Governments; Number of Respondents: 

280,028; Total Annual Responses: 

280,028; Total Annual Hours: 1,629,763. 

(For policy questions regarding this 

collection contact Rick Mazur at 410– 

786–1418.) 

Dated: August 13, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–20023 Filed 8–15–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10190, CMS–R– 

52, CMS–10492 and CMS–10416] 

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 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 159 / Friday, August 16, 2013 / Notices 50061 

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 

October 15, 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 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–10190 State Plan Preprints to 

Implement Sections 6083, 6036, 6041, 

6042, 6043, and 6044 of the Deficit 

Reduction Act (DRA) of 2005 

CMS–R–52 Conditions for Coverage of 

Suppliers of End Stage Renal Disease 

(ESRD) Services and Supporting 

Regulations 

CMS–10492 Data Submission for the 

Federally-facilitated Exchange User Fee 

Adjustment 

CMS–10416 Blueprint for Approval of 

Affordable Health Insurance 

Marketplaces 

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: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: State 

Plan Preprints to Implement Sections 

6083, 6036, 6041, 6042, 6043, and 6044 

of the Deficit Reduction Act (DRA) of 

2005; Use: State Medicaid agencies will 

complete the templates. We will review 

the information to determine if the state 

has met all of the DRA requirements 

that the state has chosen to implement. 

If the requirements are met, we will 

approve the amendments to the state’s 

Title XIX plan giving the state the 

authority to implement the flexibilities. 

For a state to receive Medicaid Title XIX 

funding, there must be an approved 

Title XIX state plan. With respect to 

section 6043, if a state adopts the costsharing provision for the non-emergency 

use of an emergency room, a hospital 

will be required to inform a beneficiary 

of the cost of the copayment and the 

availability of the service at a lesser or 

nearly no co-pay facility. That hospital 

will coordinate the referral. Form 

Number: CMS–10190 (OCN: 0938– 

0993); Frequency: Occasionally; 

Affected Public: Private sector— 

Business or other for-profits, Not-forprofit institutions, and State, Local, or 

Tribal Governments; Number of 

Respondents: 56; Total Annual 

Responses: 4,016; Total Annual Hours: 

699. (For policy questions regarding this 

collection contact Rhonda Simms at 

410–786–1200.) 

2. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Conditions for 

Coverage of Suppliers of End Stage 

Renal Disease (ESRD) Services and 

Supporting Regulations; Use: The 

information collection requirements 

described herein are part of the 

Medicare and Medicaid Programs; 

Conditions for Coverage for End-Stage 

Renal Disease Facilities. The 

requirements fall into two categories: 

Record keeping requirements and 

reporting requirements. With regard to 

the record keeping requirements, we use 

these conditions for coverage to certify 

health care facilities that want to 

participate in the Medicare or Medicaid 

programs. For the reporting 

requirements, the information is needed 

to assess and ensure proper distribution 

and effective utilization of ESRD 

treatment resources while maintaining 

or improving quality of care. The 

recordkeeping requirements imposed by 

this collection are no different than 

other conditions for coverage in that 

they reflect comparable standards 

developed by industry organizations 

such as the Renal Physicians 

Association, American Society of 

Transplant Surgeons, National Kidney 

Foundation, and the National 

Association of Patients on Hemodialysis 

and Transplantation. Form Number: 

CMS–R–52 (OCN: 0938–0386); 

Frequency: Annually; Affected Public: 

Business or other for-profit; Number of 

Respondents: 6,464; Total Annual 

Responses: 139,110; Total Annual 

Hours: 523,454. (For policy questions 

regarding this collection contact Lauren 

Oviatt at 410–786–4683.) 

3. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Data 

Submission for the Federally-facilitated 

Exchange User Fee Adjustment; Use: 

The final rule ‘‘Coverage of Certain 

Preventive Services Under the 


emcdonald on DSK67QTVN1PROD with NOTICES
50062 Federal Register / Vol. 78, No. 159 / Friday, August 16, 2013 / Notices 

Affordable Care Act’’ published by the 

Departments of Health and Human 

Services (HHS), the Treasury, and Labor 

on July 2, 2013 (78FR 39870), sets forth 

regulations regarding coverage for 

certain preventive services under 

section 2713 of the Public Health 

Service Act, as added by the Patient 

Protection and Affordable Care Act, as 

amended, and incorporated into the 

Employee Retirement Income Security 

Act of 1974 and the Internal Revenue 

Code. Section 2713 of the Public Health 

Service Act requires coverage without 

cost sharing of certain preventive health 

services, including certain contraceptive 

services, in non-exempt, nongrandfathered group health plans and 

health insurance coverage. The final 

rule establishes accommodations with 

respect to group health plans 

established or maintained by eligible 

organizations (and group health 

insurance coverage offered in 

connection with such plans). 

Eligible organizations are required to 

self-certify that they are eligible for this 

accommodation and provide a copy of 

such self-certification to their third 

party administrators. The final rule also 

set forth processes and standards to 

fund the payments for the contraceptive 

services that are provided for 

participants and beneficiaries in selfinsured plans of eligible organizations 

under the accommodation described 

previously, through an adjustment in 

the Federally-facilitated Exchange (FFE) 

user fee payable by an issuer 

participating in an FFE. 

In order to facilitate the FFE user fee 

adjustment, and ensure that these user 

fee adjustments reflect payments for 

contraceptive services provided under 

this accommodation and that the 

adjustment is applied to the appropriate 

participating issuer in an FFE, the final 

rule requires an information collection 

from applicable participating issuers 

and third party administrators. In 

particular, the final regulations at 45 

CFR 156.50(d)(2)(i) provides that a 

participating issuer who seeks an FFE 

user fee adjustment must submit to HHS 

in the year following the benefit year in 

which payments for contraceptive 

services were made under the 

previously mentioned accommodation, 

identifying information for the 

participating issuer, each third party 

administrator, and each self-insured 

group health plan, as well as the total 

dollar amount of the payments for 

contraceptive services that were 

provided during the applicable calendar 

year under the accommodation. The 

final regulation at 45 CFR 

156.50(d)(2)(iii) also requires the third 

party administrator to submit to HHS 

identifying information for the third 

party administrator, the participating 

issuer, and each self-insured group 

health plan, as well as the total number 

of participants and beneficiaries in each 

self-insured group health plan during 

the applicable calendar year, the total 

dollar amount of payments made for 

contraceptive services, and an 

attestation that the payments for 

contraceptive services were made in 

compliance with 26 CFR 54.9815– 

2713A(b)(2) or 29 CFR 2590.715– 

2713A(b)(2). 

Furthermore, to determine the 

potential number of submissions 

provided by third party administrators 

and allow HHS to prepare to receive 

submissions in calendar year 2015, the 

final regulation at 45 CFR 

156.50(d)(2)(ii) requires third party 

administrators to submit to HHS a 

notification that the third party 

administrator intends for a participating 

issuer to seek an FFE user fee 

adjustment, by the later of January 1, 

2014, or the 60th calendar day following 

the date on which the third party 

administrator receives a copy of a selfcertification from an eligible 

organization. 

The burden associated with these 

processes includes the time for 

applicable participating issuers and 

third party administrators to submit 

identifying information and total 

payments made for contraceptive 

services in the prior calendar year. HHS 

is unable to estimate the number of 

organizations that will seek user fee 

adjustments and seeks comments on 

this number in this notice. We 

anticipate that participating issuers in 

an FFE seeking a user fee adjustment 

and third party administrators with 

respect to which the FFE user fee 

adjustment is received will submit this 

information electronically. Form 

Number: CMS–10492 (OCN: 0938– 

NEW); Frequency: Once, Yearly; 

Affected Public: Private Sector— 

Business or other for-profits and Notfor-profit institutions; Number of 

Respondents: 10; Total Annual 

Responses: 1; Total Annual Hours: 8. 

(For policy questions regarding this 

collection contact Ariel Novick at 301– 

492–4309.) 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection. Title of 

Information Collection: Blueprint for 

Approval of Affordable Health 

Insurance Marketplaces; Use: All states 

(including the 50 States, and the District 

of Columbia herein referred to as states) 

have the opportunity under Section 

1311(b) of the Affordable Care Act to 

establish an Exchange (referred to 

herein as Marketplace). The original 

information collection request for the 

State Marketplace Blueprint Data 

Collection Tool specified a single 

reporting tool for all the various 

Marketplace types. This request revises 

the collection process by having 

separate collection tools for each type of 

Marketplace with the goal of reducing 

the burden. Also, at the time of the 

original request, the tool was partially 

paper-based. During the intervening 

time, we have has completed the on-line 

implementation of the tool and will 

transition all future applications to that 

system. 

Given the innovative nature of 

Marketplaces and the statutorilyprescribed relationship between the 

secretary and states in their 

development and operation, it is critical 

that the Secretary work closely with 

states to provide necessary guidance 

and technical assistance to ensure that 

states can meet the prescribed timelines, 

federal requirements, and goals of the 

statute. 

States seeking to establish a 

Marketplace must build a Marketplace 

that meets the requirements set out in 

section 1311(d) of the Affordable Care 

Act and 45 CFR 155.105. In order to 

ensure that a state seeking approval as 

a State-based Marketplace, State-based 

SHOP, or State Partnership Marketplace 

in the Federally-facilitated Marketplace 

meet all applicable requirements, the 

Secretary will require a state to submit 

a Blueprint for approval and to 

demonstrate operational readiness 

through virtual or on-site readiness 

review. Submission of the Blueprint 

Application will be online. Form 

Number: CMS–10416 (OCN: 0938– 

1172); Frequency: Once; Affected 

Public: State, Local, or Tribal 

governments; Number of Respondents: 

51; Number of Responses: 63; Total 

Annual Hours: 11,283. (For policy 

questions regarding this collection 

contact Sarah Summer 301–492–4443.) 

Dated: August 13, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–19963 Filed 8–15–13; 8:45 am] 

BILLING CODE 4120–01–P 


emcdonald on DSK67QTVN1PROD with NOTICES