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[Federal Register Volume 78, Number 91 (Friday, May 10, 2013)]
[Notices]
[Pages 27399-27400]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-11033]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-64, CMS-1957, and CMS-10169]

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) 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: Reinstatement of a 
previously approved collection; Title of Information Collection: 
Indirect Medical Education (IME) and Supporting Regulations at 42 CFR 
412.105; Direct Graduate Medical Education (GME) and Supporting 
Regulations at 412 CFR 413.75 through 83; Use: Section 1886(d)(5)(B) of 
the Social Security Act (the Act) requires additional payments to be 
made under the Medicare Prospective Payment System (PPS) for the 
indirect medical educational costs a hospital incurs in connection with 
interns and residents (IRs) in approved teaching programs. In addition, 
Title 42, Part 413, sections 75 through 83 implement section 1886(d) of 
the Act by establishing the methodology for Medicare payment of the 
cost of direct graduate medical educational activities. These payments, 
which are adjustments (add-ons) to other payments made to a hospital 
under PPS, are largely determined by the number of full-time equivalent 
(FTE) IRs that work at a hospital during its cost reporting period. In 
Federal fiscal year (FY) 2011, the estimated Medicare program payments 
for indirect medical education (IME) costs amounted to $6.59 billion. 
Medicare program payments for direct graduate medical education (GME) 
are also based upon the number of FTE-IRs that work at a hospital. In 
FY 2011, the estimated Medicare program payments for GME costs amounted 
to $2.57 billion. Form Number: CMS-R-64 (OCN: 0938-0456); Frequency: 
Reporting--Annually; Affected Public: Private Sector--Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
1,075; Total Annual Responses: 1,075; Total Annual Hours: 2,150. (For 
policy questions regarding this collection contact Milton Jacobson at 
410-786-7553. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement of a 
previously approved collection; Title of Information Collection: Social 
Security Office (SSO) Report of State Buy-in Problem; Use: Under 
Section 1843 of the Social Security Act, states may enter into an 
agreement with the Department of Health and Human Services to enroll 
eligible individuals in Medicare and pay their premiums. The purpose of 
the State Buy-in program is to assure that Medicaid is the payer of 
last resort by permitting a state to provide Medicare protection to 
certain groups of needy individuals, as part of the state's total 
assistance plan. State Buy-in also has the effect of transferring some 
medical costs for this population from the Medicaid program, which is 
partially state funded to the Medicare program, which is funded by the 
federal government and individual premiums. Generally, the States Buy-
in for individuals who meet the eligibility requirements for Medicare 
and are cash recipients or deemed cash recipients or categorically 
needy under Medicaid. In some cases, states may also include 
individuals who are not cash assistance recipients under the Medical 
Assistance Only group. The day-to-day operations of the State Buy-in 
program is accomplished through an automated data exchange process. The 
automated data exchange process is used to exchange Medicare and Buy-in 
entitlement information between the Social Security District Offices, 
Medicaid State Agencies and the Centers for Medicare & Medicaid 
Services. When problems arise however that cannot be resolved though 
the normal data exchange process, clerical actions are required. The 
CMS-1957, ``SSO Report of State Buy-In Problem'' is used to report Buy-
in problems cases. The CMS-1957 is the only standardized form available 
for communications between the aforementioned agencies for the 
resolution of beneficiary complaints and inquiries regarding State Buy-
in eligibility. Form Number: CMS-1957 (OCN: 0938-0035); Frequency: 
Reporting--Annually; Affected Public: Individuals and Households; 
Number of Respondents: 3,802; Total Annual Responses: 3,802; Total 
Annual Hours: 1,266. (For policy questions regarding this collection 
contact Lucia Diaz-Robinson at 410-247-6843. For all other issues call 
410-786-1326.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection. Title of Information Collection: Medicare Durable 
Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 
Competitive Bidding Program. Use: Since 1989, Medicare has been paying 
for durable medical equipment (DME) and supplies (other than customized 
items) using fee schedule amounts that are calculated for each item or 
category of DME identified by a Healthcare Common Procedure Coding 
System code. Payments are based on the average supplier charges on 
Medicare claims from 1986 and 1987 and are updated annually on a factor 
legislated by Congress. For many years, the Government Accountability 
Office and the Office of Inspector General of the U.S. Department of 
Health and Human Services have reported that these fees are often 
highly inflated and that Medicare has paid higher than market rates for 
several different types of DME. Due to reports of Medicare overpayment 
of DME and supplies, Congress required that CMS conduct a competitive 
bidding demonstration project for these items. Accordingly, CMS 
implemented a demonstration project for this program from 1999-2002 
which produced significant savings for beneficiaries and taxpayers 
without hindering access to DMEPOS and related services. Shortly after 
a successful demonstration of the competitive bidding program, Congress 
passed the Medicare Prescription Drug, Improvement and Modernization 
Act of 2003 and mandated a phased-in approach to implement this program 
over the course of several years beginning in 2007 in 10 metropolitan 
statistical areas (MSAs). The statute

[[Page 27400]]

specifically required the Secretary to establish and implement programs 
under which competitive bidding areas are established throughout the 
United States for contract award purposes for the furnishing of certain 
competitively priced items and services for which payment is made under 
Medicare Part B. This program is commonly known as the ``Medicare 
DMEPOS Competitive Bidding Program.''
    CMS conducted its first round of bidding for the Medicare DMEPOS 
Competitive Bidding Program in 2007 with the help of its contractor, 
the Competitive Bidding Implementation Contractor. CMS published a 
Request for Bids instructions and accompanying forms for suppliers to 
submit their bids to participate in the program. During this first 
round of bidding, DMEPOS suppliers from across the U.S. submitted bids 
identifying the MSA(s) to service and the competitively bid item(s) 
they wished to furnish to Medicare beneficiaries. CMS evaluated these 
bids and contracted with those suppliers that met all program 
requirements. The first round of bidding was successfully implemented 
on July 1, 2008.
    On July 15, 2008, however, Congress delayed this program in section 
154 of the Medicare Improvements for Patients and Providers Act of 2008 
(MIPPA). MIPPA mandated certain changes to the competitive bidding 
program which included, but are not limited to: a delay of Rounds 1 
(competition began in 2009) and 2 of the program (competition began in 
2011 in 70 specific MSAs); the exclusion of Puerto Rico and negative 
pressure wound therapy from Round 1 and group 3 complex rehabilitative 
power wheelchairs from all rounds of competition; a process for 
providing feedback to suppliers regarding missing financial 
documentation; and a requirement for contract suppliers to disclose to 
CMS information regarding subcontracting relationships. Section 154 of 
the MIPPA specified that the competition for national mail order items 
and services may be phased in after 2010 and established a rule 
requiring that a bidder demonstrate that its bid covers 50 percent (or 
higher) of the types of diabetic testing strips, based on volume (the 
``50 percent rule'') for national mail order competitions. As required 
by MIPPA, CMS conducted the competition for the Round 1 Rebid in 2009. 
The Round 1 Rebid contracts and prices became effective on January 1, 
2011.
    The Affordable Care Act, enacted on March 23, 2010, expanded the 
Round 2 competition by adding an additional 21 MSAs, bringing the total 
MSAs for Round 2 to 91. The competition for Round 2 began in December 
2011. CMS also began a competition for National Mail Order of Diabetic 
Testing Supplies at the same time as Round 2. The Round 2 and National 
Mail-Order contracts and prices have a target implementation date of 
July 1, 2013.
    The MMA requires the Secretary to re-compete contracts not less 
often than once every 3 years. Most Round 1 Rebid contracts will expire 
on December 31, 2013. (Round 1 Rebid contracts for mail-order diabetic 
testing supplies ended on December 31, 2012.) Consequently, we are 
currently in the process of re-competing the competitive bidding 
contracts in the Round 1 Rebid areas.
    The most recent approval for this information collection request 
(ICR) was issued by OMB on October 10, 2012. Since then, CMS has 
decided to sequentially update the paperwork burden necessary to 
administer the program as it expands nationally and cycles through 
multiple rounds of competition. Specifically, we are now seeking to 
update our burden estimates for certain contract maintenance forms for 
Round 2 and the national mail-order competitions. These include Form C 
and the Contract Supplier's Disclosure of Subcontractors form. We are 
also requesting approval of two additional forms: the Change of 
Ownership (CHOW) Purchaser Form and the CHOW Contract Supplier 
Notification Form, which will be utilized in all rounds of competition. 
Finally, we are retaining without change Forms A, B, and D and their 
associated burden under this ICR. We note that the information 
collection for Forms A and B is already complete. We intend to continue 
use of the forms in future rounds of competition.
    Form Number: CMS-10169 (OCN: 0938-1016). Frequency: Occasionally. 
Affected Public: Private Sector (business or other for-profits) and 
Individuals or households. Number of Respondents: 19,035. Total Annual 
Responses: 19,035. Total Annual Hours: 9,311. (For policy questions 
regarding this collection contact Michael Keane at 410-786-4495. 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 June 10, 2013.

OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer. Fax Number: (202) 395-6974. Email: OIRA_submission@omb.eop.gov.

    Dated: May 6, 2013.
Martique Jones,
Deputy Director, Regulations Development Group,Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-11033 Filed 5-9-13; 8:45 am]
BILLING CODE 4120-01-P
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