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[Federal Register Volume 75, Number 237 (Friday, December 10, 2010)]
[Notices]
[Pages 76988-76990]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-31071]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-21 and CMS-21B, CMS-37, CMS-64, CMS-10120, 
CMS-10224, CMS-10098, CMS-10292 and CMS-10220]

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 without change 
of a currently approved collection; Title of Information Collection: 
CMS-21 (Quarterly Children's Health Insurance Program (CHIP) Statement 
of Expenditures for the Title XXI Program) and CMS-21B (State 
Children's Health Insurance Program Budget Report for the Title XXI 
Program State Plan Expenditures); Use: Forms CMS-21 and -21B provide 
CMS with the information necessary to issue quarterly grant awards, 
monitor current year expenditure levels, determine the allowability of 
State claims for reimbursement, develop CHIP financial management 
information, provide for State reporting of waiver expenditures, and 
ensure that the Federally established allotment is not exceeded. 
Further, these forms are necessary in the redistribution and 
reallocation of unspent funds over the Federally mandated timeframes; 
Form Numbers: CMS-21 and CMS-21B (OMB: 0938-0731); Frequency: 
Quarterly; Affected Public: State, Local, or Tribal Governments; Number 
of Respondents: 56; Total Annual Responses: 448; Total Annual Hours: 
7,840. (For policy questions regarding this collection contact Jonas 
Eberly at 410-786-6232. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Medicaid Program Budget Report; Use: Form CMS-37 is prepared and 
submitted to the Centers for Medicare & Medicaid Services (CMS) by 
State Medicaid agencies. Form CMS-37 is the primary document used by 
CMS in developing the national Medicaid budget estimates that are 
submitted to the Office of Management and Budget and the Congress; Form 
Number: CMS-37 (OMB: 0938-0101); Frequency: Quarterly; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 56; Total Annual Responses: 224; Total Annual Hours: 
7,616. (For policy questions regarding this collection contact Jonas 
Eberly at 410-786-6232. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Quarterly Medicaid Statement of Expenditures for the Medical Assistance 
Program; Use: Form CMS-64 has been used since January 1980 by the 
Medicaid State Agencies to report their actual program benefit costs 
and administrative expenses to CMS. CMS uses this information to 
compute the Federal financial participation (FFP) for the State's 
Medicaid Program costs. Certain schedules of the CMS-64 form are used 
by States to report budget, expenditure and related statistical 
information required for implementation of the Medicaid portion of the 
State Children's Health Insurance Programs; Form Number: CMS-64 
(OMB: 0938-0067); Frequency: Quarterly; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 56; Total 
Annual Responses: 224; Total Annual Hours: 16,464. (For policy 
questions regarding this collection contact Jonas Eberly at 410-786-
6232. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
1932 State Plan Amendment Template; Use: Section 1932(a)(1)(A) of the 
Social Security Act (the Act) grants states the authority to enroll 
Medicaid beneficiaries on a mandatory basis into managed care entities, 
managed care organizations (MCOs) and primary care case managers 
(PCCMs). Under this authority, a state can amend its Medicaid state 
plan to require certain categories of Medicaid beneficiaries to enroll 
in managed care entities without being out of compliance. This template 
may be used by states to easily modify their state plans if they choose 
to implement the provisions of section 1932(a)(1)(A).
    The State Medicaid Agencies will complete the template. CMS will 
review the information to determine if the state has met all the 
requirements of section 1932(a)(1)(A) and 42 CFR 438.50. If the 
requirements are met, CMS will approve the amendment to the state's 
title XIX plan giving the state the authority to enroll Medicaid 
beneficiaries on a mandatory basis into managed care entities MCOs and 
PCCMs. For a state to receive Medicaid funding, there must be an 
approved title XIX state plan; Form Number: CMS-10120 (OMB:

[[Page 76989]]

0938-0933); Frequency: Occasionally; Affected Public: State, Local, or 
Tribal Governments; Number of Respondents: 56; Total Annual Responses: 
10; Total Annual Hours: 100. (For policy questions regarding this 
collection contact Camille Dobson at 410-786-7065. For all other issues 
call 410-786-1326.)
    5. Type of Information Collection Request: Revision of currently 
approved collection; Title of Information Collection: Healthcare Common 
Procedure Coding System (HCPCS); Use: In October 2003, the Secretary of 
Health and Human Services delegated the Center for Medicare and 
Medicaid Services (CMS) authority to maintain and distribute HCPCS 
Level II Codes. As a result, the National Panel was delineated and CMS 
continued with the decision-making process under its current structure, 
the CMS HCPCS Workgroup (herein referred to as ``the Workgroup''. CMS' 
HCPCS Workgroup is an internal workgroup comprised of representatives 
of the major components of CMS, and private insurers, as well as other 
consultants from pertinent Federal agencies. Currently the application 
intake is paper-based. However, the process has grown and the HCPCS 
staff is exploring electronic processes for the collection and storage 
of applications. We have received feedback on the nature of the 
application; and have streamlined the form into a user-friendly 
application. The content of the material is the same, but the questions 
have been refined in accordance with comments received from industry 
members; and the level of necessity of the information required to 
render quality coding decision as determined by the CMS workgroup. The 
information on the form is used to update the HCPCS code set. All 
information is received and distributed to CMS' HCPCS workgroup and is 
reviewed and discussed at workgroup meetings. In turn, CMS' HCPCS 
workgroup reaches a decision as to whether a change should be made to 
codes in the HCPCS code set. The respondent who submits the application 
form can be anyone who has an interest in obtaining a code or modifying 
an existing code. However, respondents are usually manufacturers of 
products, or consultants on behalf of the manufacturer. Form Number: 
CMS-10224 (OMB: 0938-1042; Frequency: Occasionally; Affected 
Public: Private Sector, Business and other for-profit and not-for-
profit institutions; Number of Respondents: 300; Total Annual 
Responses: 300; Total Annual Hours: 3300. (For policy questions 
regarding this collection contact Felicia Eggleston at 410-786-9287 or 
Lori Anderson at 410-786-6190. For all other issues call 410-786-1326.)
    6. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Beneficiary Satisfaction Survey; Use: The Beneficiary 
Satisfaction survey is performed to insure that the CMS 1-800-MEDICARE 
Helpline contractor is delivering satisfactory service to the Medicare 
beneficiaries. It gathers data on several Helpline operations such as 
print fulfillment and websites tool hosted on http://www.medicare.gov. 
Respondents to the survey are Medicare beneficiaries that have 
contacted 1-800-MEDICARE for information on benefits and services. CMS 
is seeking approval for additional questions to be added to the 
original collection entitled 800-Medicare Beneficiary Satisfaction 
survey. The original set of questions was used when placing outbound 
calls to callers regarding the service they received when they called 
the 800 Medicare Helpline with a Medicare question. The new expanded 
collection will include multiple survey methods to measure customer 
satisfaction not only with the Beneficiary Contact Center's (BCC's) 
handling of issues via telephone, but also the service provided to 
beneficiaries when they write a letter regarding their Medicare issue 
or use the e-mail and/or web chat services provided by the BCC. The use 
of Customer Satisfaction Surveys is critical to the CMS mission to 
provide service to beneficiaries that is convenient, accessible, 
accurate, courteous, professional and responsive to the needs of 
diverse groups. Form Number: CMS-10098 (OMB: 0938-0919); 
Frequency: Weekly, Monthly, and Yearly; Affected Public: Individuals 
and Households; Number of Respondents: 36,144; Total Annual Responses: 
36,144; Total Annual Hours: 6033. (For policy questions regarding this 
collection contact Mark Broccolino at 410-786-6128. For all other 
issues call 410-786-1326.)
    7. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: State Medicaid 
Health Information Technology Plan, Planning-Advance Planning Document 
and Update, Implementation Advance Planning Document and Update, and 
Annual Implementation of Advance Planning Document to Implement Section 
4201 of the American Reinvestment and Recovery Act of 2009; Use: 
Section 4201 of Recovery Act establishes 100 percent Federal Financial 
Participation (FFP) as reimbursement to States for making incentive 
payments to providers for meaningful use of certified electronic health 
record technology and 90 percent FFP for administering these payments. 
Additionally, States are required to conduct oversight of this program 
and ensure no duplicate payments; thus, CMS is requiring States to 
submit information to CMS for prior approval before drawing down 
funding. These documents, if States choose to implement these 
flexibilities, will require a collection of information to effectuate 
these changes.
    The State Medicaid agencies will complete the templates. CMS will 
review the information to determine if the State has met all of the 
requirements of the Recovery Act provisions the States choose to 
implement. If the requirements are met, CMS will approve the amendments 
giving the State the authority to implement their Health Information 
Technology (HIT) strategy and implementation plans. For a State to 
receive Medicaid Title XIX funding, there must be an approved State 
Medicaid HIT Plan, Planning Advance Planning Document and 
Implementation Advance Planning Document; Form Number: CMS-10292 
(OMB: 0938-1088); Frequency: Yearly, Once, Occasionally; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 56. 
(For policy questions regarding this collection contact Sherry Armstead 
at 410-786-4342. For all other issues call 410-786-1326.)
    8. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Provider 
Enrollment, Chain and Ownership System (PECOS) Security Consent Form; 
Use: The primary function of the Medicare enrollment application is to 
obtain information about the provider or supplier and whether the 
provider or supplier meets 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. In establishing a Web based application 
process, we allow providers and suppliers the ability to enroll in the 
Medicare program via the Internet. For these applicants, no security 
consent form is needed to enroll or make a change in their Medicare 
enrollment information. These applicants receive complete access to 
their own

[[Page 76990]]

enrollments through Internet-based Provider Enrollment, Chain and 
Ownership System (PECOS).
    In order to allow a provider or supplier to delegate the Medicare 
credentialing process to another individual or organization, it is 
necessary to establish a Security Consent Form for those providers and 
suppliers who choose to have another individual or organization access 
their enrollment information and complete enrollments on their behalf. 
These users could consist of administrative staff, independent 
contractors, or credentialing departments and are represented as 
Employer Organizations. Employer Organizations and its members must 
request access to enrollment data through a Security Consent Form. The 
security consent form replicates business service agreements between 
Medicare applicants and organizations providing enrollment services.
    We are proposing two different versions of the Security Consent 
Form. The form, once signed, mailed and approved, grants an employer 
organization or its members access to all current and future enrollment 
data for the Medicare provider. Form Number: CMS-10220 (OMB: 
0938-1035); Frequency: Occasionally; Affected Public: State, Local, or 
Tribal Governments; Number of Respondents: 197,500; Total Annual 
Responses: 197,500; Total Annual Hours: 49,375. (For policy questions 
regarding this collection contact Alisha Banks at 410-786-0671. 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 at http://www.cms.hhs.gov/PaperworkReductionActof1995, or E-
mail 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 8, 2011:
    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 6, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-31071 Filed 12-9-10; 8:45 am]
BILLING CODE 4120-01-P
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