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[Federal Register Volume 79, Number 124 (Friday, June 27, 2014)]
[Notices]
[Pages 36516-36518]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-15075]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10526, CMS-2540-10, CMS-265-11, CMS-10106 
and CMS-R-235]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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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 (the 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

[[Page 36517]]

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 August 26, 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------, 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-10526 Cost Sharing Reduction Reconciliation
CMS-2540-10 Skilled Nursing Facility and Skilled Nursing Facility 
Health Care Complex Cost Report
CMS-265-11 Independent Renal Dialysis Facility Cost Report and 
Supporting Regulations
CMS-10106 Medicare Authorization to Disclose Personal Health 
Information
CMS-R-235 Data Use Agreement (DUA) for Data Acquired from the Centers 
for Medicare & Medicaid Services (CMS)

    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 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: 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 
information collection establishes the data elements that a QHP issuer 
would be required to report to HHS in order to establish the cost-
sharing reductions provided on behalf of enrollees for the benefit 
year.
    Form Number: CMS-10526 (OMB control number: 0938-NEW); Frequency: 
Annually; Affected Public: Private Sector--Business or other for-
profits; Number of Respondents: 295; Total Annual Responses: 4,000,000; 
Total Annual Hours: 2,469. (For policy questions regarding this 
collection contact Patricia Meisol at 410-786-1917.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Skilled Nursing 
Facility and Skilled Nursing Facility Health Care Complex Cost Report; 
Use: Providers of services participating in the Medicare program are 
required under sections 1815(a), 1833(e) and 1861(v)(1)(A) of the 
Social Security Act (42 U.S.C. 1395g) to submit annual information to 
achieve settlement of costs for health care services rendered to 
Medicare beneficiaries. In addition, regulations at 42 CFR 413.20 and 
413.24 require adequate cost data and cost reports from providers on an 
annual basis. Form CMS-2540-10 is used by Skilled Nursing Facilities 
(SNFs) and Skilled Nursing Facility Complexes participating in the 
Medicare program to report health care costs to determine the amount of 
reimbursable costs for services rendered to Medicare beneficiaries.
    Form Number: CMS-2540-10 (OMB control number: 0938-0463); 
Frequency: Yearly; Affected Public: Private Sector--Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
14,185; Total Annual Responses: 14,185; Total Annual Hours: 2,865,370. 
(For policy questions regarding this collection contact Amelia Citerone 
at 410-786-3901.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Independent Renal 
Dialysis Facility Cost Report and Supporting Regulations; Use: 
Providers of services participating in the Medicare program are 
required under sections 1815(a) and 1861(v)(1)(A) of the Social 
Security Act (42 U.S.C. 1395g) to submit annual information to achieve 
settlement of costs for health care services rendered to Medicare 
beneficiaries. In addition, regulations at 42 CFR 413.20 and 413.24 
require adequate cost data and cost reports from providers on an annual 
basis. The Form CMS-265-11 cost report is needed to determine a 
provider's reasonable costs incurred in furnishing medical services to 
Medicare beneficiaries.
    Form Number: CMS-265-11 (OMB control number: 0938-0263); Frequency: 
Yearly; Affected Public: Private Sector--Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 5,677; Total 
Annual Responses: 5,677; Total Annual Hours: 369,005. (For policy 
questions regarding this collection contact Gail Duncan at 410-786-
7278.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Medicare Authorization to Disclose Personal Health 
Information; Use: Unless permitted or required by law, the

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Health Insurance Portability and Accountability Act (HIPAA) prohibits 
Medicare (a HIPAA covered entity) from disclosing an individual's 
protected health information without a valid authorization. In order to 
be valid, an authorization must include specified core elements and 
statements. Medicare will make available to Medicare beneficiaries a 
standard, valid authorization to enable beneficiaries to request the 
disclosure of their protected health information. This standard 
authorization will simplify the process of requesting information 
disclosure for beneficiaries and minimize the response time for 
Medicare. Form CMS-10106, the Medicare Authorization to Disclose 
Personal Health Information, will be used by Medicare beneficiaries to 
authorize Medicare to disclose their protected health information to a 
third party. Form Number: CMS-10106 (OMB control number: 0938-0930); 
Frequency: Occasionally; Affected Public: Individuals or Households; 
Number of Respondents: 1,298,329; Total Annual Responses: 1,298,329; 
Total Annual Hours: 324,582. (For policy questions regarding this 
collection contact Sam Jenkins at 410-786-3261.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Data Use 
Agreement (DUA) for Data Acquired from the Centers for Medicare & 
Medicaid Services (CMS); Use: The Privacy Act of 1974 allows for 
discretionary releases of data maintained in Privacy Act protected 
systems of records under Sec.  552a(b) (Conditions of Disclosure). The 
mandate to account for disclosures of data under the Privacy Act is 
found at Sec.  552a(c)(Accounting of Certain Disclosures). This section 
states that certain information must be maintained regarding 
disclosures made by each agency. This information is: Date, Nature, 
Purpose, and Name/Address of Recipient. Section 552a(e) sets the 
overall requirements that each agency must meet in order to maintain 
records under the Privacy Act. The Data Use Agreement (DUA) form is 
needed as part of the review of each CMS data request to ensure 
compliance with the requirements of the Privacy Act for disclosures 
that contain personally identifiable information (PII). The DUA form 
also provides data requestors and custodians with a formal means to 
agree to the data protection and destruction statutory and regulatory 
requirements of CMS' PII data. The Health Insurance Portability and 
Accountability Act (HIPAA) of 1996, Sec.  1173(d) (Security Standards 
for Health Information) requires us to protect PII. Additionally, the 
Federal Information Security Management Act (FISMA) of 2002, Sec.  3544 
(b) (Federal Agency Responsibilities--Agency Program) also requires us 
to develop policies and procedures for the protection and destruction 
of sensitive data to include PII. We use the information collected by 
the DUA to track disclosures, conditions for disclosure, accounting of 
disclosures and agency requirements dictated by the Privacy Act, HIPAA 
and FISMA.
    Form Number: CMS-R-235 (OMB control number: 0938-0734); Frequency: 
Annually; Affected Public: Private sector--business or other for-
profits and not-for-profit institutions; Number of Respondents: 9,220; 
Total Annual Responses: 9,220; Total Annual Hours: 2,740. (For policy 
questions regarding this collection contact Sharon Kavanagh at 410-786-
5441.)

    Dated: June 24, 2014.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2014-15075 Filed 6-26-14; 8:45 am]
BILLING CODE 4120-01-P
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