31618 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 

Agency and its customers and 

stakeholders. It will also allow feedback 

to contribute directly to the 

improvement of program management. 

Collecting voluntary customer 

feedback is the least burdensome, most 

effective way for the Agency to 

determine whether or not its public Web 

sites are useful to and used by its 

customers. Generic clearance is needed 

to ensure that the Agency can 

continuously improve its Web sites 

though regular surveys developed from 

these pre-defined questions. Surveying 

the Agency Web sites on a regular, 

ongoing basis will help ensure that 

users have an effective, efficient, and 

satisfying experience on any of the Web 

sites, maximizing the impact of the 

information and resulting in optimum 

benefit for the public. The surveys will 

ensure that this communication channel 

meets customer and partner priorities, 

builds the Agency’s brands, and 

contributes to the Agency’s health and 

human services impact goals. Form 

Number: CMS–10415 (OCN 0938— 

New); Frequency: Occasionally; 

Affected Public: Individuals and 

Households, Business or other forprofits and Not-for-profit institutions, 

State, Local or Tribal Governments; 

Number of Respondents: 1,000,000; 

Total Annual Responses: 1,000,000; 

Total Annual Hours: 67,000. (For policy 

questions regarding this collection 

contact John Booth at 410–786–6577. 

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 28, 2012. OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: May 22, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–12811 Filed 5–25–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services (CMS) 

[CMS–2382–N] 

Medicaid Program; Announcement of 

Requirements and Registration for 

CMS Provider Screening Innovator 

Challenge 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & 

Medicaid Services (CMS), is announcing 

the launch of the ‘‘CMS Provider 

Screening Innovator Challenge.’’ This 

Challenge is sponsored by CMS and is 

presented as part of the Partnership for 

Program Integrity Innovation program, 

and will be administered by the 

National Aeronautic and Space 

Administration’s (NASA) Federal Center 

of Excellence for Collaborative 

Innovation. This Challenge addresses 

our goals of improving our abilities to 

streamline operations, screen providers, 

and reduce fraud and abuse. 

Specifically, the challenge is an 

innovation competition to develop a 

multi-State, multi-program provider 

screening software application which 

would be capable of risk scoring, 

credentialing validation, identity 

authentication, and sanction checks, 

while lowering burden on providers and 

reducing administrative and 

infrastructure expenses for States and 

Federal programs. More information 

pertaining to the Medicaid and CHIP 

programs can be found at 

www.medicaid.gov. 

DATES: Important dates concerning the 

Challenge include the following: 

Challenge Competition Begin: 6:00 

p.m., e.d.t., May 30, 2012. 

Challenge Competition End: To be 

determined, but expected to be 

completed by October/November 2012 

timeframe. 

FOR FURTHER INFORMATION CONTACT: John 

‘‘Chip’’ Garner, 410–786–3012. 

SUPPLEMENTARY INFORMATION: 

Subject of Challenge Competition 

Entrants are asked to develop artifacts 

and components of software 

applications that can be integrated into 

an open source solution that can deliver 

a reliable, scalable, and cost-effective 

provider-screening capability for 

multiple States (or for the nation). 

We expect the winning entry to 

exhibit the following characteristics: 

1. Reduced processing and transaction 

time for submitting and receiving 

queries to authoritative data sources 

regarding provider credentials and 

sanctions. 

2. Reductions in time needed by 

providers to submit information and 

resolve discrepancies. 

3. Administrative/infrastructure 

savings from a multi-tenant provider 

screening solution. 

4. Improved availability of key 

provider data relevant for program 

participation and oversight. 

5. Improved timeliness and accuracy 

in provider participation, oversight, and 

enrollment decisions. 

6. Improved ability to implement 

sections 1902(a)(39) and 1902(a)(77) of 

the Social Security Act, as amended by 

the Patient Protection and Affordable 

Care Act (Pub. L. 111–148 and 111–152) 

subsections 6401(b) and (c) (Provider 

Screening and Other Enrollment 

Requirements Under Medicare, 

Medicaid, and CHIP), and section 6501 

(Termination of Provider Participation 

Under Medicaid if Terminated by 

Medicare or Other State Plan). 

7. Assist in better driving alignment of 

the Medicaid Information Technology 

Architecture (MITA) 3.0 framework to 

the Information and Technology 

Architecture levels. More information 

pertaining to MITA can be found at the 

following Web site: www.medicaid.gov/ 

Medicaid-CHIP–Program-Information/ 

By-Topics/Data-and-Systems/MedicaidInformation-Technology-ArchitectureMITA.html. 

General Eligibility Rules for 

Participating in the Competition 

To be eligible to win a prize under 

this Challenge, an individual or entity 

must comply with all the requirements 

under this section. 

An individual or entity shall not be 

deemed ineligible solely because the 

individual or entity used Federal 

facilities or consulted with Federal 

employees during a competition if such 

facilities and employees are made 

available to all individuals and entities 

participating in the competition on an 

equitable basis. 

A Federal entity or Federal employee 

acting within the scope of his or her 

employment is not eligible to 

participate. A Federal employee seeking 

to participate in this competition 

outside the scope of his/her 

employment should consult his/her 

ethics official prior to developing the 

submission. Employees of CMS, the 

Challenge judges, and employees of any 

other company or individual involved 

with the design, production, execution, 

or distribution of the Challenge, along 

with such employees’ or judges’ 

immediate families (spouse, parents and 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 31619 

step-parents, siblings and step-siblings, 

and children and step-children) and 

household members (people who share 

the same residence at least three (3) 

months out of the year) are not eligible 

to participate. 

Regarding Registration Process for 

Participants, interested persons should 

read the Official Rules and register at 

the Center of Excellence for 

Collaborative Innovation Challenge 

portal: http://community.topcoder.com/ 

coeci/. Registration is free and can be 

completed at any time before an entry 

is submitted in response to a particular 

competition. 

Amount of the Prize 

Based on our current assumptions, we 

estimate that the total prize amount for 

the competitions conducted as part of 

this Challenge will fall between 

$500,000 and $600,000. 

Basis Upon Which Winner Will Be 

Selected 

Challenge competition entries will be 

judged by an expert panel composed of 

CMS program staff. Judges shall be 

named after commencement of the 

Challenge. Competitions will be judged 

based upon both subjective and 

objective criteria. Should the highestscoring submitted solution be missing 

requirements or otherwise need 

modification, it will enter a 

remediation/fix phase. Projects are 

posted and administered through a 

personalized, web-based administration 

tool. All projects progress, with some 

variance, through a sequence of phases 

from Registration to Submission to 

Screening to Review to Final Fixes. 

Submissions will be screened to ensure 

they meet minimum requirements for 

the project and do not include forbidden 

material. Competition submissions with 

subjectively evaluated components (for 

example, graphical design, workflow, 

GUI layout, etc.) are anonymized and 

evaluated by the Judges. Submissions 

with objectively scored components, 

such as projects (for example, 

architecture, development, etc.) are 

scored by the Judges by their fidelity to 

exact, enumerated requirements. 

Overall, the solution must, at a 

minimum, meet the following criteria: 

1. Capability to Conduct Identity 

Verification. 

a. Capability to link individuals to 

their organizations and vice versa. 

b. Capability to match on multiple 

variations of an individual’s or 

organization’s name to ensure that the 

correct entity is verified. 

c. Ability to apply a range of 

screening rules to cross check data 

elements within the enrollment 

application. 

d. Ability to apply a range of 

screening rules to cross check data 

elements against authoritative external 

sources for consistency. 

e. Capability to establish and employ 

a graded screening methodology that 

escalates the intensity of screening for 

providers that are flagged as higher risk 

(that is, Report Card Methodology). 

2. Capability to Build Provider 

Profiles. 

a. Capability to retain screening and 

enrollment information and results, and 

compare against past and future 

screening results. 

b. Capability to create a watch list to 

ensure that providers that are suspected 

or known to be fraudulent are flagged at 

the time of screening. 

c. Capability to track re-enrollment 

attempts to ensure that slight changes to 

provider information are not considered 

a new enrollment. 

d. Capability to revalidate 

periodically to ensure that changes in 

provider profiles are updated on a 

regular basis. 

e. Capability to leverage public Web 

sites to conduct link analysis through 

which provider associations could be 

explored, and alerts posted on similar 

Web sites could be considered. 

f. Capability to capture critical 

attributes 

• Collection of application fees status. 

• Exception waiver approved status. 

• Incorporating enhanced screening 

data, including the results of site visits, 

criminal background checks, and finger 

printing. 

• Capturing licensing information, 

financial data, and any other data 

attributes which could impact a risk 

lever. 

• Other critical attributes. 

g. Capability to achieve real time 

screening, scoring, and system outputs 

(queries/reports). 

3. Capability to Evaluate and Maintain 

the Integrity of the Results. 

a. Capability to persist data sources 

scores to determine the most reliable 

source for each data element. 

b. Capability to evaluate data sources 

for reliability and accuracy. 

c. Capability to create a learning 

system to ensure that observed negative 

trends factor back into screening rules 

so as to flag suspicious enrollments 

early in the screening process, ensuring 

the ability to detect and reduce/ 

eliminate the incidence of false 

positives. 

d. Capability to create system outputs 

to assign reasons/explanations to each 

code or score used. 

e. Capability to build processes to 

allow for appropriate interpretation and 

action on screening and scoring results. 

f. Capability to ensure that each rule 

is tested and its impact is evaluated 

prior to implementing. 

4. Improves Efficiency. 

a. Capability to allow searches to find 

specific provider information with 

minimal search attempts. 

b. Capability to identify applicants, 

including individual providers and 

owners of institutional providers. 

c. Capability to verify identity and 

prior history of problems with 

Medicaid/CHIP or Medicare programs. 

d. Capability to identify and schedule 

revalidation process. 

5. Meets Architectural Guidelines. 

a. Adheres to the Architectural 

Guidance and meets the seven 

conditions and standards detailed in the 

Guidance for Exchange and Medicaid IT 

Systems, Version 2.0, located at: 

http://www.medicaid.gov/MedicaidCHIP–Program-Information/By-Topics/ 

Data-and-Systems/Downloads/ 

exchangemedicaiditguidance.pdf. 

b. Integrates into the MITA 

Framework—Is MITA Compliant. 

Information regarding MITA can be 

found at: http://www.cms.gov/ 

MedicaidInfoTechArch/. 

6. Accurate, Cost Effective, and 

Timely. 

a. Turnaround time for performing 

automated checks typical for a webbased system. 

b. Comprehensive verification of all 

data fields for all providers enrolled. 

c. Efficiency of the Screening Solution 

in terms of cost and schedule to actually 

implement: Potential extra costs (for 

example, licenses, etc.) are documented. 

d. Effectiveness of the risk-screening 

model in detecting fraud based issues. 

e. Technical soundness of risk-scoring 

in flagging potential fraudulent patterns 

and tendencies. 

Additional Information 

CMS is one of the principal agencies 

dedicated to protecting the health of 

citizens by making our world healthier, 

safer, and better for all Americans. For 

more information, see www.cms.gov. 

General Conditions 

CMS reserves the right to cancel, 

suspend, and/or modify the 

Competition, or any part of it, for any 

reason, at CMS’ sole discretion. 

Authority: This competition is 

administrated by the Federal Center of 

Excellence for Collaborative Innovation 

through a partnership between CMS and 

NASA. The partnership is in accordance with 

the National Aeronautics and Space Act (51 

U.S.C. 20113(e)) and The Economy Act (31 

U.S.C. 1535). 


srobinson on DSK4SPTVN1PROD with NOTICES
31620 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 

Dated: May 4, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2012–12633 Filed 5–25–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1441–N] 

Medicare Program; Public Meeting in 

Calendar Year 2012 for New Clinical 

Laboratory Tests Payment 

Determinations 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces a 

public meeting to receive comments and 

recommendations from the public on 

the appropriate basis for establishing 

payment amounts for new or 

substantially revised Healthcare 

Common Procedure Coding System 

(HCPCS) codes being considered for 

Medicare payment under the clinical 

laboratory fee schedule (CLFS) for 

calendar year (CY) 2013. 

DATES: Meeting Dates: The public 

meeting is scheduled for Monday, July 

16, 2012, from 9:00 a.m. to 5:00 p.m., 

and Tuesday, July 17, 2012, from 9:00 

a.m. to 12:00 p.m. All times are Eastern 

Daylight Savings Time. 

Deadline for Registration of 

Presenters: All presenters for the public 

meeting must register by July 6, 2012. 

Deadline for Written/Electronic 

Presentations: Written presentations 

must also be electronically submitted to 

on or before July 6, 2012. 

Deadline for Submitting Requests for 

Special Accommodations: Requests for 

special accommodations must be 

received no later than 5:00 p.m., on July 

6, 2012. 

Deadline for Submission of Written 

Comments: Interested parties may 

submit written comments on the 

proposed payment determinations by 

September 28, 2012, to the address 

specified in the ADDRESSES section of 

this notice. 

ADDRESSES: The public meeting will be 

held in the main auditorium of the 

central building of the Centers for 

Medicare & Medicaid Services (CMS), 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

FOR FURTHER INFORMATION CONTACT: 

Glenn McGuirk, (410) 786–5723. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 531(b) of the Medicare, 

Medicaid, and SCHIP Benefits 

Improvement and Protection Act of 

2000 (BIPA) (Pub. L. 106–554) requires 

the Secretary to establish procedures for 

coding and payment determinations for 

new clinical diagnostic laboratory tests 

under Part B of title XVIII of the Social 

Security Act (the Act) that permit public 

consultation in a manner consistent 

with the procedures established for 

implementing coding modifications for 

International Classification of Diseases 

(ICD–9–CM). The procedures and public 

meeting announced in this notice for 

new tests are in accordance with the 

procedures published in the Federal 

Register on November 23, 2001 (66 FR 

58743), to implement section 531(b) of 

BIPA. 

Section 942(b) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173) added section 1833(h)(8) of 

the Act. Section 1833(h)(8)(A) of the Act 

requires the Secretary to ‘‘establish by 

regulation procedures for determining 

the basis for, and amount of, payment 

for any clinical diagnostic laboratory 

test with respect to which a new or 

substantially revised HCPCS code is 

assigned on or after January 1, 2005’’ 

(hereinafter referred to as, ‘‘new test’’). 

A code is considered to be 

‘‘substantially revised’’ if ‘‘there is a 

substantive change to the definition of 

the test or procedure to which the code 

applies (such as a new analyte or a new 

methodology for measuring an existing 

analyte-specific test).’’ (See section 

1833(h)(8)(E)(ii) of the Act.) 

Section 1833(h)(8)(B) of the Act sets 

forth the process for determining the 

basis for, and the amount of, payment 

for new tests. Section 1833(h)(8)(B)(i) 

and (ii) of the Act requires the Secretary 

to—(1) ‘‘make available to the public 

(through an Internet Web site and other 

appropriate mechanisms)a list that 

includes any such test for which 

establishment of a payment amount is 

being considered for a year’’; and (2) 

‘‘on the same day such list is made 

available, causes to have published in 

the Federal Register notice of a meeting 

to receive comments and 

recommendations (and data on which 

recommendations are based) from the 

public on the appropriate basis * * * 

for establishing payment amounts for 

the tests on such list.’’ The list of codes 

for which the establishment of a 

payment amount under the CLFS is 

being considered for CY 2013 is posted 

on our Web site at http:// 

www.cms.hhs.gov/ClinicalLabFeeSched. 

Section 1833(h)(8)(B)(iii) of the Act 

requires that we convene a public 

meeting not less than 30 days after 

publication of the notice in the Federal 

Register. These requirements are 

codified at 42 CFR part 414, subpart G. 

Two methods are used to establish 

payment amounts for new tests. The 

first method called ‘‘crosswalking’’ is 

used when a new test is determined to 

be comparable to an existing test, 

multiple existing test codes, or a portion 

of an existing test code. The new test 

code is assigned to the local fee 

schedule amounts and the national 

limitation amount of the existing test. 

Payment for the new test is made at the 

lesser of the local fee schedule amount 

or the national limitation amount. (See 

§ 414.508(a).) 

The second method called 

‘‘gapfilling’’ is used when no 

comparable existing test is available. 

When using this method, instructions 

are provided to each Medicare carrier or 

Part A and Part B Medicare 

Administrative Contractor (MAC) to 

determine a payment amount for its 

carrier geographic area(s) for use in the 

first year. The carrier-specific amounts 

are established for the new test code 

using the following sources of 

information, if available: charges for the 

test and routine discounts to charges; 

resources required to perform the test; 

payment amounts determined by other 

payers; and charges, payment amounts, 

and resources required for other tests 

that may be comparable or otherwise 

relevant. In the second year, the test 

code is paid at the national limitation 

amount, which is the median of the 

carrier-specific amounts. (See 

§ 414.508(b).) 

II. Proposals in the CY 2013 Physician 

Fee Schedule Proposed Rule 

We are following our process to 

determine the appropriate basis and 

payment amount for new test codes 

under the CLFS for CY 2013. Some of 

these tests are molecular pathology 

tests. Stakeholders in the molecular 

pathology community continue to 

debate whether Medicare should pay for 

molecular pathology tests under the 

CLFS or the physician fee schedule 

(PFS). Medicare pays for clinical 

diagnostic laboratory tests through the 

CLFS and for services that ordinarily 

require physician work through the PFS. 

We believe that we would benefit from 

additional public comments on whether 

these tests are clinical diagnostic 

laboratory tests or whether they are 

services that should be paid under the 

PFS. Therefore, we intend to solicit 

public comments on this issue in the CY 

2013 PFS proposed rule as well as 


srobinson on DSK4SPTVN1PROD with NOTICES