Federal Register / Vol. 75, No. 223 / Friday, November 19, 2010 / Notices 70927 

786–8680. For all other issues call 410– 

786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Advance 

Beneficiary Notice of Noncoverage 

(ABN); Form Number: CMS–R–131 

(OMB#: 0938–0566); Use: Under section 

1879 of the Social Security Act, a 

physician, provider, practitioner, or 

supplier of items or services 

participating in the Medicare program, 

or taking a claim on assignment, may 

bill a Medicare beneficiary for items or 

services usually covered under 

Medicare, but denied in an individual 

case under one of the several statutory 

exclusions, if they inform the 

beneficiary, prior to furnishing the 

service, that Medicare is likely to deny 

payment. Sections 42 CFR 411.404(b) 

and (c), and 411.408(d)(2) and (f), 

require written notice be provided to 

inform beneficiaries in advance of 

potential liability for payment. 

Frequency: Once; Affected Public: 

Reporting: Weekly, Monthly, Yearly, 

Biennially and Occasionally; Number of 

Respondents: 1,326,282; Total Annual 

Responses: 43,725,850; Total Annual 

Hours: 5,099,309. (For policy questions 

regarding this collection contact Evelyn 

Blaemire at 410–786–1803. For all other 

issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid 

Payment for Prescription Drugs— 

Physicians and Hospital Outpatient 

Departments Collecting and Submitting 

Drug Identifying Information to State 

Medicaid Programs; Use: Section 6002 

of the Deficit Reduction Act (DRA) of 

2005 added provisions under section 

1927 of the Social Security Act to 

require physicians in their offices and 

hospital outpatient settings or other 

entities (e.g., non-profit facilities) to 

collect and submit the drug National 

Drug Code (NDC) numbers on Medicaid 

claims to their State in order for Federal 

Financial Participation to be available 

for these drugs. Form Number: CMS– 

10215 (OMB#: 0938–1026); Frequency: 

Weekly; Affected Public: Private Sector: 

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

Respondents: 20,000; Total Annual 

Responses: 3,910,000; Total Annual 

Hours: 15,836. (For policy questions 

regarding this collection contact 

Bernadette Leeds at 410–786–9463. For 

all other issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare/ 

Medicaid Psychiatric Hospital Survey 

Data; Use: The CMS–724 form is used to 

collect data that is not collected 

elsewhere and assists CMS in program 

planning and evaluation and in 

maintaining an accurate database on 

providers participating in the 

psychiatric hospital program. Form 

Number: CMS–724 (OMB#: 0938–0378); 

Frequency: Annually; Affected Public: 

Private Sector: Business or other forprofits and Not-for-profit institutions; 

Number of Respondents: 500; Total 

Annual Responses: 150; Total Annual 

Hours: 75. (For policy questions 

regarding this collection contact Kelley 

Leonette at 410–786–6664. For all other 

issues call 410–786–1326.) 

5. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: PACE State Plan 

Amendment Pre-print; Use: The 

Balanced Budget Act of 1997 created 

section 1934 of the Social Security Act 

that established the Program for the AllInclusive Care for the Elderly (PACE). 

The legislation established the PACE 

program as a Medicaid State plan option 

serving the frail and elderly in the home 

and community. Pursuant to the notice 

given in 64 FR 66271 (November 24, 

1999), if a State elects to offer PACE as 

an optional Medicaid benefit, it must 

complete a State Plan Amendment 

described as Enclosures #3, 4, 5, 6 and 

7. The information collected is used by 

CMS to affirm that the State elects to 

offer PACE an optional State plan 

service and the specifications of 

eligibility, payment and enrollment for 

the program. Form Number: CMS–10227 

(OMB#: 0938–1027); Frequency: Once; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

36; Total Annual Responses: 12; Total 

Annual Hours: 240. (For policy 

questions regarding this collection 

contact Angela Taube at 410–786–2638. 

For all other issues call 410–786–1326.) 

6. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid State 

Program Integrity Assessment (SPIA); 

Use: Under the provisions of the Deficit 

Reduction Act (DRA) of 2005, the 

Congress directed CMS to establish the 

Medicaid Integrity Program (MIP), CMS’ 

first national strategy to combat 

Medicaid fraud, waste, and abuse. CMS 

has two broad responsibilities under the 

MIP: (1) Reviewing the actions of 

individuals or entities providing 

services or furnishing items under 

Medicaid; conducting audits of claims 

submitted for payment; identifying 

overpayments; and educating providers 

and others on payment integrity and 

quality of care; and (2) Providing 

effective support and assistance to 

States to combat Medicaid fraud, waste, 

and abuse. 

In order to fulfill the second of these 

requirements, CMS developed SPIA. 

CMS uses SPIA to collect data on State 

Medicaid program integrity activities, 

develop reports for each State based on 

these data, determine areas to provide 

States with technical support and 

assistance, and develop measures to 

assess States’ performance. Form 

Number: CMS–10244 (OMB#: 0938– 

1033); Frequency: Annually; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 56; Total 

Annual Hours: 1,400. (For policy 

questions regarding this collection 

contact Mary Jo Cook at 410–786–3231. 

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/Paperwork

ReductionActof1995, 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. 

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 December 20, 2010. OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer. Fax 

Number: (202) 395–6974. E-mail: 

OIRA_submission@omb.eop.gov. 

Dated: November 12, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–29074 Filed 11–18–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10334 and CMS– 

10339] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 


srobinson on DSKHWCL6B1PROD with NOTICES
70928 Federal Register / Vol. 75, No. 223 / Friday, November 19, 2010 / Notices 

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 of a currently 

approved collection; Title of 

Information Collection: Enrollment 

Application for Coverage in the PreExisting Condition Insurance Plan; Use: 

The Department of Health and Human 

Services (HHS) is requesting an 

extension of this information collection 

request by the Office of Management 

and Budget (OMB). This information 

collection request originally received 

OMB approval on 6/29/2010. HHS is 

now seeking a three-year approval for 

this collection. On March 23, 2010, the 

President signed into law H.R. 3590, the 

Patient Protection and Affordable Care 

Act (Affordable Care Act), Public Law 

111–148. Section 1101 of the law 

establishes a ‘‘temporary high risk health 

insurance pool program’’ (which has 

been named the Pre-Existing Condition 

Insurance Plan, or PCIP) to provide 

health insurance coverage to currently 

uninsured individuals with pre-existing 

conditions. 

In order for individuals to be 

considered for eligibility into the 

federally-run PCIP program, they must 

submit a completed enrollment 

application to HHS. The enrollment 

application is used by HHS or its 

designee to obtain information from 

potentially eligible individuals applying 

for coverage in the PCIP program. PCIP 

is also referred to as the temporary 

qualified high risk insurance pool 

program, as it is called in the Affordable 

Care Act, but we have adopted the term 

PCIP to better describe the program and 

avoid confusion with the existing state 

high risk pool programs. The data 

collection will be used by HHS to obtain 

information from potential eligible 

individuals applying for coverage in the 

PCIP. Form Number: CMS–10334 

(OMB#: 0938–1095); Frequency: Once; 

Affected Public: Individuals and 

households; Number of Respondents: 

100,000; Total Annual Responses: 

100,000; Total Annual Hours: 92,000. 

(For policy questions regarding this 

collection contact Laura Dash at 410– 

786–8623. For all other issues call 410– 

786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Pre-Existing 

Health Insurance Plan and Supporting 

Regulations; Use: The Department of 

Health and Human Services (HHS) is 

requesting an extension of this 

information collection request by the 

Office of Management and Budget 

(OMB). This information collection 

request originally received OMB 

approval on 7/26/2010. HHS is now 

seeking a three-year approval for this 

collection. On March 23, 2010, the 

President signed into law H.R. 3590, the 

Patient Protection and Affordable Care 

Act (Affordable Care Act), Public Law 

111–148. Section 1101 of the law 

establishes a ‘‘temporary high risk health 

insurance pool program’’ (which has 

been named the Pre-Existing Condition 

Insurance Plan, or PCIP) to provide 

health insurance coverage to currently 

uninsured individuals with pre-existing 

conditions. The law authorizes HHS to 

carry out the program directly or 

through contracts with states or private, 

non-profit entities. 

We are requesting an extension for 

this package because this information is 

needed to assure that PCIP programs are 

established timely and effectively. This 

request is being made based on 

regulations that have been issued and 

contracts which have been executed by 

HHS with States or an entity on their 

behalf participating in the PCIP 

program. PCIP is also referred to as the 

temporary qualified high risk insurance 

pool program, as it is called in the 

Affordable Care Act, but we have 

adopted the term PCIP to better describe 

the program and avoid confusion with 

the existing state high risk pool 

programs. Form Number: CMS–10339 

(OMB#: 0938–1100); Frequency: 

Reporting—On occasion; Affected 

Public: State governments; Number of 

Respondents: 51; Total Annual 

Responses: 2,652; Total Annual Hours: 

36,924. (For policy questions regarding 

this collection contact Laura Dash at 

410–786–8623. 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/Paperwork

ReductionActof1995, 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 January 18, 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: November 16, 2010. 

Martique Jones, 

Director, Regulations Development Group 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2010–29253 Filed 11–18–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[Document Identifier: CMS–10356] 

Emergency Clearance: Public 

Information Collection Requirements 

Submitted to the Office of Management 

and Budget (OMB) 

AGENCY: Center for Medicare and 

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 and Medicaid 

Services (CMS), Department of Health 

and Human Services, 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; 


srobinson on DSKHWCL6B1PROD with NOTICES