292 Federal Register / Vol. 77, No. 2 / Wednesday, January 4, 2012 / Notices 

circumstances which permit exceptions 

from conducting verifications; Form 

Number: CMS–R–74 (OCN 0938–0467); 

Frequency: Monthly; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 50; Total 

Annual Responses: 8,520,000; Total 

Annual Hours: 124,054. (For policy 

questions regarding this collection 

contact Barbara Washington at (410) 

786–9964. For all other issues call (410) 

786–1326.) 

2. Type of Information Collection 

Request: Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Affordable Care 

Act Internal Claims and Appeals and 

External Review Procedures for Nongrandfathered Group Health Plans and 

Issuers and Individual Market Issuers; 

Use: The Patient Protection and 

Affordable Care Act, Public Law 111– 

148, (the Affordable Care Act) was 

enacted on March 23, 2010. As part of 

the Act, Congress added PHS Act 

section 2719, which provides rules 

relating to internal claims and appeals 

and external review processes. On July 

23, 2010 (75 FR 43330), interim final 

regulations (IFR) set forth rules 

implementing PHS Act section 2719 for 

internal claims and appeals and external 

review processes. With respect to 

internal claims and appeals processes 

for group health coverage, PHS Act 

section 2719 and our regulations 

provide that group health plans and 

health insurance issuers offering group 

health insurance coverage must comply 

with the internal claims and appeals 

processes set forth in 29 CFR 2560.503– 

1 (the DOL claims procedure regulation) 

and update such processes in 

accordance with standards established 

by the Secretary of Labor. The DOL 

claims procedure regulation requires an 

employee benefit plan to provide thirdparty notices and disclosures 

participants and beneficiaries of the 

plan. In addition, our regulations add an 

additional requirement that nongrandfathered group health plans and 

issuers of non-grandfathered health 

policies provide to the claimant, free of 

charge, any new or additional evidence 

considered, or generated by the plan or 

issuer in connection with the claim. 

The IFR also requires issuers offering 

coverage in the individual health 

insurance market to also generally 

comply with the DOL claims procedure 

regulation as updated by the Secretary 

of HHS in the IFR for their internal 

claims and appeals processes. 

Furthermore, PHS Act section 2719 

and the IFR provide that nongrandfathered group health plans, 

issuers offering group health insurance 

coverage, and self-insured nonfederal 

governmental plans (through the IFR 

amendment dated June 24, 2011) must 

comply either with a State external 

review process or a Federal review 

process. The IFR provides a basis for 

determining when such plans and 

issuers must comply with an applicable 

State external review process and when 

they must comply with the Federal 

external review process. Plans and 

issuers that are required to participate in 

the Federal external review process 

must electronically elect either the 

HHS-administered process or the 

private accredited IRO process by 

January 1, 2012. The election 

requirements associated with this ICR 

are articulated through guidance 

published June 22, 2011 at http:// 

cciio.cms.gov/resources/files/ 

hhs_srg_elections_06222011.pdf. The 

election requirements are necessary for 

the Federal external review process to 

provide an independent external review 

as requested by claimants. Form 

Number: CMS–10338 (OCN: 0938– 

1099); Frequency: Occasionally; 

Affected Public: State, Local, Tribal 

Governments; Business or other forprofit; Not-for-profit institutions. 

Number of Respondents: 46,773; 

Number of Responses: 218,657,161; 

Total Annual Hours: 930,267. (For 

policy questions regarding this 

collection, contact Colin McVeigh at 

(301) 492–4263. 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. 

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 March 5, 2012: 

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 23, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–33752 Filed 1–3–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10142 and CMS– 

R–262] 

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), 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 function; 

(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: Revision of a currently 

approved collection; Title of 

Information Collection: Bid Pricing Tool 

(BPT) for Medicare Advantage (MA) 

Plans and Prescription Drug Plans 

(PDP); Use: Under the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA), and 

implementing regulations at 42 CFR, 

Medicare Advantage organizations 

(MAO) and Prescription Drug Plans 

(PDP) are required to submit an 

actuarial pricing ‘‘bid’’ for each plan 

offered to Medicare beneficiaries for 

approval by the Centers for Medicare & 

Medicaid Services (CMS). 


wreier-aviles on DSK3TPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 2 / Wednesday, January 4, 2012 / Notices 293 

MAOs and PDPs use the Bid Pricing 

Tool (BPT) software to develop their 

actuarial pricing bid. The information 

provided in the BPT is the basis for the 

plan’s enrollee premiums and CMS 

payments for each contract year. The 

tool collects data such as medical 

expense development (from claims data 

and/or manual rating), administrative 

expenses, profit levels, and projected 

plan enrollment information. By statute, 

completed BPTs are due to CMS by the 

first Monday of June each year. 

CMS reviews and analyzes the 

information provided on the Bid Pricing 

Tool. Ultimately, CMS decides whether 

to approve the plan pricing (i.e., 

payment and premium) proposed by 

each organization. CMS is requesting to 

continue its use of the BPT for the 

collection of information for CY2013 

through CY2015. Form Number: CMS– 

10142 (OCN: 0938–0944); Frequency: 

Yearly; Affected Public: Private Sector— 

Business or other for-profits and not-forprofit institutions; Number of 

Respondents: 530; Total Annual 

Responses: 4,770; Total Annual Hours: 

143,100. (For policy questions regarding 

this collection contact Diane Spitalnic at 

(410) 786–5745. For all other issues call 

(410) 786–1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Plan Benefit 

Package (PBP) and Formulary 

Submission for Medicare Advantage 

(MA) Plans and Prescription Drug Plans 

(PDP); Use: Under the Medicare 

Modernization Act (MMA), Medicare 

Advantage (MA) and Prescription Drug 

Plan (PDP) organizations are required to 

submit plan benefit packages for all 

Medicare beneficiaries residing in their 

service area. The plan benefit package 

submission consists of the Plan Benefit 

Package (PBP) software, formulary file, 

and supporting documentation, as 

necessary. MA and PDP organizations 

use the PBP software to describe their 

organization’s plan benefit packages, 

including information on premiums, 

cost sharing, authorization rules, and 

supplemental benefits. They also 

generate a formulary to describe their 

list of drugs, including information on 

prior authorization, step therapy, 

tiering, and quantity limits. 

Additionally, CMS uses the PBP and 

formulary data to review and approve 

the plan benefit packages proposed by 

each MA and PDP organization. 

CMS requires that MA and PDP 

organizations submit a completed PBP 

and formulary as part of the annual 

bidding process. During this process, 

organizations prepare their proposed 

plan benefit packages for the upcoming 

contract year and submit them to CMS 

for review and approval. 

CMS is requesting to continue its use 

of the PBP software and formulary 

submission for the collection of benefits 

and related information for CY 2013 

through CY 2015. CMS estimates that 

571 MA organizations and 64 PDP 

organizations will be required to submit 

the plan benefit package information in 

CY 2013. Based on operational changes 

and policy clarifications to the Medicare 

program and continued input and 

feedback by the industry, CMS has 

made the necessary changes to the plan 

benefit package submission. Form 

Number: CMS–R–262 (OCN: 0938– 

0763); Frequency: Yearly; Affected 

Public: Private Sector—Business or 

other for-profits and not-for-profit 

institutions; Number of Respondents: 

635; Total Annual Responses: 6,015; 

Total Annual Hours: 53,291. (For policy 

questions regarding this collection 

contact Kristy Holtje at (410) 786–2209. 

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 February 3, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 

395–6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: December 23, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–33750 Filed 1–3–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

Center for Scientific Review; Notice of 

Closed Meetings 

Pursuant to section 10(d) of the 

Federal Advisory Committee Act, as 

amended (5 U.S.C. App.), notice is 

hereby given of the following meetings. 

The meetings will be closed to the 

public in accordance with the 

provisions set forth in sections 

552b(c)(4) and 552b(c)(6), Title 5 U.S.C., 

as amended. The grant applications and 

the discussions could disclose 

confidential trade secrets or commercial 

property such as patentable material, 

and personal information concerning 

individuals associated with the grant 

applications, the disclosure of which 

would constitute a clearly unwarranted 

invasion of personal privacy. 

Name of Committee: Cell Biology 

Integrated Review Group; Cellular 

Mechanisms in Aging and Development 

Study Section. 

Date: February 1–2, 2012. 

Time: 8 a.m. to 5 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: Hyatt Regency Bethesda, One 

Bethesda Metro Center, 7400 Wisconsin 

Avenue, Bethesda, MD 20814. 

Contact Person: John Burch, Ph.D., 

Scientific Review Officer, Center for 

Scientific Review, National Institute of 

Health, 6701 Rockledge Drive, Room 3213, 

MSC 7808, Bethesda, MD 20892, (301) 408– 

9519, burchjb@csr.nih.gov. 

Name of Committee: Cardiovascular and 

Respiratory Sciences Integrated Review 

Group; Lung Cellular, Molecular, and 

Immunobiology Study Section. 

Date: February 1–2, 2012. 

Time: 8 a.m. to 6 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: Admiral Fell Inn, 888 South 

Broadway, Baltimore, MD 21231. 

Contact Person: George M Barnas, Ph.D., 

Scientific Review Officer, Center for 

Scientific Review, National Institutes of 

Health, 6701 Rockledge Drive, Room 2180, 

MSC 7818, Bethesda, MD 20892, (301) 435– 

0696, barnasg@csr.nih.gov. 

Name of Committee: Surgical Sciences, 

Biomedical Imaging and Bioengineering 

Integrated Review Group; Surgery, 

Anesthesiology and Trauma Study Section. 

Date: February 1–2, 2012. 

Time: 11 a.m. to 5 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: Holiday Inn Fisherman’s Wharf, 

1300 Columbus Avenue, San Francisco, CA 

94133. 

Contact Person: Weihua Luo, MD, Ph.D., 

Scientific Review Officer, Center for 

Scientific Review, National Institutes of 

Health, 6701 Rockledge Drive, Room 5114, 

MSC 7854, Bethesda, MD 20892, (301) 435– 

1170, luow@csr.nih.gov. 

Name of Committee: Bioengineering 

Sciences & Technologies Integrated Review 

Group; Nanotechnology Study Section. 

Date: February 2–3, 2012. 

Time: 7 a.m. to 5 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: Fairmont Hotel San Francisco, 950 

Mason Street, San Francisco, CA 94108. 


wreier-aviles on DSK3TPTVN1PROD with NOTICES