65660 Federal Register / Vol. 78, No. 212 / Friday, November 1, 2013 / Notices 

or elect to delegate this task to a 

Surrogate. A Surrogate is an individual 

or organization identified by an 

Individual or Organizational Provider as 

someone authorized to access CMS 

computer systems, such as Internetbased PECOS, National Provider Plan 

and Enumeration System (NPPES) and 

the Medicare and Medicaid Electronic 

Health Records (EHR) Incentive Program 

Registration and Attestation System 

(HITECH), on their behalf and to modify 

or view any information contained 

therein that the Individual or 

Organizational Provider may have 

permission or right to access in 

accordance with Medicare statutes, 

regulations, policies, and usage 

guidelines for any CMS system. 

Surrogates may consist of administrative 

staff, independent contractors, 3rd party 

consulting companies or credentialing 

departments. In order for an Individual 

or Organizational Provider to delegate 

the Medicare credentialing process to a 

Surrogate to access and update their 

enrollment information in the above 

mentioned CMS systems on their behalf, 

it is required that a Security Consent 

and Surrogate Authorization Form be 

completed, or Individual and 

Organizational Providers use an 

equivalent online process via the 

PECOS Identity and Access 

Management (I&A) system. The Security 

Consent and Surrogate Authorization 

form replicates business service 

agreements between Medicare 

providers, suppliers or both and 

Surrogates providing enrollment 

services. 

We are proposing one version of the 

Security Consent and Surrogate 

Authorization Form. The form, once 

signed, mailed and approved, grants a 

Surrogate access to all current and 

future enrollment data for the 

Individual or Organization Provider. 

Form Number: CMS–10220 (OCN: 

0938–1035); Frequency: Occasionally; 

Affected Public: Individuals and Private 

Sector—Business or other for-profits 

and Not-for-profit institutions; Number 

of Respondents: 88,650; Total Annual 

Responses: 88,650; Total Annual Hours: 

22,162. (For policy questions regarding 

this collection contact Alisha Banks at 

410–786–0671.) 

6. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Medicare 

Enrollment Application for Registration 

of Eligible Entities That Provide Health 

Insurance Coverage Complementary to 

Medicare Part B; Use: The primary 

function of a Medicare enrollment 

application is to gather information 

from a provider, supplier or other entity 

that tells us who it is, whether it meets 

certain qualifications to be a health care 

provider, supplier or entity, where it 

practices or renders its services, the 

identity of the owners of the enrolling 

entity, and information necessary to 

establish correct claims payments. We 

are adding a new CMS–855 Medicare 

Registration Application, the CMS– 

855C: Medicare Enrollment Application 

for Registration of Eligible Entities That 

Provide Health Insurance Coverage 

Complementary to Medicare Part B. 

This Medicare registration application is 

to be completed by all entities that 

provide a complimentary health benefit 

plan and intend to bill Medicare as an 

indirect payment procedure (IPP) biller 

and the entity or health plan meets all 

Medicare requirements to submit claims 

for indirect payments. The entity must 

furnish the name of at least one 

authorized official, preferably the 

administrator of the health plan, who 

must sign this registration application 

attesting that the registering entity meets 

the requirements to register as an 

indirect payment procedure biller and 

will also abide by the requirements 

stated in the Certification & Attestation 

Statement in Section 10 of the 

application. 

The CMS–855C will be submitted at 

the time the applicant first requests a 

Medicare identification number for the 

sole purpose of submitting claims under 

the ‘‘Indirect Payment Procedure (IPP)’’ 

for reimbursement, and when necessary 

to report any changes to information 

previously submitted. The application 

will be used by Medicare contractors to 

collect data to ensure the applicant has 

the necessary credentials to submit 

Medicare claims for reimbursement, 

including information that allows 

Medicare contractors to ensure that the 

entity and its owners and administrators 

are not sanctioned from the Medicare 

program, or debarred, suspended or 

excluded from any other Federal agency 

or program. Form Number: CMS–855C 

(OCN: 0938—New); Frequency: 

Occasionally; Affected Public: Private 

sector—Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 440; Total Annual 

Responses: 440; Total Annual Hours: 

500. (For policy questions regarding this 

collection contact Kim McPhillips at 

410–786–5374.) 

Dated: October 29, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–26107 Filed 10–31–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1462–N] 

Medicare Program; Solicitation of Five 

Nominations to the Advisory Panel on 

Hospital Outpatient Payment (HOP, the 

Panel) 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice solicits 

nominations for five new members to 

the Advisory Panel on Hospital 

Outpatient Payment (HOP, the Panel). 

There are five vacancies on the Panel 

effective September 30, 2013. 

The purpose of the Panel is to advise 

the Secretary of the Department of 

Health and Human Services and the 

Administrator of the Centers for 

Medicare & Medicaid Services on the 

clinical integrity of the Ambulatory 

Payment Classification (APC) groups 

and their associated weights, and 

supervision of hospital outpatient 

services. 

The Secretary rechartered the Panel in 

2012 for a 2-year period effective 

through November 19, 2014. 

DATES: Submission of Nominations: We 

will consider nominations if they are 

received no later than 5 p.m. (e.s.t.) 

December 31, 2013. 

ADDRESSES: Please mail or hand deliver 

nominations to the following address: 

Centers for Medicare & Medicaid 

Services; Attn: Chuck Braver, Advisory 

Panel on HOP; Center for Medicare, 

Hospital & Ambulatory Policy Group, 

Division of Outpatient Care; 7500 

Security Boulevard; Mail Stop C4–05– 

17 Baltimore, MD 21244–1850. 

Web site: For additional information 

on the Panel and updates to the Panel’s 

activities, we refer readers to our Web 

site at the following address: http:// 

www.cms.gov/Regulations-andGuidance/Guidance/FACA/ 

AdvisoryPanelonAmbulatory

PaymentClassificationGroups.html. 

FOR FURTHER INFORMATION CONTACT: 

Persons wishing to nominate 

individuals to serve on the Panel or to 

obtain further information may contact 

Chuck Braver at the following email 

address: APCPanel@cms.hhs.gov or call 

(410) 786–3985. 

News Media: Representatives should 

contact the CMS Press Office at (202) 

690–6145. 

SUPPLEMENTARY INFORMATION: 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 212 / Friday, November 1, 2013 / Notices 65661 

I. Background 

The Secretary of the Department of 

Health and Human Services (the 

Secretary) is required by section 

1833(t)(9)(A) of the Social Security Act 

(the Act), and section 222 of the Public 

Health Service Act (PHS Act) to consult 

with an expert outside advisory panel 

regarding the clinical integrity of the 

Ambulatory Payment Classification 

(APC) groups and relative payment 

weights that are components of the 

Medicare Hospital Outpatient 

Prospective Payment System (OPPS), 

and the appropriate supervision level 

for hospital outpatient services. The 

Panel is governed by the provisions of 

the Federal Advisory Committee Act 

(FACA) (Pub. L. 92–463), as amended (5 

U.S.C. Appendix 2), which sets forth 

standards for the formation and use of 

advisory panels. The panel may 

consider data collected or developed by 

entities and organizations (other than 

the Department of Health and Human 

Services) as part of their deliberations. 

The Charter requires that the Panel 

meet up to three times annually. We 

consider the technical advice provided 

by the Panel as we prepare the proposed 

and final rules to update the OPPS for 

the following calendar year. 

The Panel shall consist of a chair and 

up to 19 members who are full-time 

employees of hospitals, hospital 

systems, or other Medicare providers 

that are subject to the OPPS. (For 

purposes of the Panel, consultants or 

independent contractors are not 

considered to be full-time employees in 

these organizations.) 

The current Panel members are as 

follows: (Note: The asterisk [*] indicates 

the Panel members whose terms end 

effective September 30, 2013.) 

• E.L. Hambrick, M.D., J.D., Chair, a 

CMS Medical Officer. 

• Karen Borman, M.D. 

• Ruth L. Bush, M.D., M.P.H.* 

• Lanny Copeland, M.D. 

• Kari S. Cornicelli, C.P.A., FHFMA 

• Dawn L. Francis, M.D., M.H.S.* 

• David A. Halsey, M.D.* 

• Brain D. Kavanagh, M.D., M.P.H. 

• Scott Manaker, M.D., Ph.D. 

• John Marshall, CRA, RCC, RT 

• Jim Nelson 

• Leah Osbahr 

• Jacqueline Phillips 

• Daniel J. Pothen, M.S., RHIA, CHPS, 

CPHIMS, CCS, CCS–P, CHC* 

• Gregory J. Przbylski, M.D.* 

• Traci Rabine 

• Michael Rabovsky, M.D. 

• Marianna V. Spanki-Varelas M.D., 

Ph.D., M.B.A. 

• Gale Walker 

• Kris Zimmer 

Panel members serve without 

compensation, according to an advance 

written agreement; however, for the 

meetings, CMS reimburses travel, meals, 

lodging, and related expenses in 

accordance with standard Government 

travel regulations. CMS has a special 

interest in ensuring, while taking into 

account the nominee pool, that the 

Panel is diverse in all respects of the 

following: geography; rural or urban 

practice; race, ethnicity, sex, and 

disability; medical or technical 

specialty; and type of hospital, hospital 

health system, or other Medicare 

provider subject to the OPPS. 

Based upon either self-nominations or 

nominations submitted by providers or 

interested organizations, the Secretary, 

or her designee, appoints new members 

to the Panel from among those 

candidates determined to have the 

required expertise. New appointments 

are made in a manner that ensures a 

balanced membership under the FACA 

guidelines. 

II. Criteria for Nominees 

The Panel must be fairly balanced in 

its membership in terms of the points of 

view represented and the functions to 

be performed. Each Panel member must 

be employed full-time by a hospital, 

hospital system, or other Medicare 

provider subject to payment under the 

OPPS. All members must have technical 

expertise to enable them to participate 

fully in the Panel’s work. Such expertise 

encompasses hospital payment systems; 

hospital medical care delivery systems; 

provider billing systems; APC groups; 

Current Procedural Terminology codes; 

and alpha-numeric Health Care 

Common Procedure Coding System 

codes; and the use of, and payment for, 

drugs, medical devices, and other 

services in the outpatient setting, as 

well as other forms of relevant expertise. 

For supervision deliberations, the Panel 

shall have members that represent the 

interests of Critical Access Hospitals 

(CAHs), who advise CMS only regarding 

the level of supervision for hospital 

outpatient services. 

It is not necessary for a nominee to 

possess expertise in all of the areas 

listed, but each must have a minimum 

of 5 years experience and currently have 

full-time employment in his or her area 

of expertise. Generally, members of the 

Panel serve overlapping terms up to 4 

years, based on the needs of the Panel 

and contingent upon the rechartering of 

the Panel. A member may serve after the 

expiration of his or her term until a 

successor has been sworn in. 

Any interested person or organization 

may nominate one or more qualified 

individuals. Self-nominations will also 

be accepted. Each nomination must 

include the following: 

• Letter of Nomination stating the 

reasons why the nominee should be 

considered. 

• Curriculum vitae or resume of the 

nominee. 

• Written and signed statement from 

the nominee that the nominee is willing 

to serve on the Panel under the 

conditions described in this notice and 

further specified in the Charter. 

• The hospital or hospital system 

name and address, or CAH name and 

address, as well as all Medicare hospital 

and or Medicare CAH billing numbers 

of the facility where the nominee is 

employee. 

III. Copies of the Charter 

To obtain a copy of the Panel’s 

Charter, we refer readers to our Web site 

at the following: http://www.cms.gov/

Regulations-and-Guidance/Guidance/

FACA/AdvisoryPanelonAmbulatory

PaymentClassificationGroups.html. 

IV. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare— 

Supplementary Medical Insurance Program). 

Dated: October 29, 2013. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2013–26258 Filed 10–31–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Food and Drug Administration 

[Docket No. FDA–2013–N–1161] 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request; Food Safety 

Survey 

AGENCY: Food and Drug Administration, 

HHS. 

ACTION: Notice. 

SUMMARY: The Food and Drug 

Administration (FDA or we) is 

announcing an opportunity for public 

comment on our proposed collection of 

certain information. Under the 

Paperwork Reduction Act of 1995 (the 


emcdonald on DSK67QTVN1PROD with NOTICES