Federal Register / Vol. 78, No. 226 / Friday, November 22, 2013 / Notices 70059 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10502, CMS– 

10503, CMS–10504, CMS–10509, CMS– 

10418 and CMS–10157] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Notice. 

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 

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 

January 21, 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 ll, 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–10502 LTCH Quality Reporting 

Program: Program Evaluation 

CMS–10503 Inpatient Rehabilitation 

Facilities (IRF) Quality Reporting Program 

(QRP): Program Evaluation 

CMS–10504 Hospice Quality Reporting 

Program: Program Evaluation 

CMS–10509 Prospective Evaluation of 

Evidence-Based Community Wellness and 

Prevention Programs 

CMS–10418 Annual MLR and Rebate 

Calculation Report and MLR Rebate 

Notices 

CMS–10157 HIPAA Eligibility Transaction 

System (HETS) Trading Partner Agreement 

(TPA) 

Under the Paperwork Reduction Act 

(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 Collections 

1. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Long Term Care 

Hospital Quality Reporting Program: 

Program Evaluation; Use: Section 

3004(a) of the Affordable Care Act 

(ACA) mandated that we establish a 

quality reporting program for Long Term 

Care Hospitals (LTCHs). Specifically, 

section 3004(a) added section 

1886(m)(5) to the Social Security Act 

(the Act) to establish a quality reporting 

program for LTCHs. This program 

requires that quality data be submitted 

by LTCH providers in a time, form and 

manner specified by the Secretary. 

We are interested in exploring how 

LTCH providers are responding to the 

new quality reporting program (QRP) 

and its measures. We believe that it is 

important to understand early trends in 

outcomes, to make adjustments as 

needed to enhance the effectiveness of 

the program, and to seek opportunities 

to minimize provider burden, and 

ensure the QRP is useful and 

meaningful to providers. The 

methodology employed in the 

evaluation is the utilization of 

qualitative interviews (as opposed to 

quantitative statistical methods). In 

consultation with research experts, we 

have decided that at this juncture it 

would be meaningful to use a rich, 

contextual approach to evaluate the 

process and success of the QRP 

initiative. 

The decision to pursue this 

quantitative methodology in 2013, in 

which we learned that providers are 

anxious to have their voice heard, but 

that they did not feel comfortable 

expressing themselves fully in public 

open door forums. Providers desired 

some level of confidentiality, which this 

methodology affords. The intended use 

of the information collected is to help 

inform us about CMS providers’ 

experiences related to the QRPs, such as 

program impact related to quality 

improvement, burden, process-related 

issues, and education. This will also 

inform future measurement 

development for the LTCH QRP, future 

steps related to data validation, as well 

as future monitoring and evaluation. 

General findings may be used to discuss 

our future efforts in the QRP. Form 

Number: CMS–10502 (OCN: 0938– 

NEW); Frequency: Occasionally; 

Affected Public: Private sector— 

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

Respondents: 30; Total Annual 

Responses: 30; Total Annual Hours: 71. 

(For policy questions regarding this 


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70060 Federal Register / Vol. 78, No. 226 / Friday, November 22, 2013 / Notices 

collection contact Caroline Gallaher at 

410–786–8705.) 

2. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Inpatient 

Rehabilitation Facilities Quality 

Reporting Program: Program Evaluation; 

Use: Section 3004 of the Affordable Care 

Act (ACA) mandated that we establish 

a quality reporting program for Inpatient 

Rehabilitation Facilities (IRFs). 

Specifically, section 3004(a) added 

section 1886(j)(7) to the Social Security 

Act (‘‘the Act’’) to establish a quality 

reporting program (QRP) for IRFs. This 

program requires IRFs to submit quality 

data in a time, form and manner 

specified by the Secretary. 

We are interested in exploring how 

IRF providers are responding to the new 

QRP and its measures. We believe that 

it is important to understand early 

trends in outcomes, to make 

adjustments as needed to enhance the 

effectiveness of the program, and to seek 

opportunities to minimize provider 

burden, and ensure the quality reporting 

program is useful and meaningful to the 

providers. The methodology employed 

in the evaluation is the utilization of 

qualitative interviews (as opposed to 

quantitative statistical methods). In 

consultation with research experts, we 

have decided that at this juncture it 

would be meaningful to use a rich, 

contextual approach to evaluation the 

process and success of the QRP 

initiative. The decision to pursue this 

quantitative methodology in 2013, in 

which we learned that providers are 

anxious to have their voice heard, but 

that they did not feel comfortable 

expressing themselves fully in public 

open door forums. Providers desired 

some level of confidentiality, which this 

methodology affords. 

The intended use of the information 

collected is to help inform CMS 

providers’ experiences related to the 

QRPs, such as program impact related to 

quality improvement, burden, processrelated issues, and education. This will 

also inform future measurement 

development for the IRF QRP, future 

steps related to data validation, as well 

as future monitoring and evaluation. 

General findings may be used to discuss 

our future efforts in the QRP. Form 

Number: CMS–10503 (OCN: 0938– 

NEW); Frequency: Occasionally; 

Affected Public: Private sector— 

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

Respondents: 30; Total Annual 

Responses: 30; Total Annual Hours: 71. 

(For policy questions regarding this 

collection contact Caroline Gallaher at 

410–786–8705.) 

3. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Hospice Quality 

Reporting Program: Program Evaluation; 

Use: Section 3004(c) of the Affordable 

Care Act (ACA) mandated that we 

establish a quality reporting program 

(QRP) for hospices. Specifically, section 

3004(c) added section 1814(i)(5) to the 

Social Security Act (the Act) to establish 

a quality reporting program for 

hospices. This program requires that 

quality data be submitted by hospice 

providers in a time, form and manner 

specified by the Secretary. 

We are interested in exploring how 

hospice providers are responding to the 

new QRP and its measures. We believe 

that it is important to understand early 

trends in outcomes, to make 

adjustments as needed to enhance the 

effectiveness of the program, and to seek 

opportunities to minimize provider 

burden, and ensure the quality reporting 

program is useful and meaningful to the 

providers. The methodology employed 

in the evaluation is the utilization of 

qualitative interviews (as opposed to 

quantitative statistical methods). In 

consultation with research experts, we 

have decided that at this juncture it 

would be meaningful to use a rich, 

contextual approach to evaluation the 

process and success of the QRP 

initiative. The decision to pursue this 

quantitative methodology in 2013, in 

which we learned that providers are 

anxious to have their voice heard, but 

that they did not feel comfortable 

expressing themselves fully in public 

open door forums. Providers desired 

some level of confidentiality, which this 

methodology affords. 

The intended use of the information 

collected is to help inform CMS 

providers’ experiences related to the 

QRPs, such as program impact related to 

quality improvement, burden, processrelated issues, and education. This will 

also inform future measurement 

development for the hospice QRP, 

future steps related to data validation, as 

well as future monitoring and 

evaluation. General findings may be 

used to discuss our future efforts in the 

QRP. Form Number: CMS–10504 (OCN: 

0938–NEW); Frequency: Occasionally; 

Affected Public: Private sector— 

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

Respondents: 30; Total Annual 

Responses: 30; Total Annual Hours: 71. 

(For policy questions regarding this 

collection contact Caroline Gallaher at 

410–786–8705.) 

4. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Prospective 

Evaluation of Evidence-Based 

Community Wellness and Prevention 

Programs; Use: Section 4202(b) of the 

Affordable Care Act (ACA) mandated 

that we conduct an evidence review and 

independent evaluation of wellness 

programs focusing on the following six 

intervention areas: Chronic disease selfmanagement, increasing physical 

activity, reducing obesity, improving 

diet and nutrition, reducing falls, and 

mental health management. In response 

to the ACA mandate, we adopted a 

three-phase approach to evaluate the 

impact of wellness programs on 

Medicare beneficiary health, utilization, 

and costs to determine whether broader 

Medicare beneficiary participation in 

wellness programs could lower future 

growth in Medicare spending. Phase I 

consisted of a comprehensive literature 

review and environmental scan to 

identify a list of wellness programs for 

further evaluation. Phase II involved a 

retrospective evaluation of 10 wellness 

programs in the targeted intervention 

areas mentioned above. The purpose of 

the Phase II evaluation was to use 

Medicare claims data to assess the 10 

wellness programs’ impact on Medicare 

beneficiary outcomes including health 

service utilization and medical costs. 

The findings in Phase II were promising 

in that several wellness programs 

demonstrated the potential to save 

medical costs among participating 

beneficiaries. 

Phase III of our evaluation, of which 

this work is the key component, aims to 

round out our understanding of how 

wellness programs affect Medicare 

beneficiaries and what cost saving 

opportunities exist for the Medicare 

program. This evaluation effort will (1) 

describe the overall distribution of 

readiness to engage with wellness 

programs in the Medicare population, 

(2) better adjust for selection biases of 

individual programs and interventions 

using beneficiary level survey data, (3) 

evaluate program impacts on health 

behaviors, self-reported health 

outcomes, and claims-based measures of 

utilization and costs, and (4) better 

describe program implementation, 

operations and cost in relation to the 

expected benefits. The results of these 

analyses will be used to inform wellness 

and prevention activities in the future. 

To achieve the goals of this project, 

we will be conducting a nationally 

representative survey of Medicare 

beneficiaries to assess their readiness to 

participate in community-based 

wellness programs. National estimates 

of Medicare beneficiary demand for 

wellness services and benefits will be 

generated from this population-based 


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Federal Register / Vol. 78, No. 226 / Friday, November 22, 2013 / Notices 70061 

readiness national survey. In addition, 

we will partner with evidence-based 

wellness programs for the purposes of 

enrolling an estimated 2,000 

participants per program. Surveys of 

program participants will be conducted 

to assess program impacts on health and 

behavior. Form Number: CMS–10509 

(OCN: 0938–NEW); Frequency: Semiannually; Affected Public: Individuals 

and households; Number of 

Respondents: 20,833; Total Annual 

Responses: 45,420; Total Annual Hours: 

18,531. (For policy questions regarding 

this collection contact Benjamin Howell 

at 410–786–4942.) 

5. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Annual MLR 

and Rebate Calculation Report and MLR 

Rebate Notices; Use: Under Section 

2718 of the Affordable Care Act and 

implementing regulation at 45 CFR Part 

158, a health insurance issuer (issuer) 

offering group or individual health 

insurance coverage must submit a report 

to the Secretary concerning the amount 

the issuer spends each year on claims, 

quality improvement expenses, nonclaims costs, Federal and State taxes 

and licensing and regulatory fees, and 

the amount of earned premium. An 

issuer must provide an annual rebate if 

the amount it spends on certain costs 

compared to its premium revenue 

(excluding Federal and States taxes and 

licensing and regulatory fees) does not 

meet a certain ratio, referred to as the 

medical loss ratio (MLR). An interim 

final rule (IFR) implementing the MLR 

was published on December 1, 2010 (75 

FR 74865) and modified by technical 

corrections on December 30, 2010 (75 

FR 82277), which added Part 158 to 

Title 45 of the Code of Federal 

Regulations. The IFR was effective 

January 1, 2011. A final rule regarding 

selected provisions of the IFR was 

published on December 7, 2011 (76 FR 

76574) and an interim final rule 

regarding an issue not included in 

issuers’ reporting obligations 

(disbursement of rebates by non-federal 

governmental plans) was also published 

December 7, 2011 (76 FR 76596) Both 

rules published on December 7, 2011 

and were effective January 1, 2012. Each 

issuer is required to submit annually 

MLR data, including information about 

any rebates it must provide, on a form 

we prescribed, for each State in which 

the issuer conducts business. Each 

issuer is also required to provide a 

rebate notice to each policyholder that 

is owed a rebate and each subscriber of 

policyholders that are owed a rebate for 

any given MLR reporting year. 

Additionally, each issuer is required to 

maintain for a period of seven years all 

documents, records and other evidence 

that support the data included in each 

issuer’s annual report to the Secretary. 

Based upon HHS’ experience in the 

MLR data collection and evaluation 

process, HHS is updating its annual 

burden hour estimates to reflect the 

actual numbers of submissions, rebates 

and rebate notices. The 2013 MLR 

Reporting Form and instructions also 

reflect changes for the 2013 reporting 

year and beyond that are set forth in the 

March 2012 update to 45 CFR 

158.120(d)(5) regarding aggregation of 

student health plans on a nationwide 

basis, similar to expatriate plans. The 

instructions also addresses recent 

applicability guidance issued by the 

Departments of Labor, Treasury and 

HHS concerning expatriate plan 

reporting prior to plan years ending 

before or on December 31, 2015. In 

2014, it is expected that issuers will 

send fewer notices and rebate checks to 

policyholders and subscribers which 

will reduce burden on issuers. On the 

other hand, the requirement to report 

data on student health plans will 

increase burden for some issuers. It is 

estimated that there will be a net 

reduction in total information collection 

burden. Form Number: CMS–10418 

(OCN: 0938–1164); Frequency: 

Annually; Affected Public: Private 

sector—Business or other for-profits and 

not-for-profit institutions; Number of 

Respondents: 522; Number of 

Responses: 3,394; Total Annual Hours: 

294,911. (For policy questions regarding 

this collection, contact Julie McCune at 

(301) 492–4196.) 

6. Type of Information Collection 

Request: Reinstatement of a previously 

approved collection; Title of 

Information Collection: HIPAA 

Eligibility Transaction System (HETS) 

Trading Partner Agreement (TPA); Use: 

The HIPAA Eligibility Transaction 

System (HETS) is intended to allow the 

release of eligibility data to Medicare 

providers, suppliers or their authorized 

billing agents for the purposes of 

preparing accurate Medicare claims, 

determining beneficiary liability or 

determining eligibility for specific 

services. Such information may not be 

disclosed to anyone other than 

providers, suppliers or a beneficiary for 

whom a claim has been filed. Form 

Number: CMS–10157 (OCN: 0938– 

0960); Frequency: Yearly; Affected 

Public: Private sector—Business or other 

for-profit and not-for-profit institutions; 

Number of Respondents: 1,000; Total 

Annual Responses: 1,000; Total Annual 

Hours: 125. (For policy questions 

regarding this collection contact Ada 

Sanchez at 410–786–9466.) 

Dated: November 19, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–28049 Filed 11–21–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects 

Title: OCSE–75 Tribal Child Support 

Enforcement Program Annual Data 

Report. 

OMB No.: 0970–0320. 

Description: The data collected by 

form OCSE–75 are used to prepare the 

OCSE preliminary and annual data 

reports. In addition, Tribes 

administering CSE programs under Title 

IV–D of the Social Security Act are 

required to report program status and 

accomplishments in an annual narrative 

report and submit the OCSE–75 report 

annually. 

Respondents: Tribal Child Support 

Enforcement Organizations or the 

Department/Agency/Bureau responsible 

for Child Support Enforcement in each 

tribe. 

ANNUAL BURDEN ESTIMATES

Instrument Number of respondents Number of responses per 

respondent 

Average burden hours per 

response 

Total burden hours 

Estimated Total Annual Burden 

Hours: 3,600. 

In compliance with the requirements 

of Section 506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the 

Administration for Children and 


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