67298 Federal Register / Vol. 88, No. 188 / Friday, September 29, 2023 / Notices 

$100 established in 2003. In accordance 

with section 1869(b)(1)(E)(iii) of the Act, 

the adjusted threshold amounts are 

rounded to the nearest multiple of $10. 

Therefore, the CY 2024 AIC threshold 

amount for ALJ hearings is $180.00. The 

AIC threshold amount for judicial 

review changes to $1,837.02 based on 

the 83.702 percent increase over the 

initial threshold amount of $1,000. This 

amount was rounded to the nearest 

multiple of $10, resulting in the CY 

2024 AIC threshold amount of $1,840.00 

for judicial review. 

C. Summary Table of Adjustments in 

the AIC Threshold Amounts 

In the following table we list the CYs 

2020 through 2024 threshold amounts. 

CY 2020 CY 2021 CY 2022 CY 2023 CY 2024 

ALJ Hearing ......................................................................... $170 $180 $180 $180 $180 

Judicial Review .................................................................... 1,670 1,760 1,760 1,850 1,840 

III. Collection of Information 

Requirements 

This document announces the annual 

adjustment in the AIC threshold 

amounts. It does not impose any 

‘‘collection of information’’ 

requirements as defined under 5 CFR 

1320.3(c). Consequently, the notice is 

not subject to the requirements of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

The Administrator of the Centers for 

Medicare & Medicaid Services (CMS), 

Chiquita Brooks-LaSure, having 

reviewed and approved this document, 

authorizes Vanessa Garcia, who is the 

Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Vanessa Garcia, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2023–21500 Filed 9–28–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10718, CMS– 

10142 and CMS–10540] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 

the necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions, 

the accuracy of the estimated burden, 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected, and the use of automated 

collection techniques or other forms of 

information technology to minimize the 

information collection burden. 

DATES: Comments must be received by 

November 28, 2023. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number. 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, please access the CMS PRA 

website by copying and pasting the 

following web address into your web 

browser: https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William N. Parham at (410) 786–4669. 

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–10718 Model Medicare 

Advantage and Medicare Prescription 

Drug Plan Individual Enrollment 

Request Form 

CMS–10142 Bid Pricing Tool (BPT) for 

Medicare Advantage (MA) Plans and 

Prescription Drug Plans (PDP) 

CMS–10540 Quality Improvement 

Strategy Implementation Plan, 

Progress Report, and Modification 

Summary Supplement Forms 

Under the 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 Collection 

1. Type of Information Collection 

Request: Revision with change to the 

currently approved collection; Title of 

Information Collection: Model Medicare 

Advantage and Medicare Prescription 

Drug Plan Individual Enrollment 

Request Form; Use: The enrollment 

form is considered a ‘‘model’’ under 

Medicare regulations at §§ 422.2262 and 

423.2262, for purposes of 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 88, No. 188 / Friday, September 29, 2023 / Notices 67299 

communication and marketing review 

and approval; therefore, MA and Part D 

plans are able to modify the language, 

content, format, or order of the 

enrollment form. The model enrollment 

form includes the minimal amount of 

information to process the enrollment, 

located in Section 1 of the MA/PDP 

enrollment form, and other limited 

information, in Section 2, that the 

sponsor is required (i.e. race and 

ethnicity data, accessible format 

preference) or chooses (i.e. premium 

payment information) to provide to the 

beneficiary. 

CMS expects MA and PDP 

organizations to ensure the enrollment 

form complies with CMS’ instructions 

regarding content and format. New and 

current enrollees that utilize the 

enrollment form to elect an MA or Part 

D plan must acknowledge the 

requirement to: (1) maintain Medicare 

Part A and B to stay in MA, or Part A 

or B to stay in Part D; (2) reside in the 

plan’s service area; (3) make a valid 

request during a valid election period; 

(4) follow plan rules; (5) consent to the 

disclosure and exchange of information 

between the plan and CMS; and (6) 

enroll in only one Medicare health plan 

and that enrollment in the MA or Part 

D plan automatically disenrolls them 

from any other Medicare health plan 

and prescription drug plan. 

CMS will use this information to: 

track beneficiary enrollment, including 

tracking patterns in enrollment by race 

and ethnicity, sexual orientation, and 

gender identity over time; to identify, 

monitor, and develop effective and 

efficient strategies and incentives to 

reduce and eliminate health and health 

care inequities; to validate existing race 

and ethnicity imputation methods; and 

to ensure that clinically appropriate and 

equitable care (in terms of payment, 

access and quality) is consistently 

provided to all Medicare beneficiaries. 

Form Number: CMS–10718 (OMB 

control number: 0938–0832); Frequency: 

Occasionally; Affected Public: 

Individuals and Households, Private 

sector—(Business or other for-profits 

and Not-for-profit institutions); Number 

of Respondents: 19,815,897; Total 

Annual Responses: 39,632,597; Total 

Annual Hours: 10,557,541. (For policy 

questions regarding this collection 

contact AnhViet Nguyen at 410–786– 

4548). 

2. Type of Information Collection 

Request: Revision with change to the 

currently approved collection; Title of 

Information Collection: Bid Pricing Tool 

(BPT) for Medicare Advantage (MA) 

Plans and Prescription Drug Plans (PDP; 

Use: 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 CMS. The MAOs and PDPs 

use the Bid Pricing Tool (BPT) software 

to develop their actuarial pricing bid. 

The competitive bidding process 

defined by the ‘‘The Medicare 

Prescription Drug, Improvement, and 

Modernization Act’’ (MMA) applies to 

both the MA and Part D programs. It is 

an annual process that encompasses the 

release of the MA rate book in April, the 

bid’s that plans submit to CMS in June, 

and the release of the Part D and RPPO 

benchmarks, which typically occurs in 

August. Form Number: CMS–10142 

(OMB control number: 0938–0832); 

Frequency: Annually; Affected Public: 

Private sector—(Business or other forprofits and Not-for-profit institutions); 

555; Total Annual Responses: 4,995; 

Total Annual Hours: 149,850 (For 

policy questions regarding this 

collection contact Rachel Shevland at 

410–786–3026). 

3. Type of Information Collection 

Request: Extension of a previously 

approved collection; Title of 

Information Collection: Quality 

Improvement Strategy Implementation 

Plan, Progress Report, and Modification 

Summary Supplement Forms; Use: 

Section 1311(c)(1)(E) of the Affordable 

Care Act requires qualified health plans 

(QHPs) offered through an Exchange 

must implement a quality improvement 

strategy (QIS) as described in section 

1311(g)(1). Section 1311(g)(3) of the 

Affordable Care Act specifies the 

guidelines under Section 1311(g)(2) 

shall require the periodic reporting to 

the applicable Exchange the activities 

that a qualified health plan has 

conducted to implement a strategy as 

described in section 1311(g)(1). CMS 

intends to have QHP issuers complete 

the appropriate QIS forms annually for 

implementation and progress reporting 

of their quality improvement strategies. 

The QIS forms will include topics to 

assess an issuer’s compliance in creating 

a payment structure that provides 

increased reimbursement or other 

incentives to improve the health 

outcomes of plan enrollees, prevent 

hospital readmissions, improve patient 

safety and reduce medical errors, 

promote wellness and health, and 

reduce health and health care 

disparities, as described in Section 

1311(g)(1) of the Affordable Care Act. 

QIS forms will allow: (1) the 

Department of Health & Human Services 

(HHS) to evaluate the compliance and 

adequacy of QHP issuers’ quality 

improvement efforts, as required by 

Section 1311(c) of the Affordable Care 

Act, and (2) HHS will use the issuers’ 

validated information to evaluate the 

issuers’ quality improvement strategies 

for compliance with the requirements of 

Section 1311(g) of the Affordable Care 

Act. Form Number: CMS–10540 (OMB 

control number: 0938–1286); Frequency: 

Annually; Affected Public: Public sector 

(Individuals and Households), Private 

sector (Business or other for-profits and 

not-for-profit institutions); Number of 

Respondents: 250; Total Annual 

Responses: 250; Total Annual Hours: 

4,933. (For policy questions regarding 

this collection contact Preeti Hans at 

301.492.5144). 

Dated: September 26, 2023. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2023–21523 Filed 9–28–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10710] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 

(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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 


lotter on DSK11XQN23PROD with NOTICES1