Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Notices 59773 

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/Paperwork

ReductionActof1995. 

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–10538 Prior Authorization Form 

for Beneficiaries Enrolled in Hospice 

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: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Prior 

Authorization Form for Beneficiaries 

Enrolled in Hospice; Use: The form 

would be completed by the prescriber or 

the beneficiary’s hospice, or if the 

prescriber or hospice provides the 

information verbally to the Part D 

sponsor, the form would be completed 

by the sponsor. Information provided on 

the form would be used by the Part D 

sponsor to establish coverage of the drug 

under Medicare Part D. Per statute, 

drugs that are necessary for the 

palliation and management of the 

terminal illness and related conditions 

are not eligible for payment under Part 

D. The standard form provides a vehicle 

for the hospice provider, prescriber or 

sponsor to document that the drug 

prescribed is ‘‘unrelated’’ to the 

terminal illness and related conditions. 

It also gives a hospice organization the 

option to communicate a beneficiary’s 

change in hospice status and care plan 

to Part D sponsors. Form Number: CMS– 

10538 (OMB control number 0938-New; 

Frequency: Occasionally; Affected 

Public: Private sector (business or other 

for-profits); Number of Respondents: 

424; Total Annual Responses: 376,487; 

Total Annual Hours: 31,374. (For policy 

questions regarding this collection 

contact Shelly Winston at 410–786– 

3694). 

Dated: September 30, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–23613 Filed 10–2–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10237, CMS– 

10357 and CMS–10499] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

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 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 on the collection(s) of 

information must be received by the 

OMB desk officer by November 3, 2014. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 or Email: 

OIRA_submission@omb.eop.gov. 

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: Under the 

Paperwork Reduction Act of 1995 (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 (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-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 that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Part C— 

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59774 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Notices 

Medicare Advantage and 1876 Cost Plan 

Expansion Application; Use: The 

information will be collected under the 

solicitation of Part C applications from 

MA, EGWP Plan, and Cost Plan 

applicants and will be used to ensure 

that applicants meet our requirements 

and support the determination of 

contract awards. Participation in all 

programs is voluntary in nature; only 

organizations that are interested in 

participating in the program will 

respond to the solicitation. The MA– 

PDs that voluntarily participate in the 

Part C program must submit a Part D 

application and successful bid. The 

package has been revised subsequent to 

the publication of the 30-day Federal 

Register notice (July 11, 2014; 79 FR 

40105). Form Number: CMS–10237 

(OMB control number: 0938–0935); 

Frequency: Yearly; Affected Public: 

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

Number of Respondents: 566; Total 

Annual Responses: 566; Total Annual 

Hours: 22,625. (For policy questions 

regarding this collection contact Melissa 

Staud at 410–786–3669). 

2. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection: 

Title of Information Collection: Letter 

Requesting Waiver of Medicare/

Medicaid Enrollment Application Fee; 

Submission of Fingerprints; Submission 

of Medicaid Identifying Information; 

Medicaid Site Visit and Rescreening; 

Use: Section 6401 of the Affordable Care 

Act (ACA) establishes a number of 

important payment safeguard 

provisions. The provisions are designed 

to improve the integrity of the Medicare, 

Medicaid, and Children’s Health 

Insurance Programs (CHIP) so as to 

reduce fraud, waste and abuse. The 

provisions include the following: 

• Medicare Enrollment Application 

Fee Waiver Request: Certain providers 

and suppliers enrolling in Medicare will 

be required to submit a fee with their 

application. Under 42 CFR 424.514, if 

the applicant believes it has a hardship 

that justifies a waiver of the application 

fee, it may submit a letter describing 

said hardship. 

• Fingerprints: Certain providers and 

suppliers enrolling in Medicare, 

Medicaid, and CHIP will be required to 

submit fingerprints—either digitally or 

via the FD–258 standard fingerprint 

card—of their owners. 

• Suspension of Medicaid Payments: 

A State Medicaid agency shall suspend 

all Medicaid payments to a provider 

when there is a pending investigation of 

a credible allegation of Medicaid fraud 

against an individual or entity, unless it 

has good cause not to suspend payments 

or to suspend payment only in part. The 

State Medicaid agency may suspend 

payments without first notifying the 

provider of its intention to suspend 

such payments. A provider may request, 

and must be granted, administrative 

review where State law so requires. 

• Collection of Social Security 

Numbers (SSNs) and Dates of Birth 

(DOBs) for Medicaid and CHIP 

Providers: The State Medicaid agency or 

CHIP agency must require that all 

persons with an ownership or control 

interest in a Medicaid or CHIP provider 

submit their SSNs and DOBs. 

• Site Visits for Medicaid-only or 

CHIP-only providers: A State Medicaid 

agency or CHIP agency must conduct 

on-site visits for providers it determines 

to be ‘‘moderate’’ or ‘‘high’’ categorical 

risk. 

• Rescreening of Medicaid and CHIP 

Providers Every 5 Years: A State 

Medicaid agency or CHIP agency must 

screen all providers at least every 5 

years. This is consistent with the 

Medicare requirement in current 42 CFR 

424.515 that providers and suppliers 

revalidate their enrollment information 

at least every 5 years. 

Form Number: CMS–10357 (OMB 

control number: 0938–1137); Frequency: 

On occasion; Affected Public: Private 

sector—Business or for-profit and Notfor-profit institutions and State, Local, 

or Tribal Governments; Number of 

Respondents: 960,981; Total Annual 

Responses: 960,981; Total Annual 

Hours: 1,248,082. (For policy questions 

regarding this collection contact Frank 

Whelan at 410–786–1302). 

3. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Public Health 

Agency/Registry Readiness to Support 

Meaningful Use; Use: The Medicare and 

Medicaid Electronic Health Record 

(EHR) Incentive Programs provide 

incentives for the meaningful use of 

Certified Electronic Health Record 

Technology (CEHRT). We defined 

meaningful use as a set of objectives and 

measures in either Stage 1 or Stage 2 

depending on how long an eligible 

provider has participated in the 

program. Both Stage 1 (3 objectives) and 

Stage 2 (5 objectives) of meaningful use 

contain objectives and measures that 

require eligible providers to determine 

the readiness of public health agencies 

and registries to receive electronic data 

from CEHRT. Public comments on the 

notice of proposed rulemaking for Stage 

2 of meaningful use (77 FR 13697) 

asserted that the burden for each 

individual eligible provider to 

determine the readiness of multiple 

public health agencies and registries 

could be nearly eliminated if we were 

to maintain a database on the readiness 

of public health agencies and registries. 

In the final rule for Stage 2 of 

meaningful use (77 FR 53967), we 

agreed that the burden on eligible 

providers, public health agencies and 

registries would be greatly reduced and 

established that we would create such a 

database and it would serve as the 

definitive information source for 

determining public health agency and 

registry readiness to receive electronic 

data associated with the public health 

meaningful use objectives. The 

information will be made publicly 

available on the CMS Web site 

(www.cms.gov/EHRincentiveprograms) 

in order to provide a centralized 

repository of this information to eligible 

providers and eliminate there multiple 

individual inquiries to multiple public 

health agencies and registries. Form 

Number: CMS–10499 (OMB control 

number: 0938—New); Frequency: 

Yearly; Affected Public: Private sector— 

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

Respondents: 250; Total Annual 

Responses: 250; Total Annual Hours: 

83. (For policy questions regarding this 

collection contact Kathleen Connors de 

Laguna at 410–786–2256). 

Dated: September 30, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–23614 Filed 10–2–14; 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: Reunification Procedures for 

Unaccompanied Alien Children. 

OMB No.: 0970–0278. 

Description: Following the passage of 

the 2002 Homeland Security Act (Pub. 

L. 107–296), the Administration for 

Children and Families (ACF), Office of 

Refugee Resettlement (ORR), is charged 

with the care and placement of 

unaccompanied alien children in 

Federal custody, and implementing a 

policy for the release of these children, 

when appropriate, upon the request of 

suitable sponsors while awaiting 

immigration proceedings. In order for 

ORR to make determinations regarding 

the release of these children, the 

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