Federal Register / Vol. 72, No. 56 / Friday, March 23, 2007 / Notices 13793 

Dated: March 8, 2007. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E7–4901 Filed 3–22–07; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10095] 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Detailed 

Explanation of Non-Coverage and 

Notice of Medicare Non-Coverage and 

Supporting Regulations in 42 CFR 

422.624 and 42 CFR 422.626; Use: 

Providers will deliver a Notice of 

Medicare Non-Coverage to enrollees at 

least two days prior to the end of 

covered services in skilled nursing 

facilities, home health agencies, and 

comprehensive outpatient rehabilitation 

facilities. Enrollees will use this 

information to determine whether they 

wish to appeal the service termination 

to the Quality Improvement 

Organization (QIO) in their State. If the 

enrollee decides to appeal, the Medicare 

Health organization will send the QIO 

and the enrollee a Detailed Explanation 

of Non-Coverage detailing the rationale 

for the termination decision. Form 

Number: CMS–10095 (OMB#: 0938–

0910); Frequency: Reporting: Yearly; 

Affected Public: Business or other forprofit and Not-for-profit institutions; 

Number of Respondents: 454; Total 

Annual Responses: 47,558; Total 

Annual Hours: 23,780.52. 

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. 

Written comments and 

recommendations for the proposed 

information collections must be mailed 

or faxed within 30 days of this notice 

directly to the OMB desk officer: OMB 

Human Resources and Housing Branch, 

Attention: Carolyn Lovett, New 

Executive Office Building, Room 10235, 

Washington, DC 20503, Fax Number: 

(202) 395–6974. 

Dated: March 16, 2007. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E7–5296 Filed 3–22–07; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10216, CMS–R–

0053, CMS–179, CMS–10137, CMS–10069 

and CMS–R–246] 

Agency Information Collection 

Activities: Proposed Collection; 

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) 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 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. 

1. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Alternative 

Benefits State Plan Amendment Health 

Opportunity Accounts (HOA) 

Demonstration Program; Use: The DRA 

provides States with numerous 

flexibilities in operating their State 

Medicaid programs. For example, 

Section 6082 of the DRA allows up to 

10 States to operate Medicaid 

demonstrations to test alternative 

systems for delivering their Medicaid 

benefits. Under these demonstrations, 

States would have the flexibility to 

deliver their Medicaid benefits to 

volunteer beneficiaries through a 

program that is comprised of an HOA 

and a High Deductible Health Plan 

(HDHP). Under the DRA, States can 

submit a State Plan Pre-print to CMS to 

effectuate this change to their Medicaid 

programs. CMS will provide a State 

Medicaid Director letter providing 

guidance on this provision and the 

implementation of the DRA and the 

associated State Plan Amendment 

template for use by States to modify 

their Medicaid State Plans if they 

choose to implement this flexibility; 

Form Number: CMS–10216 (OMB#: 

0938–1007); Frequency: Reporting: Onetime; Affected Public: State, Local or 

tribal Government; Number of 

Respondents: 56; Total Annual 

Responses: 10; Total Annual Hours: 10. 

2. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Imposition of 

Cost Sharing Charges Under Medicare 

and Supporting Regulations Contained 

in 42 CFR 447.53; Use: The purpose of 

this collection is to ensure that States 

impose nominal cost sharing charges 

upon categorically and medically needy 

individuals as allowed by law and 

implementing regulations. States must 

identify in their State plan the 

following: (1) The service for which the 

charge is made; (2) The amount of the 

charge; (3) The basis for determining the 

charge; (4) The method used to collect 

the charge; (5) The basis for determining 

whether an individual is unable to pay 

the charge and the way in which the 

individual will be identified to 

providers; and, (6) The procedures for 

implementing and enforcing the 

exclusions from cost sharing; Form 


sroberts on PROD1PC70 with NOTICES
13794 Federal Register / Vol. 72, No. 56 / Friday, March 23, 2007 / Notices 

Number: CMS–R–0053 (OMB#: 0938–

0429); Frequency: Reporting: 

Occasionally; Affected Public: State, 

Local or tribal Government; Number of 

Respondents: 56; Total Annual 

Responses: 2; Total Annual Hours: 20. 

3. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Transmittal and 

Notice of Approval of State Plan 

Material and Supporting Regulations in 

42 CFR 430.10–430.20 and 440.167; 

Use: The CMS–179 is used by State 

agencies to transmit State plan material 

to the Centers for Medicare & Medicaid 

Services (CMS) for approval prior to 

amending their State plan. The State 

plan is the method in which States 

inform staff of State policies, standards, 

procedures and instructions. The CMS–

179 is currently used by State agencies 

administering the Medicaid program 

and CMS regional offices (RO). State 

agencies use the form to submit State 

plan amendments (SPAs) (including 

supporting documentation) to the CMS 

RO for review and approval prior to 

amending their plan in accordance with 

42 CFR 430.10–430.20. The CMS–179 

includes instructions for completing the 

form. The inclusion of instructions is to 

assist State agencies in completing the 

form, thereby ensuring a more uniform 

and timely plan amendment approval 

process. The CMS–179 is the only 

source available to State agencies for 

submittal/approval of SPAs. This plan 

amendment approval process is 

necessary to ensure the State plan 

continues to meet statutory and 

regulatory requirements and thereby 

ensure the State’s eligibility for Federal 

financial participation. CMS will use 

this information to track the estimated 

Federal budget impact associated with 

the SPAs. This information may result 

in more accurate Federal Medicaid 

expenditure estimates; Form Number: 

CMS–179 (OMB#: 0938–0193); 

Frequency: Reporting: Occasionally; 

Affected Public: State, Local or tribal 

Government; Number of Respondents: 

56; Total Annual Responses: 10; Total 

Annual Hours: 560. 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Application for 

Prescription Drug Plans (PDP); 

Application for Medicare Advantage 

Prescription Drug (MA–PD); 

Application for Cost Plans To Offer 

Qualified Prescription Drug Coverage; 

Application for Employer Group Waiver 

Plans To Offer Prescription Drug 

Coverage; Service Area Expansion 

Application for Prescription Drug 

Coverage; Use: Collection of this 

information is mandated in Part D of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003. The application requirements are 

codified in Subpart K of 42 CFR part 

423. Coverage for the prescription drug 

benefit is provided through prescription 

drug plans (PDPs) that offer drug-only 

coverage, or through Medicare 

Advantage (MA) organizations that offer 

integrated prescription drug and health 

care coverage (MA–PD plans). PDPs 

must offer a basic drug benefit. 

Medicare Advantage Coordinated Care 

Plans (MA–CCPs) must offer either a 

basic benefit or may offer broader 

coverage for no additional cost. 

Medicare Advantage Private Fee for 

Service Plans (MA–PFFS) may choose to 

offer a Part D benefit. Cost Plans that are 

regulated under Section 1876 of the 

Social Security Act, and Employer 

Group Plans may also provide a Part D 

benefit. If any of the contracting 

organizations meet basic requirements, 

they may also offer supplemental 

benefits through enhanced alternative 

coverage for an additional premium. 

The information will be collected 

under the solicitation of proposals from 

PDP, MA–PD, Cost Plan, and Employer 

Group Waiver Plans applicants. The 

collected information will be used by 

CMS to: (1) Insure that applicants meet 

CMS requirements, and (2) support the 

determination of contract awards. 

The major program change that has 

occurred in Part D applications was that 

CMS removed several attestations 

related to Health Insurance Portability 

and Accountability Act (HIPAA), bids 

and privacy; Form Number: CMS–10137 

(OMB#: 0938–0936); Frequency: 

Reporting: Once; Affected Public: 

Business or other for-profit and Not-forprofit institutions; Number of 

Respondents: 857; Total Annual 

Responses: 857; Total Annual Hours: 

28,122. 

5. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Medicare 

Waiver Demonstration Application; Use: 

The Medicare Waiver Demonstration 

Application will be used to collect 

standard information needed to 

implement congressionally mandated 

and administration high priority 

demonstrations. The application will be 

used to gather information about the 

characteristics of the applicant’s 

organization, benefits, and services they 

propose to offer, success in operating 

the model, and evidence that the model 

is likely to be successful in the Medicare 

program. The standard application will 

be used for all waiver demonstrations 

and will reduce the burden on 

applicants, provide for consistent and 

timely information collections across 

demonstrations, and provide a userfriendly format for respondents; Form 

Number: CMS–10069 (OMB#: 0938–

0880); Frequency: Reporting: Once; 

Affected Public: Business or other forprofit and Not-for-profit institutions; 

Number of Respondents: 75; Total 

Annual Responses: 75; Total Annual 

Hours: 6000. 

6. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Medicare 

CAHPS Survey; Use: The collection of 

Consumer Assessment of Healthcare 

Providers and Systems (CAHPS) Survey 

measures is necessary to hold health 

and prescription drug plans accountable 

for the quality of care and services they 

deliver. This requirement will allow 

CMS to obtain information for the 

proper oversight of the program. This 

information is used to help beneficiaries 

choose among plans, contribute to 

improved quality of care through 

identification of quality improvement 

opportunities, and assist CMS in 

carrying out its responsibilities; Form 

Number: CMS–R–246 (OMB#: 0938–

0732); Frequency: Reporting: Yearly; 

Affected Public: Individuals or 

households; Number of Respondents: 

660,000; Total Annual Responses: 

660,000; Total Annual Hours: 217,800. 

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 at the address below, no 

later than 5 p.m. on May 22, 2007. 

CMS, Office of Strategic Operations 

and Regulatory Affairs, Division of 

Regulations Development—A, 

Attention: Melissa Musotto, Room C4–

26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Dated: March 16, 2007. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E7–5297 Filed 3–22–07; 8:45 am] 

BILLING CODE 4120–01–P 


sroberts on PROD1PC70 with NOTICES