Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices 35445 

speech-language pathology services. It is 

used by the State agencies to enter new 

provider into the Automated Survey 

Process Environment (ASPEN). CMS– 

1893 is used by the State survey agency 

to record data collected during an onsite survey of a provider of outpatient 

physical therapy and/or speechlanguage pathology services, to 

determine compliance with the 

applicable conditions of participation, 

and to report this information to the 

Federal government. The form is 

primarily a coding worksheet designed 

to facilitate data reduction and retrieval 

into the ASPEN system. The 

information needed to make 

certification decisions is available to 

CMS only through the use of 

information abstracted from the form; 

Form Numbers: CMS–1856 and CMS– 

1893 (OMB#: 0938–0065); Frequency: 

Annually, occasionally; Affected Public: 

Private Sector; Business or other forprofit and not-for-profit institutions; 

Number of Respondents: 2,968; Total 

Annual Responses: 495; Total Annual 

Hours: 866. (For policy questions 

regarding this collection contact Georgia 

Johnson at 410–786–6859. For all other 

issues call 410–786–1326.) 

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 by the OMB desk officer at 

the address below, no later than 5 p.m. 

on July 18, 2011: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–6974, E-mail: 

OIRA_submission@omb.eop.gov. 

Dated: June 14, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–15057 Filed 6–16–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10334 and CMS– 

10373] 

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: Revision of a currently 

approved collection; Title of 

Information Collection: Application for 

Coverage in the Pre-Existing Condition 

Insurance Plan; Use: The Department of 

Health and Human Services (HHS) 

Centers for Medicare & Medicaid 

Services, Center for Consumer 

Information and Insurance Oversight is 

requesting clearance by the Office of 

Management and Budget for 

modifications to this previously 

approved collection package. These 

changes are being requested to (1) 

provide a mechanism for a PCIP 

enrollee who has moved from a stateadministered PCIP to quickly and 

efficiently enroll into the federallyadministered PCIP (2) provide a 

mechanism for a PCIP applicant to 

identify a third party entity will pay 

their premium to ensure appropriate 

premium billing (3) provide a 

mechanism whereby a licensed 

insurance agent or broker may identify 

their referral of an applicant (4) request 

employer information to expand ways to 

identify and prevent instances of insurer 

dumping and (5) make clarifications to 

existing application language. Form 

Number: CMS–10334 (OCN: 0938–1095) 

Frequency: Once; Affected Public: 

Individuals or households; Number of 

Respondents: 83,333; Number of 

Responses: 83,333; Total Annual Hours: 

179,499. (For policy questions regarding 

this collection, contact Laura Dash at 

410–786–8623. For all other issues call 

(410) 786–1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medical Loss 

Ratio Quarterly Reporting; Use: Under 

Section 2718 of the Affordable Care Act 

and implementing regulations at 45 CFR 

Part 158 (75 FR 74865, December 1, 

2010) as modified by technical 

corrections on December 30, 2010 (75 

FR 82277), 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, 

non-claims costs, Federal and State 

taxes and licensing or regulatory fees, 

and the amount of earned premium. An 

issuer must provide an annual rebate to 

enrollees if the amount it spends on 

certain costs compared to its premium 

revenue (excluding Federal and States 

taxes and licensing or 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 is effective January 

1, 2011. Issuers are required to submit 

annual MLR reporting data for each 

large group market, small group market, 

and individual market within each State 

in which the issuer conducts business. 

For policies that have a total annual 

limit of $250,000 or less (sometimes 

referred to as ‘‘mini-med plans’’) and for 

group policies that primarily cover 

employees working outside the United 

States (referred to as ‘‘expatriate plans’’), 

the IFR applies a special circumstance 

adjustment to the MLR data for the 2011 

MLR reporting year. In order to evaluate 

the appropriateness of this special 

circumstance adjustment for years 2012 

and beyond, issuers that provide such 

policies are required to submit quarterly 

MLR data to the Secretary for the 2011 

MLR reporting year. We received several 

comments in response to the emergency 

30-day comment period that was 

associated with CMS–10373. We have 

taken into consideration all of the 

revisions that were proposed and have 

amended the quarterly reporting form to 

include issuer contact information and 


emcdonald on DSK2BSOYB1PROD with NOTICES
35446 Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices 

technical amendments to better align 

the proposed quarterly reporting form to 

the reporting forms that issuers submit 

to the National Association of Insurance 

Commissioners (NAIC). We have also 

amended the form to create two 

separate, but practically identical, forms 

with corresponding instructions, so as 

to allow issuers to nationally aggregate 

the experience of expatriate plans and to 

allow issuers to separately report the 

experience of mini-med plans and 

expatriate plans. We have also supplied 

the instructions in a separate document 

rather than at the bottom of each 

reporting form. Form Number: CMS– 

10373 (OCN: 0938–1132); Frequency: 

Quarterly; Affected Public: Private 

Sector: Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 75; Number of Responses: 

825; Total Annual Hours: 51,480. (For 

policy questions regarding this 

collection, contact Carol Jimenez at 

(301) 492–4109. For all other issues, call 

(410) 786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web site 

at http://www.cms.gov/ 

PaperworkReductionActof1995/PRAL/ 

list.asp#TopOfPage 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 at 410–786– 

1326. 

In commenting on the proposed 

information collections, please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by August 16, 2011: 

1. Electronically. You may submit 

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) 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, Room C4–26–05, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: June 14, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–15072 Filed 6–16–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–1856 and CMS– 

1893, CMS–10381 and CMS–10342] 

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: (CMS–1856) 

Request for Certification in the Medicare 

and/or Medicaid Program to Provide 

Outpatient Physical Therapy and/or 

Speech Pathology Services, and (CMS– 

1893) Outpatient Physical Therapy— 

Speech Pathology Survey Report; Use: 

CMS–1856 is used as an application to 

be completed by providers of outpatient 

physical therapy and/or speechlanguage pathology services requesting 

participation in the Medicare and 

Medicaid programs. This form initiates 

the process for obtaining a decision as 

to whether the conditions of 

participation are met as a provider of 

outpatient physical therapy and/or 

speech-language pathology services. It is 

used by the State agencies to enter new 

provider into the Automated Survey 

Process Environment (ASPEN). CMS– 

1893 is used by the State survey agency 

to record data collected during an onsite survey of a provider of outpatient 

physical therapy and/or speechlanguage pathology services, to 

determine compliance with the 

applicable conditions of participation, 

and to report this information to the 

Federal government. The form is 

primarily a coding worksheet designed 

to facilitate data reduction and retrieval 

into the ASPEN system. The 

information needed to make 

certification decisions is available to 

CMS only through the use of 

information abstracted from the form; 

Form Numbers: CMS–1856 and CMS– 

1893 (OMB#: 0938–0065); Frequency: 

Annually, occasionally; Affected Public: 

Private Sector; Business or other forprofit and not-for-profit institutions; 

Number of Respondents: 2,968; Total 

Annual Responses: 495; Total Annual 

Hours: 866. (For policy questions 

regarding this collection contact Georgia 

Johnson at 410–786–6859. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Version 5010/ 

ICD–10 Industry Readiness Assessment, 

Use: The Health Insurance Portability 

and Accountability Act of 1996 (HIPAA) 

requires the Secretary of HHS to adopt 

transaction standards that covered 

entities are required to use when 

electronically conducting certain health 

care administrative transactions, such as 

claims, remittance, eligibility and 

claims status requests and responses. 

Accordingly, on January 16, 2009, HHS 

published final rules adopting by 

regulation two sets of standards for 

HIPAA transactions: Version 5010 

standards for eight types of electronic 

health care transactions (claims, 

eligibility inquiries, remittance advices, 

etc.) and ICD–10 code set standards. The 

final rules set compliance dates of 

January 1, 2012 for Version 5010 

standards and October 1, 2013 for ICD– 

10 standards. HIPAA transactions not 

meeting the standards by those dates 

will be rejected. The final rules also 

outlined interim milestones that 

organizations should meet in order to 

achieve compliance by the required 

dates. For Version 5010, these interim 

milestones include completing internal 

testing and being able to send and 

receive compliant transactions by 

December 2010, commencing external 

testing with trading partners by January 

2011, and completing that testing and 

moving into production by the 

compliance date of January 1, 2012. 


emcdonald on DSK2BSOYB1PROD with NOTICES