20366 Federal Register / Vol. 75, No. 74 / Monday, April 19, 2010 / Notices 

Hours: 242,376. (For policy questions 

regarding this collection contact 

Elizabeth Goldstein at 410–786–6665. 

For all other issues call 410–786–1326.) 

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Medicare Part C 

and Part D Data Validation (42 CFR 

422.516g and 423.514g); Use: 

Organizations contracted to offer 

Medicare Part C and Part D benefits are 

required to report data to the Centers for 

Medicare & Medicaid Services on a 

variety of measures. In order for the data 

to be useful for monitoring and 

performance measurement, the data 

must be reliable, valid, complete, and 

comparable among sponsoring 

organizations. To meet this goal, CMS is 

developing reporting standards and data 

validation specifications with respect to 

the Part C and Part D reporting 

requirements. These standards will 

provide a review process for Medicare 

Advantage Organizations (MAOs), Cost 

Plans, and Part D sponsors to use to 

conduct data validation checks on their 

reported Part C and Part D data. Form 

Number: CMS–10305 (OMB#: 0938– 

NEW); Frequency: Yearly; Affected 

Public: Business or other for-profit; 

Number of Respondents: 710; Total 

Annual Responses: 710; Total Annual 

Hours: 231,410. (For policy questions 

regarding this collection contact Terry 

Lied at 410–786–8973. For all other 

issues call 410–786–1326.) 

4. Type of Information Collection 

Request: New collection; Title of 

Information Collection: New Quality 

Measures for Medicare Advantage 

Organizations; Use: For CMS to 

strengthen the oversight of quality 

improvement programs implemented by 

Medicare Advantage organizations, 

there is a need to collect additional data 

on quality and outcomes measures in 

order to better track plan performance. 

Examples of additional areas on which 

CMS plans to collect data are postsurgical infections or patient falls. 

Collection will begin during contract 

year 2012. The specific data elements 

that will be collected are currently 

under development. Form Number: 

CMS–10313 (OMB#: 0938–NEW); 

Frequency: Yearly; Affected Public: 

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

Respondents: 624; Total Annual 

Responses: 624; Total Annual Hours: 

624,000. (For policy questions regarding 

this collection contact Sabrina Ahmed 

at 410–786–7499. 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.hhs.gov/ 

PaperworkReductionActof1995, or 

E-mail 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. 

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 June 18, 2010: 

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: April 13, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–8958 Filed 4–16–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–416 and CMS– 

R–297] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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: Annual Early 

and Periodic Screening, Diagnostic and 

Treatment (EPSDT) Services 

Participation Report; Form Number: 

CMS–416 (OMB#: 0938–0354); Use: 

States are required to submit an annual 

report on the provision of EPSDT 

services pursuant to section 

1902(a)(43)(D) of the Social Security 

Act. These reports provide CMS with 

data necessary to assess the 

effectiveness of State EPSDT programs, 

to determine a State’s results in 

achieving its participation goal and to 

respond to inquiries. Respondents are 

State Medicaid Agencies. The data is 

due April 1 of every year so States need 

to have the form and instructions as 

soon as possible in order to report 

timely. Frequency: Yearly; Affected 

Public: State, Tribal and Local 

governments; Number of Respondents: 

56; Total Annual Responses: 112; Total 

Annual Hours: 1,568. (For policy 

questions regarding this collection 

contact Cindy Ruff at 410–786–5916. 

For all other issues call 410–786–1326.) 

2. 1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Request for 

Employment Information; Use: Section 

1837(i) of the Social Security Act 

provides for a special enrollment period 

for individuals who delay enrolling in 

Medicare Part B because they are 

covered by a group health plan based on 

their own or a spouse’s current 

employment status. When these 

individuals apply for Medicare Part B, 

they must provide proof that the group 

health plan coverage is (or was) based 

on current employment status. This 

form is used by the Social Security 

Administration to obtain information 

from employers regarding whether a 

Medicare beneficiary’s coverage under a 

group health plan is based on current 

employment status. Form Number: 

CMS–R–297 (OMB#: 0938–0787); 

Frequency: Once; Affected Public: 

Private Sector: Business or other forprofits and Not-for-profit institutions; 

Number of Respondents: 5,000; Total 

Annual Responses: 5,000; Total Annual 

Hours: 1,250. (For policy questions 

regarding this collection contact Kevin 


wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
Federal Register / Vol. 75, No. 74 / Monday, April 19, 2010 / Notices 20367 

Simpson at 410–786–0017. 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.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. 

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 June 18, 2010: 

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: April 9, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–8901 Filed 4–16–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

[Document Identifier: CMS–10295, CMS– 

10234, CMS–10303, CMS–10066 and CMS– 

R–193] 

Centers for Medicare & Medicaid 

Services 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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: Recovery Act— 

Reporting Requirements for States 

Under FMAP Increase and TMA 

Provisions; Use: The American 

Recovery and Reinvestment Act of 2009 

(Recovery Act), Public Law 111–5, 

requires that States submit quarterly 

reports to the Secretary of Health and 

Human Services in accordance with 

section 5001 Temporary Increase of 

Medicaid Federal Medical Assistance 

Percentage (FMAP) and section 5004(d) 

Extension of Transitional Medical 

Assistance (TMA). The reports under 

section 5001 are required for the period 

of October 1, 2008–September 30, 2011. 

The reports under section 5004 are 

required beginning on July 1, 2009 until 

the Federal authority for TMA coverage 

sunsets (now scheduled to sunset on 

December 31, 2010). Each State 

Medicaid agency will submit its 

quarterly reports to the appropriate 

Regional Office of CMS. The reports will 

be compiled and summarized for annual 

reports to Congress. Form Number: 

CMS–10295 (OMB#: 0938–1073); 

Frequency: Reporting—Quarterly; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

50; Total Annual Responses: 200; Total 

Annual Hours: 600. (For policy 

questions regarding this collection 

contact Richard Strauss at 410–786– 

2019. For all other issues call 410–786– 

1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: State Plan Preprint implementing Section 6087 of the 

Deficit Reduction Act: Optional SelfDirection Personal Assistance Services 

(PAS) Program (Cash and Counseling); 

Form Number: CMS–10234 (OMB#: 

0938–1024); Use: Information submitted 

via the State Plan Amendment (SPA) 

pre-print is used by CMS and Regional 

Offices to analyze a State’s proposal to 

implement Section 6087 of the Deficit 

Reduction Act (DRA). State Medicaid 

Agencies will complete the SPA preprint, and submit it to CMS for a 

comprehensive analysis. The pre-print 

contains assurances, check-off items, 

and areas for States to describe policies 

and procedures for subjects such as 

quality assurance, risk management, and 

voluntary and involuntary 

disenrollment; Frequency: Reporting— 

Once; Affected Public: State, Local, or 

Tribal Government; Number of 

Respondents: 56; Total Annual 

Responses: 20; Total Annual Hours: 

400. (For policy questions regarding this 

collection contact Carrie Smith at 410– 

786–4485. For all other issues call 410– 

786–1326.) 

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Medicare 

Gainsharing Demonstration Evaluation: 

Physician Focus Groups; Use: The 

proposed physician focus groups are 

part of an overall evaluation of the 

Centers for Medicare & Medicaid 

Services CMS’ congressionally 

mandated Medicare Gainsharing 

Demonstration Evaluation. The 

Congress, under Section 5007 of the 

Deficit Reduction Act (DRA) of 2005, 

requires CMS to conduct a qualified 

gainsharing program to test alternative 

ways that hospitals and physicians can 

share in efficiency gains. The primary 

goal of the demonstration is to evaluate 

gainsharing as a means to align 

physician and hospital incentives to 

improve quality and efficiency. The 

demonstration has two mandated 

Reports to Congress. Results from 

physician focus groups will be included 

in both Reports to Congress. Form 

Number: CMS–10303 (OMB#: 0938– 

New); Frequency: Once; Affected Public: 

Private Sector, Business or other for 

profits; Number of Respondents: 192; 

Total Annual Responses: 96; Total 

Annual Hours: 96. (For policy questions 

regarding this collection contact 

William Buczko at 410–786–6593. For 

all other issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Detailed Notice 

of Discharge (DND); Use: A beneficiary/ 

enrollee who wishes to appeal a 

determination by a Medicare health 

plan or hospital that inpatient care is no 

longer necessary, may request Quality 

Improvement Organization (QIO) review 

of the determination. On the date the 

QIO receives the beneficiary’s/enrollee’s 

request, it must notify the plan and 

hospital that the beneficiary/enrollee 

has filed a request for an expedited 

determination. The plan (for a managed 

care enrollee) or hospital (for an original 


wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1