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[Federal Register Volume 80, Number 20 (Friday, January 30, 2015)]
[Notices]
[Pages 5118-5120]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-01790]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-R-306, CMS-10371, CMS-10392, CMS-10418, CMS-
10472, CMS-10494 and CMS-10549]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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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 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 must be received by March 31, 2015.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number (OCN). 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 ___, 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, 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:

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-R-306 Use of Restraint and Seclusion in Psychiatric Residential 
Treatment Facilities (PRTFs) for Individuals Under Age 21 and 
Supporting Regulations
CMS-10371 Cooperative Agreements to Support Establishment of State-
Operated Health Insurance Exchanges
CMS-10392 Consumer Operated and Oriented (CO-OP) Program
CMS-10418 Annual MLR and Rebate Calculation Report and MLR Rebate 
Notices
CMS-10472 Exchange Functions: Standards for Navigators and Non-
Navigator Assistance
CMS-10494 Standards for Navigators and Non-Navigator Assistance 
Personnel; Consumer Assistance Tools and Programs of an Exchange and 
Certified Application Counselors
CMS-10549 Generic Clearance for Questionnaire Testing and 
Methodological Research for the Medicare Current Beneficiary Survey 
(MCBS)

    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: Extension of a currently 
approved collection; Title of Information Collection: Use of Restraint 
and Seclusion in Psychiatric Residential Treatment Facilities (PRTFs) 
for Individuals Under Age 21 and Supporting Regulations; Use: 
Psychiatric residential treatment facilities are required to report 
deaths, serious injuries and attempted suicides to the State Medicaid 
Agency and the Protection and Advocacy Organization. They are also 
required to provide residents the restraint and seclusion policy in 
writing, and to document in the residents' records all activities 
involving the use of restraint and seclusion. Form Number: CMS-R-306 
(OMB Control Number 0938-0833); Frequency: Occasionally; Affected 
Public: Private sector (Business or other for-profits); Number of 
Respondents: 390; Total Annual Responses: 1,466,795; Total Annual 
Hours: 431,062. (For policy questions regarding this collection contact 
Cindy Ruff at 410-786-5916).
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Cooperative 
Agreements to Support Establishment of State-Operated Health Insurance 
Exchanges; Use: All States (including the 50 States, consortia of 
States, and the District of Columbia herein referred to as States) had 
the opportunity under Section 1311(b) of the Affordable Care to apply 
for three types of grants: (1) Planning grants; (2) Early Innovator 
grants for early development of information technology; and (3) 
Establishment grants to develop, implement and start-up Marketplaces. 
As of January 1st, 2015, the Secretary has disbursed over $5.4 billion 
under

[[Page 5119]]

this grant program and, as of that date, there were 79 active 
establishment grants awarded to 28 states. As the State-Based 
Marketplaces (SBM) and Small Business Health Options Program (SHOP) 
have matured and moved from the developmental phases to full-operation, 
the reporting requirements for the states have been modified and 
streamlined to insure only information necessary to provide effective 
oversight of their operations by CMS is collected. Given the innovative 
nature of Exchanges and the statutorily-prescribed relationship between 
the Secretary and States in their development and operation, it is 
critical that the Secretary work closely with States to provide 
necessary guidance and technical assistance to ensure that States can 
meet the prescribed timelines, federal requirements, and goals of the 
statute and the grants awarded to them. Form Number: CMS-10371 (OMB 
Control Number: 0938-1119); Frequency: Once; Affected Public: State 
Government agencies, non-profit entities; Number of Respondents: 28; 
Number of Responses: 48; Total Annual Hours: 31,404. (For policy 
questions regarding this collection contact Dena Pushkin at 301-492-
4342.)
    3. Type of Information Collection Request: Revision of a currently 
approved information collection; Title of Information Collection: 
Consumer Operated and Oriented (CO-OP) Program; Use: The Consumer 
Operated and Oriented Plan (CO-OP) program was established by Section 
1322 of the Affordable Care Act. This program provides for loans to 
establish at least one consumer-operated, qualified nonprofit health 
insurance issuer in each State. Issuers supported by the CO-OP program 
will offer at least one qualified health plan at the silver level of 
benefits and one at the gold level of benefits in the individual market 
State Health Benefit Exchanges (Exchanges). At least two-thirds of 
policies or contracts offered by a CO-OP will be open to individuals 
and small employers. Profits generated by the nonprofit CO-OPs will be 
used to lower premiums, improve benefits, improve the quality of health 
care delivered to their members, expand enrollment, or otherwise 
contribute to the stability of coverage offered by the CO-OP. By 
increasing competition in the health insurance market and operating 
with a strong consumer focus, the CO-OP program will provide consumers 
more choices, greater plan accountability, increased competition to 
lower prices, and better models of care, benefiting all consumers, not 
just CO-OP members.
    The CO-OP program will provide nonprofits with loans to fund start-
up costs and State reserve requirements, in the form of Start-up Loans 
and Solvency Loans. An applicant may apply for (1) joint Start-up and 
Solvency Loans; or (3) only a Solvency Loan. Planning Loans are 
intended to help loan recipients determine the feasibility of operating 
a CO-OP in a target market. Start-up Loans are intended to assist loan 
recipients with the many start-up costs associated with establishing a 
new health insurance issuer. Solvency Loans are intended to assist loan 
recipients with meeting the solvency requirements of States in which 
the applicant seeks to be licensed to issue qualified health plans. 
Form Number: CMS-10392 (OMB control number: 0938-1139); Frequency: 
Occasionally; Affected Public: Private sector (Not-for-profit 
institutions); Number of Respondents: 23; Total Annual Responses: 675; 
Total Annual Hours: 93,220. (For policy questions regarding this 
collection contact Deepti Loharikar 301-492-4126).
    4. Type of Information Collection Request: Revision of a currently 
approved information collection; Title of Information Collection: 
Annual MLR and Rebate Calculation Report and MLR Rebate Notices; Use: 
Under Section 2718 of the Affordable Care Act and implementing 
regulation at 45 CFR part 158, 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 and regulatory fees, the amount of earned 
premium, and beginning with the 2014 reporting year, the amounts 
related to the transitional reinsurance, risk adjustment, and risk 
corridors. An issuer must provide an annual rebate if the amount it 
spends on certain costs compared to its premium revenue (excluding 
Federal and States taxes and licensing and 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. A final rule 
regarding selected provisions of the IFR was published on December 7, 
2011 (76 FR 76574, CMS-9998-FC) and an interim final rule regarding an 
issue not included in issuers' reporting obligations (disbursement of 
rebates by non-federal governmental plans) was also published December 
7, 2011 (76 FR 76596, CMS-9998-IFC2). Both rules published on December 
7, 2011 are effective January 1, 2012. Each issuer is required to 
submit annually MLR data, including information about any rebates it 
must provide, on a form prescribed by CMS, for each State in which the 
issuer conducts business. Each issuer is also required to provide a 
rebate notice to each policyholder that is owed a rebate and each 
subscriber of policyholders that are owed a rebate for any given MLR 
reporting year. Additionally, each issuer is required to maintain for a 
period of seven years all documents, records and other evidence that 
support the data included in each issuer's annual report to the 
Secretary. Under Section 1342 of the Patient Protection and Affordable 
Care Act and implementing regulation at 45 CFR part 153, issuers of 
qualified health plans (QHPs) must participate in a risk corridors 
program. A QHP issuer is required to pay charges to or receive payments 
from CMS based on the ratio of the issuer's allowable costs to the 
target amount. A final rule (Premium Stabilization Rule) implementing 
the risk corridors program was published on March 23, 2012 (77 FR 
17220), which added Part 153 to Title 45 of the Code of Federal 
Regulations. The Premium Stabilization Rule is effective May 22, 2012. 
Final rules (2014 and 2015 Payment Notices) outlining the risk 
corridors benefit and payment parameters for the 2014 and 2015 benefit 
years were published on March 11, 2013 (78 FR 15410) and March 11, 2014 
(79 FR 13744), respectively. The 2014 and 2015 Payment Notices are 
effective April 30, 2013 and May 12, 2014, respectively. Each QHP 
issuer is required to submit an annual report to CMS concerning the 
issuer's allowable costs, allowable administrative costs, and the 
amount of premium.
    Based upon our experience in the MLR data collection and evaluation 
process, we are updating its annual burden hour estimates to reflect 
the actual numbers of submissions, rebates and rebate notices. In 
addition, we are updating its annual burden hour estimates to reflect 
the additional burden (published in the 2015 Payment Notice) related to 
the risk corridors data submission requirements.
    The 2014 MLR Reporting Form and instructions reflect changes for 
the 2014 reporting year and beyond that are set forth in the March 2013 
update to 45 CFR part 158 regarding the MLR reporting and rebate 
distribution deadlines and the accounting for the transitional 
reinsurance, risk

[[Page 5120]]

adjustment, and risk corridors. The 2014 MLR Reporting Form and 
instructions are also modified to include the reporting elements 
required under the risk corridors data submission requirements in 45 
CFR 153.530. In 2015, it is expected that issuers will send fewer 
notices and rebate checks to policyholders and subscribers, which will 
reduce burden on issuers. On the other hand, the requirement to report 
the risk corridors data will increase burden for QHP issuers. It is 
estimated that there will be a net reduction in total burden from 
294,911 to 271,600. Form Number: CMS-10418 (OMB control number: 0938-
1164); Frequency: Annually; Affected Public: Private Sector, Business 
or other for-profits and not-for-profit institutions; Number of 
Respondents: 517; Number of Responses: 3,307; Total Annual Hours: 
271,600. (For policy questions regarding this collection, contact Julie 
McCune at (301) 492-4196.)
    5. Type of Information Collection Request: Revision of a previously 
approved information collection; Title of Information Collection: 
Patient Protection and Affordable Care Act; Consumer Assistance Tools 
and Programs of an Exchange and Certified Application Counselors; 
Exchange and Insurance Market Standards for 2015; Use: Section 
1321(a)(1) of the Affordable Care Act directs and authorizes the 
Secretary to issue regulations setting standards for meeting the 
requirements under title I of the Affordable Care Act, with respect to, 
among other things, the establishment and operation of Exchanges. 
Pursuant to this authority, regulations have been finalized at 45 CFR 
155.215(b)(1) to require Navigators, as well as those non-Navigator 
personnel to whom 45 CFR 155.215 applies, requires completion of HHS 
approved training for initial certification and annual recertification 
prior to providing application and enrollment assistance. The training 
will include an optional training quality questionnaire providing 
Navigators and non-Navigator assistance personnel to whom 45 CFR 
155.215 applies, an opportunity to provide feedback to CMS regarding 
the training and any improvements that can be made in the future. Form 
Number: CMS-10472 (OMB Control Number: 0938-1220); Frequency: On 
Occasion; Affected Public: State, Local, or Tribal Governments, Private 
Sector (not-for-profit institutions); individuals or households; Number 
of Respondents: 5,610; Number of Responses: 5,610; Total Annual Hours: 
37,036. (For policy questions regarding this collection, contact 
Heather Raeburn at 301-492-4224.)
    6. Type of Information Collection Request: Revision of a previously 
approved information collection; Title of Information Collection: 
Patient Protection and Affordable Care Act; Consumer Assistance Tools 
and Programs of an Exchange and Certified Application Counselors; 
Exchange and Insurance Market Standards for 2015; Use: Section 
1321(a)(1) of the Affordable Care Act directs and authorizes the 
Secretary to issue regulations setting standards for meeting the 
requirements under title I of the Affordable Care Act, with respect to, 
among other things, the establishment and operation of Exchanges. 
Pursuant to this authority, regulations establishing the certified 
application counselor program have been finalized at 45 CFR 155.225. In 
accordance with 155.225(d)(1) and (7), certified application counselors 
in all Exchanges are required to be initially certified and recertified 
on at least an annual basis and successfully complete Exchange-required 
training. Form Number: CMS-10494 (OMB Control Number: 0938-1205); 
Frequency: On Occasion; Affected Public: State, Local, or Tribal 
Governments, Private Sector (Not-for-profit institutions); Individuals 
or Households; Number of Respondents: 30,000; Number of Responses: 
30,000; Total Annual Hours: 7,500. (For policy questions regarding this 
collection, contact Tricia Beckmann at 301-492-4328.)
    7. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Generic 
Clearance for Questionnaire Testing and Methodological Research for the 
Medicare Current Beneficiary Survey (MCBS); Use: The purpose of this 
OMB clearance package is to clear a Generic Clearance to support an 
effort to evaluate the operations and content of the Medicare Current 
Beneficiary Survey (MCBS). The MCBS is a continuous, multipurpose 
survey of a nationally representative sample of aged, disabled, and 
institutionalized Medicare beneficiaries. The MCBS, which is sponsored 
by the Centers for Medicare & Medicaid Services (CMS), is the only 
comprehensive source of information on the health status, health care 
use and expenditures, health insurance coverage, and socioeconomic and 
demographic characteristics of the entire spectrum of Medicare 
beneficiaries.
    The core of the MCBS is a series of interviews with a stratified 
random sample of the Medicare population, including aged and disabled 
enrollees, residing in the community or in institutions. Questions are 
asked about enrollees' patterns of health care use, charges, insurance 
coverage, and payments over time. Respondents are asked about their 
sources of health care coverage and payment, their demographic 
characteristics, their health and work history, and their family living 
circumstances. In addition to collecting information through the core 
questionnaire, the MCBS collects information on special topics through 
supplements. For example, questions are asked about enrollees' income 
and assets, access to health care, health and functional status and 
satisfaction with care. Special supplements also focus on emerging 
trends in health care. Form Number: CMS-10549 (OMB control number 0938-
New); Frequency: Occasionally; Affected Public: Individuals or 
Households; Number of Respondents: 1,500; Total Annual Responses: 
1,500; Total Annual Hours: 1,117. (For policy questions regarding this 
collection contact William Long at 410-786-7927.)

    Dated: January 27, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-01790 Filed 1-29-15; 8:45 am]
BILLING CODE 4120-01-P
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