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
Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices 35447 

Entities cannot implement ICD–10 

standards until they are in compliance 

with Version 5010; the interim 

milestone for ICD–10 is to begin 

compliance activities (gap analysis, 

design, development, internal testing) 

by January 2011. 

CMS has developed an education and 

communication campaign to support the 

adoption of and transition to Version 

5010 and ICD–10. The education and 

communication activities will be 

targeted towards the millions of 

professionals across the health care 

industry who must take steps to prepare 

for the implementation of the new codes 

and transaction standards. CMS is 

requesting Office of Management and 

Budget (OMB) approval to conduct 

survey research to monitor the health 

care industry’s awareness of, and 

preparation for, the transition to Version 

5010 and ICD–10. The aggregated data 

obtained through the survey will help 

inform CMS outreach and education 

efforts to help affected entities (health 

care providers, health plans, 

clearinghouses, and then vendors who 

service them) meet interim milestones 

and achieve timely compliance so that 

they can continue to process HIPAA 

transactions without interruption. 

CMS has contracted to conduct a 

tracking survey of populations charged 

with implementing Version 5010 and 

ICD–10 electronic transaction 

processing, specifically payers (health 

insurance plans and managed care 

organizations), providers (hospitals and 

primary care providers), and vendors 

(software providers, third-party billers 

and clearinghouses). A selfadministered web-based survey will be 

the data collection. The data collection 

field period is expected to be four weeks 

in Summer 2011. Form Number: CMS– 

10381 (OMB#: 0938–NEW); Frequency: 

Once; Affected Public: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

600; Total Annual Responses: 600; Total 

Annual Hours: 150. (For policy 

questions regarding this collection 

contact Rosali Topper at 410–786–7260. 

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

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Annual Limits 

Waiver Online Application Form; Use: 

Under section 2711(a)(2) of the Public 

Health Service Act, as amended by the 

Affordable Care Act section 1302(b), 

The Secretary of Health and Human 

Services is required to impose 

restrictions on the dollar value of 

essential benefits provided by new or 

existing group health plans or 

individual policies in the market 

between September 23, 2010 and 

January 1, 2014. The interim final 

regulations published June 28, 2010 (45 

CFR 147.126) give the Secretary the 

authority to waive these restricted 

annual limits if compliance would 

result in a significant increase in 

premium or significant decrease in 

access to benefits for those already 

covered. CMS is in the process of 

evaluating applications for waivers of 

annual limits and seeks to publish an 

updated Microsoft Excel spreadsheet to 

standardize and simplify the data 

collection process. Applicants must fill 

out (1) spreadsheet per application. The 

spreadsheet is a mandatory component 

of each waiver application necessary to 

fulfill the statutory requirements under 

section 2711(a)(2) of the Public Health 

Service Act. The information collected 

includes applicant contact information; 

information about the annual limit(s) on 

the overall plan or policy and on 

essential health benefits (as defined by 

the Affordable Care Act section 

1302(b)); information about plan design 

such as copayment, coinsurance, and 

deductibles; financial projections by 

enrollee tier; and a description of how 

a significant decrease in access to 

benefits would result from compliance 

with section 2711(a)(2) of the Affordable 

Care Act. This information is required to 

accurately and objectively assess 

whether compliance with the restricted 

annual limits would result in the 

aforementioned significant increase in 

premium or significant decrease in 

access to benefits, on which the grant of 

a waiver is conditioned in the interim 

final regulations. The updated 

spreadsheet contains a more detailed 

description of what values should be 

entered into each cell. This description 

should save applicants time when 

completing the spreadsheet initially, 

and it should lessen the need for 

applicants to go back and correct 

mistakes after submission. Form 

Number: CMS–10342 (OCN: 0938– 

1105); Frequency: Annually; Affected 

Public: Private Sector; Number of 

Respondents: 4,872; Number of 

Responses: 4,608,372; Total Annual 

Hours: 178,183. (For policy questions 

regarding this collection, contact Erika 

Kottenmeier at (301) 492–4170. 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, Email: OIRA_submission@omb.eop.gov. 

Dated: June 14, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–15071 Filed 6–16–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Child and Family Services Plan 

(CFSP), Annual Progress and Servicers 

Review (ASPR), and Annual Budget 

Expenses Request and Estimated 

Expenditures (CFS–101). 

OMB No.: 0980–0047. 

Description 

Under title IV–B, subparts 1 and 2, of 

the Social Security Act (the Act), States, 

Territories, and Tribes are required to 

submit a Child and Family Services 

Plan (CFSP). The CFSP lays the 

groundwork for a system of coordinated, 

integrated, and culturally relevant 

family services for the subsequent five 

years (45 CFR 1357.15(a)(1)). The CFSP 

outlines initiatives and activities the 

State, Tribe or territory will carry out in 

administering programs and services to 

promote the safety, permanency, and 

well-being of children and families. By 

June 30 of each year, States, Territories, 

and Tribes are also required to submit 

an Annual Progress and Services Report 

(APSR) and a financial report called the 

CFS–101. The APSR is a Yearly report 

that discusses progress made by a State, 

Territory or Tribe in accomplishing the 

goals and objectives cited in its CFSP 

(45 CFR 1357.16(a)). The APSR contains 

new and updated information about 

service needs and organizational 

capacities throughout the five-year plan 

period. The CFS–101 has three parts. 

Part I is an annual budget request for the 

upcoming fiscal year. Part II includes a 

summary of planned expenditures by 


emcdonald on DSK2BSOYB1PROD with NOTICES