26034 Federal Register / Vol. 78, No. 86 / Friday, May 3, 2013 / Notices 

performance. Such data uses require 

more rigorous designs that address: the 

target population to which 

generalizations will be made, the 

sampling frame, the sample design 

(including stratification and clustering), 

the precision requirements or power 

calculations that justify the proposed 

sample size, the expected response rate, 

methods for assessing potential nonresponse bias, the protocols for data 

collection, and any testing procedures 

that were or will be undertaken prior 

fielding the study. Depending on the 

degree of influence the results are likely 

to have, such collections may still be 

eligible for submission for other generic 

mechanisms that are designed to yield 

quantitative results. 

The Agency received no comments in 

response to the 60-day notice published 

in the Federal Register on December 22, 

2010 (75 FR 80542, pages 80542–80543). 

This is a new collection of 

information. Respondents will be 

screened and selected from Individuals 

and Households, Businesses, 

Organizations, and/or State, Local or 

Tribal Government. Below we provide 

CDC’s projected annualized estimate for 

the next three years. There is no cost to 

respondents other than their time. The 

estimated annualized burden hours for 

this data collection activity are 13,933. 

Type of collection Number of 

respondents 

Annual 

frequency 

per response 

Average 

number of 

activities 

Hours per 

response 

Online surveys ................................................................................................. 20,000 1 2 20/60

In person interviews ......................................................................................... 120 1 2 60/60 

Focus groups ................................................................................................... 120 1 2 90/60 

Ron A. Otten, 

Director, Office of Scientific Integrity, Office 

of the Associate Director for Science, Office 

of the Director, Centers for Disease Control 

and Prevention. 

[FR Doc. 2013–10435 Filed 5–2–13; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–276, CMS–339, 

and CMS–R–282] 

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: Reinstatement with change of a 

previously approved collection; Title: 

Prepaid Health Plan Cost Report; Use: 

Health Maintenance Organizations and 

Competitive Medical Plans contracting 

with the Secretary under section 1876 of 

the Social Security Act are required to 

submit a budget and enrollment 

forecast, semi-annual interim report, 

interim final cost report, and a final 

certified cost report in accordance with 

42 CFR 417.572 through 417.576. Health 

Care Prepayment Plans contracting with 

the Secretary under section 1833 of the 

Social Security Act are required to 

submit a budget and enrollment 

forecast, semi-annual interim report, 

and final cost report in accordance with 

42 CFR 417.808 and 417.810. CMS is 

requesting approval for the 

reinstatement with change of form 

CMS–276. The Cost Report outlines the 

provisions for implementing sections 

1876(h) and 1833(a)(1)(A) of the Act. 

The purposes of the revisions are to 

implement certain changes associated 

with the Affordable Care Act, clarify 

instructions, and update outdated issues 

within the Cost Report and the Budget 

Report. Form Number: CMS–276 (OCN 

0938–0165); Frequency: Yearly; Affected 

Public: Private Sector—Business or 

other for-profits and not-for-profit 

institutions; Number of Respondents: 

77; Total Annual Responses: 106; Total 

Annual Hours: 4,372. (For policy 

questions regarding this collection 

contact Temeshia Johnson at 410–786– 

8692. For all other issues call 410–786– 

1326.) 

2. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Medicare 

Provider Cost Report Reimbursement 

Questionnaire; Use: The purpose of 

form CMS–339 is to assist the provider 

in preparing an acceptable cost report 

and to minimize subsequent contact 

between the provider and its Medicare 

Administrative Contractor (MAC). The 

form provides the basic data necessary 

to support the information in the cost 

report. 

Exhibit 1 of form CMS–339 contains 

a series of reimbursement-oriented 

questions which serve to update 

information on the operations of the 

provider. It is arranged topically 

regarding financial activities such as 

independent audits, provider 

organization and operation, etc. The 

MAC is responsible for the settlement of 

the Medicare cost report and must 

determine the reasonableness and the 

accuracy of the reimbursement claimed. 

This process includes performing both a 

desk review of the cost report and an 

analysis leading to a decision to settle 

the cost report with or without further 

audit. The form provides essential 

information to enable the MAC to make 

the audit or no audit decision, scope of 

the audit if one is necessary, and to 

update the provider documentation (i.e., 

documentation to support the financial 

profile of the provider). If the 

information is not collected, the MAC 

will have to go onsite to each provider 

to get this information. Consequently, it 

is far less burdensome and extremely 

cost effective to capture this information 

through the form CMS–339. 

Exhibit 2 of form CMS–339 is a listing 

of bad debts pertaining to uncollectible 

Medicare deductible and coinsurance 

amounts. Preparation of the listing is a 

convenient way for providers to supply 

the MAC with information needed to 

determine the allowability of the bad 

debts for reimbursement. Some items 

required to determine allowability that 

are included on this exhibit are patient’s 


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Federal Register / Vol. 78, No. 86 / Friday, May 3, 2013 / Notices 26035 

name, dates of service, date first bill 

sent to beneficiary, and date the 

collection effort ceased. Supplying the 

MAC with this information may be all 

that is required for the MAC to 

determine whether or not the bad debt 

is allowable. This too may eliminate a 

visit to the provider to gather this 

needed data. Form Number: CMS–339 

(OCN 0938–0301); Frequency: Yearly; 

Affected Public: Private Sector— 

Business or other for-profits and not-forprofit institutions; Number of 

Respondents: 23,391; Total Annual 

Responses: 23,391; Total Annual Hours: 

75,625. (For policy questions regarding 

this collection contact Christine 

Dobrzycki at 410–786–3389. For all 

other issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Extension. Title of Information 

Collection: Medicare Advantage 

Appeals and Grievance Data Disclosure 

Requirements (42 CFR 422.111). Use: 

Section 1852(c)(2)(C) of the Social 

Security Act and 42 CFR 422.111(c)(3) 

require that Medicare Advantage (MA) 

organizations and demonstrations 

disclose information pertaining to the 

number of disputes, and their 

disposition in the aggregate, with the 

categories of grievances and appeals to 

any individual eligible to elect an MA 

organization who requests this 

information. MA organizations and 

demonstrations remain under a 

requirement to collect and provide this 

information to individuals eligible to 

elect an MA organization, we continue 

to need the same format and form for 

reporting. Form Number: CMS–R–282 

(OCN 0938–0778). Frequency: Annually 

and semi-annually. Affected Public: 

Private Sector (business or other forprofit and not-for-profit institutions). 

Number of Respondents: 51,370. Total 

Annual Responses: 52,260. Total 

Annual Hours: 5,414. (For policy 

questions regarding this collection 

contact Stephanie Simons at 206–615– 

2420. 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 June 3, 2013. OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: April 30, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–10530 Filed 5–2–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10146, CMS– 

10286, CMS–10308, and CMS–10339] 

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: Notice of Denial 

of Medicare Prescription Drug Coverage. 

Use: Section 1860D–4(g)(1) of the Social 

Security Act, requires that Part D plan 

sponsors who deny prescription drug 

coverage must provide a written notice 

of the denial to the enrollee. The written 

notice must include a statement, in 

understandable language, of the reasons 

for the denial and a description of the 

appeals process. The Part D denial 

notice has been revised for clarity and 

includes new optional language for Part 

D plan sponsors to use when explaining 

their denial rationale. Specifically, CMS 

has added optional language in the 

denial rationale section of the notice to 

allow plans to populate text explaining 

that a drug denied under Part D may be 

(or is) covered under a different benefit, 

such as Part B. The instructions have 

also been changed to guide plans on 

when to use this optional text. CMS 

solicits feedback on this new addition as 

well as other situations where another 

benefit may cover a drug (i.e. employer 

group benefits) and what changes to the 

denial notice may be helpful in 

addressing those situations. CMS also 

seeks comment regarding the potential 

viability and usefulness of developing a 

combined notice for Part C and Part D, 

which would allow MA–PD plans that 

deny a drug under Part D to 

simultaneously issue an approval letter 

under Part B. Form Number: CMS– 

10146 (OCN 0938–0976). Frequency: 

Occasionally. Affected Public: Private 

sector (business or other for-profits). 

Number of Respondents: 596. Total 

Annual Responses: 1,497,929. Total 

Annual Hours: 374,482. (For policy 

questions regarding this collection 

contact Caroline L Baker at 410–786– 

0116. For all other issues call 410–786– 

1326.) 

2. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved information 

collection; Title of Information 

Collection: Notice of Research Exception 

under the Genetic Information 

Nondiscrimination Act; Use: Under the 

Genetic Information Nondiscrimination 

Act of 2008 (GINA), a plan or issuer may 

request (but not require) a genetic test in 

connection with certain research 

activities so long as such activities 

comply with specific requirements, 

including: (i) The research complies 

with 45 CFR part 46 or equivalent 

federal regulations and applicable state 

or local law or regulations for the 

protection of human subjects in 

research; (ii) the request for the 

participant or beneficiary (or in the case 

of a minor child, the legal guardian of 

such beneficiary) is made in writing and 

clearly indicates that compliance with 

the request is voluntary and that noncompliance will have no effect on 

eligibility for benefits or premium or 

contribution amounts; and (iii) no 

genetic information collected or 

acquired will be used for underwriting 

purposes. The Secretary of Labor or the 

Secretary of Health and Human Services 

is required to be notified if a group 

health plan or health insurance issuer 

intends to claim the research exception 

permitted under Title I of GINA. 

Nonfederal governmental group health 

plans and issuers solely in the 


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