Federal Register / Vol. 80, No. 15 / Friday, January 23, 2015 / Notices 3603 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–29] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Notice. 

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 24, 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 lll, 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–29 Verification of Clinic Data— 

Rural Health Clinic Form and 

Supporting Regulations 

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: Verification of 

Clinic Data—Rural Health Clinic Form 

and Supporting Regulations; Use: The 

form is utilized as an application to be 

completed by suppliers of Rural Health 

Clinic (RHC) services requesting 

participation in the Medicare program. 

This form initiates the process of 

obtaining a decision as to whether the 

conditions for certification are met as a 

supplier of RHC services. It also 

promotes data reduction or introduction 

to and retrieval from the Automated 

Survey Process Environment (ASPEN) 

and related survey and certification 

databases by the CMS Regional Offices. 

Should any question arise regarding the 

structure of the organization, this 

information is readily available. Form 

Number: CMS–29 (OMB control number 

0938–0074); Frequency: Occasionally 

(initially and then every six years); 

Affected Public: Private Sector (Business 

or other for-profit and Not-for-profit 

institutions); Number of Respondents: 

900; Total Annual Responses: 900; Total 

Annual Hours: 150. (For policy 

questions regarding this collection 

contact Shonte ́ Carter at 410–786–3532.) 

Dated: January 20, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–01128 Filed 1–22–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10538 and CMS– 

10527] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

ACTION: Notice. 

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 

(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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the 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 


tkelley on DSK3SPTVN1PROD with NOTICES
3604 Federal Register / Vol. 80, No. 15 / Friday, January 23, 2015 / Notices 

technology to minimize the information 

collection burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by February 23, 2015. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 OR, Email: 

OIRA_submission@omb.eop.gov. 

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/Paperwork

ReductionActof1995. 

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: Under the 

Paperwork Reduction Act of 1995 (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 (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-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 that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: New collection (request for a 

new OMB control number); Title of 

Information Collection: Prior 

Authorization Form for Beneficiaries 

Enrolled in Hospice; Use: The form 

would be completed by the prescriber or 

the beneficiary’s hospice, or if the 

prescriber or hospice provides the 

information verbally to the Part D 

sponsor, the form would be completed 

by the sponsor. Information provided on 

the form would be used by the Part D 

sponsor to establish coverage of the drug 

under Medicare Part D. Per statute, 

drugs that are necessary for the 

palliation and management of the 

terminal illness and related conditions 

are not eligible for payment under Part 

D. The standard form provides a vehicle 

for the hospice provider, prescriber or 

sponsor to document that the drug 

prescribed is ‘‘unrelated’’ to the 

terminal illness and related conditions. 

It also gives a hospice organization the 

option to communicate a beneficiary’s 

change in hospice status and care plan 

to Part D sponsors. The package has 

been revised subsequent to the 

publication of the 60-day Federal 

Register notice on October 3, 2014 (79 

FR 59772). Form Number: CMS–10538 

(OMB control number 0938—New); 

Frequency: Occasionally; Affected 

Public: Private sector (business or other 

for-profits); Number of Respondents: 

424; Total Annual Responses: 376,487; 

Total Annual Hours: 31,374. (For policy 

questions regarding this collection 

contact Shelly Winston at 410–786– 

3694). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Annual 

Eligibility Redetermination, Product 

Discontinuation and Renewal Notices; 

Use: Section 1411(f)(1)(B) of the 

Affordable Care Act directs the 

Secretary of Health and Human Services 

(the Secretary) to establish procedures 

to redetermine the eligibility of 

individuals on a periodic basis in 

appropriate circumstances. Section 

1321(a) of the Affordable Care Act 

provides authority for the Secretary to 

establish standards and regulations to 

implement the statutory requirements 

related to Exchanges, QHPs and other 

components of title I of the Affordable 

Care Act. Under section 2703 of the PHS 

Act, as added by the Affordable Care 

Act, and sections 2712 and 2741 of the 

PHS Act, enacted by the Health 

Insurance Portability and 

Accountability Act of 1996, health 

insurance issuers in the group and 

individual markets must guarantee the 

renewability of coverage unless an 

exception applies. 

The final rule ‘‘Patient Protection and 

Affordable Care Act; Annual Eligibility 

Redeterminations for Exchange 

Participation and Insurance 

Affordability Programs; Health 

Insurance Issuer Standards Under the 

Affordable Care Act, Including 

Standards Related to Exchanges’’ (79 FR 

52994), provides that an Exchange may 

choose to conduct the annual 

redetermination process for a plan year 

(1) in accordance with the existing 

procedures described in 45 CFR 

155.335; (2) in accordance with 

procedures described in guidance 

issued by the Secretary for the coverage 

year; or (3) using an alternative 

proposed by the Exchange and approved 

by the Secretary. The guidance 

document ‘‘Guidance on Annual 

Redeterminations for Coverage for 

2015’’ contains the procedures that the 

Secretary is specifying for the 2015 

coverage year, as noted in (2) above. 

These procedures will be adopted by the 

Federally-facilitated Exchange. Under 

this option, the Exchange will provide 

three notices. These notices may be 

combined. 

The final rule also amends the 

requirements for product renewal and 

re-enrollment (or non-renewal) notices 

to be sent by Qualified Health Plan 

(QHP) issuers in the Exchanges and 

specifies content for these notices. The 

accompanying guidance document 

‘‘Form and Manner of Notices When 

Discontinuing or Renewing a Product in 

the Group or Individual Market’’ 

provides standard notices for product 

discontinuation and renewal to be sent 

by issuers of individual market QHPs 

and issuers in the individual market. 

Issuers in the small group market may 

use the draft Federal standard small 

group notices released in the June 26, 

2014, bulletin ‘‘Draft Standard Notices 

When Discontinuing or Renewing a 

Product in the Small Group or 

Individual Market’’, or any forms of the 

notice otherwise permitted by 

applicable laws and regulations. States 

that are enforcing the Affordable Care 

Act may develop their own standard 

notices, for product discontinuances, 

renewals, or both, provided the Statedeveloped notices are at least as 

protective as the Federal standard 

notices. Form Number: CMS–10527; 

Frequency: Annual; Affected Public: 

Private Sector, State Governments; 

Number of Respondents: 2,945; Number 

of Responses: 12,224; Total Annual 

Hours: 149,186. (For policy questions 

regarding this collection, contact Usree 

Bandyopadhyay at 410–786–6650.) 

Dated: January 20, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–01127 Filed 1–22–15; 8:45 am] 

BILLING CODE 4120–01–P 


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