### 60843 Federal Register/ Vol. 76, No. 190 / Friday, September 30, 2011 / Notices

the popHealth system related to meaningful use measures; and/or target patients with high disease burden in need of early intervention.

Eligibility Rules for Participating in the Competition: To be eligible to win a prize under this challenge, an individual or entity:

(1) Shall have registered to participate in the competition under the rules promulgated by Office of the National
Coordinator for Health Information Technology;

(2) Shall have complied with all the requirements under this section;

(3) In the case of a private entity, shall be incorporated in and maintain a primary place of business in the United States, and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States; and

(4) May not be a Federal entity or Federal employee acting within the scope of their employment.

An individual or entity shall not be deemed ineligible because the individual or entity used Federal
facilities or consulted with Federal employees during a competition if the facilities and employees are made
available to all individuals and entities participating in the competition on an equitable basis.

Registered participants shall be required to agree to assume any and all risks and waive claims against the
Federal Government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from their participation in a competition, whether the injury, death, damage, or loss arises through negligence or otherwise.

Participants shall be required to obtain liability insurance or demonstrate financial responsibility, in amounts determined by the head of the
Office of the National Coordinator for Health Information Technology, for claims by—

(1) A third party for death, bodily injury, or property damage, or loss resulting from an activity carried out in connection with participation in a competition, with the Federal
Government named as an additional insured under the registered participant’s insurance policy and registered participants agreeing to indemnify the Federal Government against third party claims for damages arising from or related to competition activities; and

(2) the Federal Government for damage or loss to Government property resulting from such an activity. Participants must be teams of at least two people.

All participants are required to provide written consent to the rules upon or before submitting an entry.

**DATES :** 

• Submission Period Begins: 12:01 a.m., EDT, September 26, 2011.

• Submission Period Ends: 11:59 p.m., EDT, February 3, 2012.

Registration Process for Participants: To register for this challenge participants should:

• Access the http:// www.challenge.govWeb site and search for the ‘‘popHealth Tools Development Challenge’’.

• Access the ONC Investing in Innovation (i2) Challenge Web site at:

Æ http://www.health2challenge.org/ category/onc/.

Æ A registration link for the challenge can be found on the landing page under the challenge description.

Amount of the Prize:

• First Prize: $75,000.

• Second Prize: $20,000.

• Third Prize: $5,000. Awards may be subject to Federal income taxes and HHS will comply with IRS withholding and reporting requirements, where applicable.

Basis Upon Which Winner Will Be
Selected:

The judging panel will make selections based upon the following

criteria:

1. Ability to integrate with popHealth system and build upon existing functionality.

2. Impact on stakeholders. 3. Usability and design. 4. Creativity and Innovation. Additional Information: Ownership of intellectual property is determined by the following:

• Each entrant retains title and full ownership in and to their submission. Entrants expressly reserve all intellectual property rights not expressly granted under the challenge
agreement.

• By participating in the challenge, each entrant hereby irrevocably grants to Sponsor and Administrator a limited, non-exclusive, royalty free, worldwide, license and right to reproduce, publically perform, publically display,
and use the Submission to the extent necessary to administer the challenge, and to publically perform and publically display the Submission, including, without limitation, for advertising and promotional purposes relating to the challenge. Dated: September 26, 2011.

Farzad Mostashari, National Coordinator for Health Information Technology.

[FR Doc. 2011–25295 Filed 9–29–11; 8:45 am]

**BILLING CODE 4150–45–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[Document Identifier: CMS–9042, CMS– 10374, CMS–10385, CMS–10402 and CMS–**  **10396]**

**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: Accelerated Payments and Supporting Regulations 42 CFR, Section 412.116(f), 412.632(e), 413.64(g), 413.350(d), and 484.245; Use: This information is used by the contractor to determine the provider’s eligibility for accelerated payments. If
this information were not furnished with an accelerated payment request,
the contractor would not be able to assess whether the provider’s financial difficulties justified the accelerated
payment; Form Number: CMS–9042 (OMB # 0938–0269); Frequency: Yearly; Affected Public: Private Sector; Business or other for-profit and not-for-profit institutions; Number of Respondents:

37,804; Total Annual Responses: 945; Total Annual Hours: 473. (For policy


### 60844 Federal Register/ Vol. 76, No. 190 / Friday, September 30, 2011 / Notices

questions regarding this collection
contact Leonard Fisher at 410–786–4574
TTY. For all other issues call 410–786– 1326.)

2. Type of Information Collection Request: New collection of information; Title of Information Collection: Training Needs Assessment, Evaluation/Survey— Question Compilation; Use: The intent
of this information collection is to assist
in the creation and enhancement of training for Federal and State health care surveyors and certification specialists. The purpose of the collection is to gather information for training needs assessment, training analysis, related demographic, psychographics and technographics to support the development and enhancement of training and training aids; Form Number: CMS–10374 (OMB # 0938–New); Frequency: Half-year (2 per year); Affected Public: State, Local, or Tribal Governments; Number of Respondents: 2,161; Total Annual Responses: 4,322; Total Annual Hours: 1,430. (For policy questions regarding this collection contact Etolia Biggs at
410–786–8664. For all other issues call 410–786–1326.)

3. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Expedited Checklist: Medicaid Eligibility & Enrollment Systems—Advance Planning Document (E&E–APD); Use: Under sections 1903(a)(3)(A)(i) and 1903(a)(3)(B) of the Social Security Act,
CMS has issued new standards and conditions that must be met by States for Medicaid technology investments (including traditional claims processing systems, as well as eligibility systems) to be eligible for enhanced match funding. The Checklist will be submitted by States to the E&E APD
National Coordinator for review and coordination in the Eligibility/ Enrollment Systems APD approval assignment. The information requested
on the Checklist will be used to determine and approve enhanced FFP to
States and to determine how States are complying with the seven standards and conditions; Form Number: CMS–10385 (OMB#: 0938–1125); Frequency: Occasionally;Affected Public: State, Local, or Tribal Governments; Number of Respondents: 56; Total Annual Responses: 168; Total Annual Hours: 204. (For policy questions regarding this
collection contact Richard Friedman at
410–786–4451. For all other issues call 410–786–1326.)

4. Type of Information Collection Request: New collection; Title of Information Collection: Medicaid State Plan Preprint for Use by States When Implementing Section 6401 of the
Patient Protection and Affordable Care Act under the Medicaid Program; Use: The Secretary, in consultation with the Department of Health of Human Services’ Office of the Inspector General, is required to establish procedures under which screening is conducted with respect to providers of
medical or other items or services and suppliers under Medicare, Medicaid, and CHIP. The Secretary is also required to impose a fee on each institutional provider of medical or other items or services or supplier that would be used by the Secretary for program integrity efforts. States are required to comply with the process of screening providers and suppliers as established by the Secretary under 1866(j)(2) of the
Affordable Care Act. The Office of General Counsel through guidance, is requiring that States use the Medicaid State Plan Preprint to assure CMS compliance with the law. CMS will use the information to review and approve the State plan. States would refer to the State plan on an as needed basis to manage and operate their Medicaid programs under Title XIX of the Social Security Act; Form Number: CMS– 10402 (OMB # 0938–New); Frequency: Once;Affected Public: State, Local, or Tribal Governments; Number of Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 14. (For policy questions regarding this
collection contact Richard Friedman. at
410–786–4451. For all other issues call 410–786–1326.)

5. Type of Information Collection Request: New collection; Title of Information Collection: Medication Therapy Management Program Improvements—Standardized Format.

Use: The Medicare Modernization Act of 2003 (MMA) under title 42 CFR Part 423, Subpart D, established the requirements that Part D sponsors must meet with regard to medication therapy management (MTM) programs. Beginning in 2010, sponsors must offer an interactive, person-to-person comprehensive medication review (CMR) by a pharmacist or other qualified provider at least annually. A CMR is a review of a beneficiary’s medications, including prescription and over-the-counter (OTC) medications, herbal therapies, and dietary supplements, which is intended to aid in assessing medication therapy and optimizing patient outcomes. Sponsors must summarize the CMR and provide an individualized written or printed summary to the beneficiary. The burden
associated with the time and effort necessary for Part D sponsors to conduct CMRs with written summaries was estimated previously under OMB Control Number 0938–0964 as 937,500 hours with total labor cost of $112.5
million.

The Affordable Care Act (ACA) under Section 10328 specifies that the Secretary, in consultation with relevant stakeholders, develop a standardized format for the action plan and written or printed summary that are given to
beneficiaries as a result of their CMRs. The standardized format will replace whatever formats Part D sponsors are using for their written CMR summaries and action plans prior to 2013. Beginning in January, 2013, Part D sponsors will collect information required by the new standardized format, and provide that information to
Medicare beneficiaries after their CMRs on forms that comply with the requirements specified by CMS for the
standardized format. The use of the
standardized format will increase the burden associated with providing the
CMRs with written summaries and action plans as described in this
submission. The use of the standardized format will support a uniform and
consistent level of MTMP communications with beneficiaries, improve the ability of beneficiaries to understand and manage their medications safely and effectively, and support improved healthcare outcomes
and lower overall healthcare costs. The final standardized format will be posted
in the 2013 Call Letter for implementation by Part D sponsors in January 2013. Form Number: CMS– 10396 (OCN: 0938–New); Frequency: Yearly;Affected Public: Private Sector— Business or other For-profits; Number of Respondents: 673; Number of Responses: 1,875,000; Total Annual

Hours: 1,179,894. (For policy questions regarding this collection, contact Gary
Wirth at 410–786–3997. 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 for the proposed information collections must be received by the OMB desk officer at the address below, no later than 5 p.m. on October 31,

2011.


### 60845 Federal Register/ Vol. 76, No. 190 / Friday, September 30, 2011 / Notices

OMB, Office of Information and

Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202) 395–

6974, E-mail:

OIRA

_submission@omb.eop.gov.

Dated: September 27, 2011.
Martique Jones, Director, Regulations Development Group, Division B, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2011–25271 Filed 9–29–11; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[Document Identifier: CMS–10241, CMS– 10412, CMS–R–263, CMS–R–262, CMS–**  **10142 and CMS–855(O)]**

**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: Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings; Use: CMS will develop a National Average Drug Acquisition Cost (NADAC) for States to consider when developing reimbursement methodology. The NADAC is a new pricing benchmark
that will be based on the national average costs that pharmacies pay to acquire Medicaid covered outpatient drugs. It is intended to provide States with a more accurate reference price to base reimbursement for prescription drugs and will be based on drug acquisition costs collected directly from pharmacies through a nationwide survey process. This survey will be conducted on a monthly basis to ensure
that the NADAC reference file remains current and up-to-date. A NADAC Survey Request for Information has been developed to send to random pharmacies for voluntary completion. CMS proposes to add the survey to an existing collection, ‘‘Annual State Report and Annual State Performance Rankings.’’ The requirements and
burden associated with the annual report/rankings are unaffected by this proposed action; Form Number: CMS– 10241 (OCN: 0938–1041); Frequency: Biennially, Once; Affected Public:Private Sector; Business or other forprofits; Number of Respondents: 30,000; Total Annual Responses: 30,000; Total
Annual Hours: 15,000. (For policy questions regarding this collection
contact Lisa Ferrandi at 410–786–5445. For all other issues call 410–786–1326.)

2. Type of Information Collection Request: New collection; Title of Information Collection: Section 1115 Demonstration: Long Term Services and Supports and Other Service Models for
Individuals with Disabilities and Chronic Conditions; Use: Section 1115 of the Social Security Act provides the Secretary of Health and Human Services broad authority to authorize experimental, pilot, or demonstration projects likely to assist in promoting the objectives of the Medicaid statute. Flexibility under Section 1115 is sufficiently broad to allow states to test substantially new ideas of policy merit. States seeking interventions for individuals needing LTSS to lower costs, improve care and improve health
can utilize the 1115 demonstration to
test and deliver innovative services and approaches to better and more efficiently meet the needs of this population. Section 1115 demonstrations provide a vehicle for innovations in both care delivery and payment methodologies. Demonstrations must be ‘‘budget neutral’’ over the life of the project, meaning they cannot be expected to cost the Federal government more than it
would cost without the waiver. State Medicaid agencies are responsible for developing section 1115 demonstration applications and submitting them to CMS; Form Number: CMS–10412 (OCN: 0938–New); Frequency: Once;Affected
Public: State, Local, or Tribal Governments; Number of Respondents:

56; Total Annual Responses: 56; Total
Annual Hours: 2,240. (For policy questions regarding this collection contact Adrienne Delozer at 410–786–
0278. For all other issues call 410–786– 1326.)

3. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Site Investigation for Durable Medical Equipment (DME) Suppliers; Use: CMS is mandated to identify and implement measures to prevent fraud and abuse in the Medicare program. To meet this challenge, CMS has moved forward to improve the quality of the process for enrolling suppliers into the Medicare program by establishing a uniform application for enumerating suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Implementation of enhanced procedures for verifying the enrollment information has also improved the enrollment process. As part of this process, verification of compliance with supplier standards is necessary. The site investigation form has been used in the past to aid the Medicare contractor (the National Supplier Clearinghouse and/or its subcontractors) in verifying compliance with the required supplier standards found in 42 CFR 424.57(c). The primary function of the site investigation form is to provide a standardized, uniform tool to gather information from a DMEPOS supplier
that tells us whether it meets certain qualifications to be a DMEPOS supplier (as found in 42 CFR 424.57(c)) and where it practices or renders its

services.

This site investigation form collects the same information as its predecessor, with the exception of one new yes/no question under the ‘‘Records and Telephone’’ section (question 11(a)) used to verify if the DMEPOS supplier maintains physician ordering/referring records for the supplies and/or services it renders to Medicare beneficiaries (if applicable). This information is required by Section 1833(q) of the Social Security Act which states that all physicians and non-physician practitioners that meet the definitions at section 1861(r) and 1842(b)(18)(C) be uniquely identified for
all claims for services that are ordered
or referred. Other information collected on this site investigation remains unchanged, but has been reformatted for greater functionality. Form Number: CMS–R–263 (OCN: 0938–0749); Frequency: Once;Affected Public:
Private Sector—Business or other forprofits and not-for-profit institutions; Number of Respondents: 30,000; Total Annual Responses: 30,000; Total
Annual Hours: 15,000. (For policy questions regarding this collection contact Kimberly McPhillips at 410–