Federal Register / Vol. 76, No. 98 / Friday, May 20, 2011 / Notices 29249 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10232, CMS– 

10251, CMS–R–185, and CMS–R–211] 

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: Revision of currently approved 

collection; Title of Information 

Collection: State Plan Template to 

Implement Section 6062 of the Deficit 

Reduction Act; Form No.: CMS–10232 

(OMB#: 0938–1045); Use: The Deficit 

Reduction Act (DRA) provides States 

with numerous flexibilities in operating 

their State Medicaid Programs. Section 

6062 of the DRA (Opportunity for 

families of Disabled Children to 

Purchase Medicaid Coverage for Such 

Children) provides States the 

opportunity to provide Medicaid 

benefits to disabled children who would 

otherwise be ineligible because of 

family income that is above the State’s 

highest Medicaid eligibility standards 

for children. States must establish a 

State Plan for medical assistance to 

implement this provision. To do this, 

State Medicaid Agencies will complete 

the template. CMS will review the 

information to determine if the State has 

met all the requirements of the DRA 

provision; Frequency: Once; Affected 

Public: State, Federal, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 10; Total 

Annual Hours: 60. (For policy questions 

regarding this collection contact Barbara 

Washington at 410–786–9964. For all 

other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Integrated 

Medicare and Medicaid State Plan 

Preprint; Form No.: CMS–10251 (OMB#: 

0938–1047); Use: The Integrated Care 

Preprint is an optional tool for use by 

States to highlight the arrangements 

provided between the State and 

Medicare Advantage Special Needs 

Plans that are also providing Medicaid 

services. The preprint also provides the 

opportunity for States to confirm that 

their integrated care model complies 

with Federal statutory and regulatory 

requirements. State Medicaid Agencies 

may complete the preprint and CMS 

will review the information provided to 

determine if the State has properly 

completed and explained their 

integrated care arrangements and that 

the appropriate assurances have been 

met; Frequency: Once; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 56; Total 

Annual Responses: 10; Total Annual 

Hours: 200. (For policy questions 

regarding this collection contact Mary 

Pat Farkas at 410–786–5731. For all 

other issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Extension of currently 

approved collection; Title of 

Information Collection: Granting and 

Withdrawal of Deeming Authority to 

Private Nonprofit Accreditation 

Organizations and of State Exemption 

Under State Laboratory Programs and 

Supporting Regulations; Form No.: 

CMS–R–185 (OMB#: 0938–0686); Use: 

The information required is necessary to 

determine whether a private 

accreditation organization/State 

licensure program standards and 

accreditation/licensure process is at 

least equal to or more stringent than 

those of the Clinical Laboratory 

Improvement Amendments of 1988 

(CLIA). If an accreditation organization 

is approved, the laboratories that it 

accredits are ‘‘deemed’’ to meet the CLIA 

requirements based on this 

accreditation. Similarly, if a State 

licensure program is determined to have 

requirements that are equal to or more 

stringent than those of CLIA, its 

laboratories are considered to be exempt 

from CLIA certification and 

requirements. The information collected 

will be used by HHS to: Determine 

comparability/equivalency of the 

accreditation organization standards 

and policies or State licensure program 

standards and policies to those of the 

CLIA program; to ensure the continued 

comparability/equivalency of the 

standards; and to fulfill certain statutory 

reporting requirements; Frequency: 

Occasionally; Affected Public: Private 

Sector: Business or other for-profits, 

Not-for-profit institutions; Number of 

Respondents: 8; Total Annual 

Responses: 96; Total Annual Hours: 

384. (For policy questions regarding this 

collection contact Minnie Christian at 

410–786–3339. For all other issues call 

410–786–1326.) 

4. Type of Information Collection 

Request: Revision of currently approved 

collection; Title of Information 

Collection: Model Application Template 

and Instructions for State Child Health 

Plan Under Title XXI of the Social 

Security Act, State Children’s Health 

Insurance Program; Form No.: CMS–R– 

211 (OMB#: 0938–0707); Use: The 

information will be used to assess State 

plan performance and health outcomes 

and to evaluate the amount of substitute 

private coverage and the effect of 

subsidies on access to coverage; 

Frequency: Yearly, occasionally; 

Affected Public: State, Federal, or Tribal 

Governments; Number of Respondents: 

40; Total Annual Responses: 40; Total 

Annual Hours: 3,200. (For policy 

questions regarding this collection 

contact Nancy Goetschius at 410–786– 

0707. For all other issues call 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 20, 2011. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS Desk 

Officer, Fax Number: (202) 395–6974, Email: OIRA_submission@omb.eop.gov. 

Dated: May 16, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–12394 Filed 5–19–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–5501–N] 

Medicare Program; Pioneer 

Accountable Care Organization Model: 

Request for Applications 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 


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