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[Federal Register Volume 80, Number 75 (Monday, April 20, 2015)]
[Notices]
[Pages 21721-21723]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-09009]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-855R, CMS-10394, CMS-10371, CMS-10472 and 
CMS-10494]

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

ACTION: Notice.

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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 
technology to minimize the information collection burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by May 20, 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/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: 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: Revision of a currently 
approved collection; Title of Information Collection: Medicare 
Enrollment Application: Reassignment of Medicare Benefits; Use: The 
primary function of the CMS 855R enrollment application is to allow 
physicians and non-physician practitioners to reassign their Medicare 
benefits to a group practice and to gather information from the 
individual that tells us who he/she is, where he or she renders 
services, and information necessary to establish correct claims 
payment. The goal of periodically evaluating and revising the CMS-855R 
enrollment application is to simplify and clarify the information 
collection without jeopardizing our need to collect specific 
information. At this time, CMS is making very few minor revisions to 
the CMS-855R (Reassignment of Benefits) Medicare enrollment application 
(OMB No. 0938-1179). Two sections within the form are being reversed to 
maintain sync with online and paper forms. The previously approved CMS 
855R section 2 collected information regarding the individual 
practitioner who is reassigning benefits and section 3 collected 
information regarding the organization/group receiving the reassigned 
benefits. These two sections have been reversed so that section 2 now 
collects information on

[[Page 21722]]

the regarding the organization/group receiving the reassigned benefits 
and section 3 now collects information on the individual practitioner 
who is reassigning benefits. No information or data collection within 
these sections was revised. The sections were merely re-sequenced and 
re-numbered to maintain sync between online and paper forms. With the 
exception of this section reversal and adding the word ``optional'' to 
sections 4 and 5 (primary practice location and contact person 
information), there are no other revisions. These revisions offer no 
new data collection in this revision package. The addition of the 
optional choice in sections 4 and 5 could potentially reduce the burden 
to providers who choose not to complete either or both optional 
sections. Form Number: CMS-855R (OMB control number 0938-1179); 
Frequency: Occasionally; Affected Public: State, Local, or Tribal 
Governments, Private sector (For-profit and Not-for-profit 
institutions); Number of Respondents: 379,619; Total Annual Responses: 
379,619; Total Annual Hours: 94,905. (For policy questions regarding 
this collection contact Kim McPhillips at 410-786-7278).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Application to Be 
a Qualified Entity to Receive Medicare Data for Performance 
Measurement; Use: Section 10332 of the Patient Protection and 
Affordable Care Act (ACA) requires the Secretary to make standardized 
extracts of Medicare claims data under parts A, B, and D available to 
``qualified entities'' for the evaluation of the performance of 
providers of services and suppliers. The statute provides the Secretary 
with discretion to establish criteria to determine whether an entity is 
qualified to use claims data to evaluate the performance of providers 
of services and suppliers. We are proposing at section 42 CFR 401.703 
to evaluate an organization's eligibility across three areas: 
Organizational and governance capabilities, addition of claims data 
from other sources (as required in the statute), and data privacy and 
security. This is the application through which organizations will 
provide information to CMS to determine whether they will be approved 
as a qualified entity. Form Number: CMS-10394 (OMB control number: 
0938-1144); Frequency: Occasionally; Affected Public: Private sector--
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 35; Total Annual Responses: 35; Total Annual Hours: 
6,833. (For policy questions regarding this collection contact Kari 
Gaare at 410-786-8612).
    3. Type of Information Collection Request: Revision of a currently 
approved information collection; Title of Information Collection: 
Cooperative Agreements to Support Establishment of State-Operated 
Health Insurance Exchanges; Use: All States (including the 50 States, 
consortia of States, and the District of Columbia herein referred to as 
States) had the opportunity under section 1311(b) of the Affordable 
Care to apply for three types of grants: (1) Planning grants; (2) Early 
Innovator grants for early development of information technology; and 
(3) Establishment grants to develop, implement and start-up 
Marketplaces. As of January 1st, 2015, the Secretary has disbursed over 
$5.4 billion under this grant program and, as of that date, there were 
79 active establishment grants awarded to 28 states. As the State-Based 
Marketplaces (SBM) and Small Business Health Options Program (SHOP) 
have matured and moved from the developmental phases to full-operation, 
the reporting requirements for the states have been modified and 
streamlined to insure only information necessary to provide effective 
oversight of their operations by CMS is collected.
    Given the innovative nature of Exchanges and the statutorily-
prescribed relationship between the Secretary and States in their 
development and operation, it is critical that the Secretary work 
closely with States to provide necessary guidance and technical 
assistance to ensure that States can meet the prescribed timelines, 
federal requirements, and goals of the statute and the grants awarded 
to them. Form Number: CMS-10371 (OMB control number: 0938-1119); 
Frequency: Once; Affected Public: State Government agencies, Private 
sector (Not-for-profit institutions); Number of Respondents: 28; Number 
of Responses: 48; Total Annual Hours: 31,404. (For policy questions 
regarding this collection, contact Dena Puskin at (301) 492-4342.)
    4. Type of Information Collection Request: Revision of a previously 
approved information collection; Title of Information Collection: 
Exchange Functions: Standards for Navigators and Non-Navigator 
Assistance Personnel; Use: Section 1321(a)(1) of the Affordable Care 
Act directs and authorizes the Secretary to issue regulations setting 
standards for meeting the requirements under title I of the Affordable 
Care Act, with respect to, among other things, the establishment and 
operation of Exchanges. Pursuant to this authority, regulations have 
been finalized at 45 CFR 155.215(b)(1) to require Navigators, as well 
as those non-Navigator personnel to whom 45 CFR 155.215 applies, 
requires completion of HHS approved training for initial certification 
and annual recertification prior to providing application and 
enrollment assistance. The training will include an optional training 
quality survey providing Navigators and non-Navigator assistance 
personnel to whom 45 CFR 155.215 applies, an opportunity to provide 
feedback to CMS regarding the training and any improvements that can be 
made in the future. Form Number: CMS-10472 (OMB control number. 0938-
1220); Frequency: On Occasion; Affected Public: State, Local, or Tribal 
Governments, Private sector (Not-for-profit institutions), Individuals 
or Households; Number of Respondents: 5,610; Number of Responses: 
5,610; Total Annual Hours: 37,036. (For policy questions regarding this 
collection, contact Heather Raeburn at 301-492-4224.)
    5. Type of Information Collection Request: Revision of a previously 
approved information collection; Title of Information Collection: 
Patient Protection and Affordable Care Act; Consumer Assistance Tools 
and Programs of an Exchange and Certified Application Counselors; 
Exchange and Insurance Market Standards for 2015; Use: Section 
1321(a)(1) of the Affordable Care Act directs and authorizes the 
Secretary to issue regulations setting standards for meeting the 
requirements under title I of the Affordable Care Act, with respect to, 
among other things, the establishment and operation of Exchanges. 
Pursuant to this authority, regulations establishing the certified 
application counselor program have been finalized at 45 CFR 155.225. In 
accordance with 155.225(d)(1) and (7), certified application counselors 
in all Exchanges are required to be initially certified and recertified 
on at least an annual basis and successfully complete Exchange-required 
training. Form Number: CMS-10494 (OMB control number: 0938-1205); 
Frequency: On Occasion; Affected Public: State, Local, or Tribal 
Governments, Private sector (Not-for-profit institutions), Individuals 
or Households; Number of Respondents: 35,000; Number of Responses: 
190,000; Total Annual Hours: 27,110. (For policy questions regarding 
this collection, contact Tricia Beckmann at 301-492-4328.)

[[Page 21723]]

    Dated: April 15, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-09009 Filed 4-17-15; 8:45 am]
 BILLING CODE 4120-01-P
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