Federal Register / Vol. 86, No. 164 / Friday, August 27, 2021 / Notices 48149 

questionnaire, which provides a set of 

shared health indicators for all BRFSS 

partners. The BRFSS core questionnaire 

consists of fixed core, rotating core, and 

emerging core questions. Fixed core 

questions are asked every year. Rotating 

core questions cycle on and off the core 

questionnaire in two- or three-year 

cycles, depending on the question. 

Emerging core questions are included in 

the core questionnaire as needed to 

collect data on urgent or emerging 

health topics such as infectious disease. 

In addition, the BRFSS includes a series 

of optional modules on a variety of 

topics. In off years, when the rotating 

questions are not included in the core 

questionnaire, they are offered to states 

as optional modules. This framework 

allows each state to produce a 

customized BRFSS survey by appending 

selected optional modules to the core 

survey. States may select which, if any, 

optional modules to administer. As 

needed, CDC provides technical and 

methodological assistance to state 

BRFSS coordinators in the construction 

of their state-specific surveys. Each state 

administers its BRFSS questionnaire 

throughout the calendar year. 

CDC periodically updates the BRFSS 

core survey and optional modules. The 

purpose of this Revision request is to 

add the following topics to the 

questionnaires: COVID vaccination, 

impact of the COVID pandemic, 

periodontal disease, additional 

questions on heart attack and stroke, 

disaster/pandemic preparedness, 

veterans’ health, and the use of newly 

available tobacco products. In addition, 

this request seeks approval for 

reinstating topics which have been 

included in BRFSS in the past, 

dependent upon state interest and 

funding. 

Participation in BRFSS is voluntary 

and there is no cost to participate. The 

average time burden per response will 

be 22 minutes. The total time burden 

across all respondents will be 

approximately 287,798 hours. 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of 

respondents Form name Number of respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(in hours) 

U.S. General Population .................. Landline Screener ......................................................... 173,000 1 1/60 

Cell Phone Screener ..................................................... 694,000 1 1/60 

Field Test Screener ...................................................... 900 1 1/60 

Annual Survey Respondents (Adults 

>18 Years).

BRFSS Core Survey by Phone Interview .....................

BRFSS Optional Modules by Phone Interview .............

480,000 

440,000 

1 

1 

15/60 

15/60 

BRFSS Core Survey by Online Survey ........................ 100,000 1 10/60 

BRFSS Optional Modules by Online Survey ................ 80,000 1 10/60 

Field Test Respondents (Adults >18 

Years).

Field Test Survey by Phone Interview .......................... 500 1 45/60 

Jeffrey M. Zirger, 

Lead, Information Collection Review Office, 

Office of Scientific Integrity, Office of Science, 

Centers for Disease Control and Prevention. 

[FR Doc. 2021–18538 Filed 8–26–21; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–6063–N7] 

Medicare Program; National Expansion 

Implementation for All Remaining 

States and Territories of the Prior 

Authorization Model for Repetitive, 

Scheduled Non-Emergent Ambulance 

Transports 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

implementation dates for all remaining 

states and territories for the national 

expansion of the Prior Authorization 

Model for Repetitive, Scheduled NonEmergent Ambulance Transports. 

DATES: This expansion of the Prior 

Authorization Model for Repetitive, 

Scheduled Non-Emergent Ambulance 

Transports will begin on December 1, 

2021 for independent ambulance 

suppliers garaged in Arkansas, 

Colorado, Louisiana, Mississippi, New 

Mexico, Oklahoma, and Texas; and no 

earlier than: February 1, 2022 for 

independent ambulance suppliers 

garaged in Alabama, American Samoa, 

California, Georgia, Guam, Hawaii, 

Nevada, Northern Mariana Islands and 

Tennessee; April 1, 2022 for 

independent ambulance suppliers 

garaged in Florida, Illinois, Iowa, 

Kansas, Minnesota, Missouri, Nebraska, 

Puerto Rico, Wisconsin, and U.S. Virgin 

Islands; June 1, 2022 for independent 

ambulance suppliers garaged in 

Connecticut, Indiana, Maine, 

Massachusetts, Michigan, New 

Hampshire, New York, Rhode Island, 

and Vermont; and August 1, 2022 for 

independent ambulance suppliers 

garaged in Alaska, Arizona, Idaho, 

Kentucky, Montana, North Dakota, 

Ohio, Oregon, South Dakota, Utah, 

Washington, and Wyoming. 

FOR FURTHER INFORMATION CONTACT: 

Angela Gaston, (410) 786–7409. 

Questions regarding the national 

expansion of the Prior Authorization 

Model for Repetitive, Scheduled NonEmergent Ambulance Transports should 

be sent to AmbulancePA@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In the November 23, 2020 Federal 

Register (85 FR 74725), we published a 

notice titled ‘‘Medicare Program; 

National Expansion of the Prior 

Authorization Model for Repetitive, 

Scheduled Non-Emergent Ambulance 

Transport,’’ which announced the 

national expansion of the Prior 

Authorization Model for Repetitive, 

Scheduled Non-Emergent Ambulance 

Transports under section 1834(l)(16) of 

the Act, as added by section 515(b) of 

the Medicare Access and CHIP 

Reauthorization Act of 2015 (MACRA) 

(Pub. L. 114–10). The states that 

participated in the model under section 

1115A of the Social Security Act (the 

Act), which included Delaware, the 

District of Columbia, Maryland, New 

Jersey, North Carolina, Pennsylvania, 

South Carolina, Virginia, and West 

Virginia, previously transitioned to the 

national model on December 2, 2020. 

Due to the COVID–19 Public Health 

Emergency, we delayed the 

implementation of the expansion to any 

additional states. 


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48150 Federal Register / Vol. 86, No. 164 / Friday, August 27, 2021 / Notices 

II. Provisions of the Notice 

This notice announces the 

implementation dates for all remaining 

states and territories for the national 

expansion of the Prior Authorization 

Model for Repetitive, Scheduled NonEmergent Ambulance Transports under 

section 1834(l)(16) of the Act, as added 

by section 515(b) of MACRA (Pub. L. 

114–10). This expansion of the model 

will begin on December 1, 2021 for 

independent ambulance suppliers 

garaged in Arkansas, Colorado, 

Louisiana, Mississippi, New Mexico, 

Oklahoma, and Texas; and no earlier 

than— 

• February 1, 2022 for independent 

ambulance suppliers garaged in 

Alabama, American Samoa, California, 

Georgia, Guam, Hawaii, Nevada, 

Northern Mariana Islands and 

Tennessee; 

• April 1, 2022 for independent 

ambulance suppliers garaged in Florida, 

Illinois, Iowa, Kansas, Minnesota, 

Missouri, Nebraska, Puerto Rico, 

Wisconsin, and U.S. Virgin Islands; 

• June 1, 2022 for independent 

ambulance suppliers garaged in 

Connecticut, Indiana, Maine, 

Massachusetts, Michigan, New 

Hampshire, New York, Rhode Island, 

and Vermont; and 

• August 1, 2022 for independent 

ambulance suppliers garaged in Alaska, 

Arizona, Idaho, Kentucky, Montana, 

North Dakota, Ohio, Oregon, South 

Dakota, Utah, Washington, and 

Wyoming. 

We will continue to test in the 

remaining states and territories whether 

prior authorization helps reduce 

expenditures, while maintaining or 

improving quality of care, by using the 

prior authorization process described in 

the November 23, 2020 Federal Register 

(85 FR 74725) to reduce utilization of 

services that do not comply with 

Medicare policy. Prior authorization 

helps ensure that all relevant clinical or 

medical documentation requirements 

are met before services are furnished to 

beneficiaries and before claims are 

submitted for payment. It further helps 

to ensure that payment complies with 

Medicare documentation, coverage, 

payment, and coding rules. Prior 

authorization also allows ambulance 

suppliers to address coverage issues 

prior to furnishing services. 

The model establishes a process for 

requesting prior authorization for 

repetitive, scheduled non-emergent 

ambulance transports. The use of prior 

authorization does not create new 

clinical documentation requirements. 

Instead, it requires the same information 

that is already required to support 

Medicare payment, just earlier in the 

process. 

Submitting a prior authorization 

request for repetitive, scheduled nonemergent ambulance transports is 

voluntary. However, an ambulance 

supplier or beneficiary is encouraged to 

submit to the Medicare Administrative 

Contractor (MAC) a request for prior 

authorization along with all relevant 

documentation to support Medicare 

coverage of the transports. If prior 

authorization has not been requested by 

the fourth round trip in a 30-day period, 

the subsequent claims will be stopped 

for prepayment review. Please see the 

November 23, 2020 Federal Register (85 

FR 74725) for additional details on the 

prior authorization model and process. 

We will expand outreach and 

education efforts on this model to 

affected ambulance suppliers in all 

states and territories, through such 

methods as an operational guide, 

frequently asked questions (FAQs) on 

our website, a physician letter 

explaining the ambulance suppliers’ 

need for the proper documentation, 

open door forums, and educational 

events and materials issued by the 

MACs. We will work to limit any 

adverse impact on beneficiaries and to 

educate affected beneficiaries about the 

model process. Beneficiaries will 

continue to have all applicable 

administrative appeal rights for denied 

claims associated with a non-affirmed 

prior authorization decision. 

Additional information is available on 

the CMS website at http://go.cms.gov/ 

PAAmbulance. 

III. Collection of Information 

Requirements 

As required by chapter 35 of title 44, 

United States Code (the Paperwork 

Reduction Act of 1995), the information 

collection burden associated with this 

national model (Form CMS–10708— 

Ambulance Prior Authorization) is 

currently approved under OMB control 

number 0938–1380 which expires on 

August 31, 2023. 

IV. Regulatory Impact Statement 

We have examined the impact of this 

rule as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Act, section 

202 of the Unfunded Mandates Reform 

Act of 1995 (March 22, 1995; Pub. L. 

104–4), Executive Order 13132 on 

Federalism (August 4, 1999), and the 

Congressional Review Act (5 U.S.C. 

804(2)). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A Regulatory Impact Analysis 

(RIA) must be prepared for major rules 

with economically significant effects 

($100 million or more in any 1 year). 

This rule does not reach the economic 

threshold and thus is not considered a 

major rule. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of less than $8.0 million to $41.5 

million in any 1 year. Individuals and 

states are not included in the definition 

of a small entity. We are not preparing 

an analysis for the RFA because we have 

determined, and the Secretary certifies, 

that this notice will not have a 

significant economic impact on a 

substantial number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare an RIA if a rule 

may have a significant impact on the 

operations of a substantial number of 

small rural hospitals. This analysis must 

conform to the provisions of section 604 

of the RFA. For purposes of section 

1102(b) of the Act, we define a small 

rural hospital as a hospital that is 

located outside of a Metropolitan 

Statistical Area for Medicare payment 

regulations and has fewer than 100 

beds. We are not preparing an analysis 

for section 1102(b) of the Act because 

we have determined, and the Secretary 

certifies, that this notice will not have 

a significant impact on the operations of 

a substantial number of small rural 

hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2021, that threshold is approximately 

$158 million. This rule will have no 

consequential effect on state, local, or 

tribal governments or on the private 

sector. 

Executive Order 13132 establishes 

certain requirements that an agency 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 86, No. 164 / Friday, August 27, 2021 / Notices 48151 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on state and local 

governments, preempts state law, or 

otherwise has Federalism implications. 

Since this regulation does not impose 

any costs on state or local governments, 

the requirements of Executive Order 

13132 are not applicable. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

not reviewed by the Office of 

Management and Budget. 

The Administrator of the Centers for 

Medicare & Medicaid Services (CMS), 

Chiquita Brooks-LaSure, having 

reviewed and approved this document, 

authorizes Lynette Wilson, who is the 

Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Dated: August 24, 2021. 

Lynette Wilson, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2021–18543 Filed 8–26–21; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Head Start Family and Child 

Experiences Survey (FACES) (OMB 

#0970–0151) 

AGENCY: Office of Planning, Research, 

and Evaluation, Administration for 

Children and Families, HHS. 

ACTION: Request for public comment. 

SUMMARY: The Office of Planning, 

Research, and Evaluation (OPRE), 

Administration for Children and 

Families (ACF), U.S. Department of 

Health and Human Services (HHS), is 

proposing to collect data for a new wave 

of the Head Start Family and Child 

Experiences Survey (FACES) as well as 

a follow-up to a special data collection 

fielded in the fall of 2021. 

DATES: Comments due within 60 days of 

publication. In compliance with the 

requirements of the Paperwork 

Reduction Act of 1995, ACF is soliciting 

public comment on the specific aspects 

of the information collection described 

above. 

ADDRESSES: Copies of the proposed 

collection of information can be 

obtained and comments may be 

forwarded by emailing 

OPREinfocollection@acf.hhs.gov. 

Alternatively, copies can also be 

obtained by writing to the 

Administration for Children and 

Families, Office of Planning, Research, 

and Evaluation, 330 C Street SW, 

Washington, DC 20201, Attn: OPRE 

Reports Clearance Officer. All requests, 

emailed or written, should be identified 

by the title of the information collection. 

SUPPLEMENTARY INFORMATION: 

Description: The purpose of the 

FACES data collection is to support the 

2007 reauthorization of the Head Start 

program (Pub. L. 110–134), which calls 

for periodic assessments of Head Start’s 

quality and effectiveness. FACES 2019 

focuses on Head Start Regions I through 

X (which are geographically based); 

AIAN (American Indian and Alaska 

Native) FACES 2019 focuses on Region 

XI (which funds Head Start programs 

that serve federally recognized 

American Indian and Alaska Native 

tribes). Both studies will provide data 

on a set of key indicators for Head Start 

programs. Information about the Head 

Start program recruitment and center 

selection processes and on the fall 2019, 

spring 2020, and fall 2021 data 

collection activities for both FACES and 

AIAN FACES can be found here: https:// 

www.reginfo.gov/public/do/ 

PRAViewICR?ref_nbr=202005-0970-009. 

This 60-day notice describes: 

• The spring 2022 round of FACES 

program- and classroom-level data 

collection. 

• A follow-up in spring 2022 of the 

fall 2021 FACES and AIAN FACES 

child-level data collection. 

FACES spring 2022 data collection 

will take place in 180 Head Start 

programs nationwide. Of the 180 

programs, 60 will have participated in 

fall data collection and 120 will be 

added to participate in classroom- and 

program-data collection only. AIAN 

FACES will continue in the same 22 

programs that participated in 2019, 

2020, and 2021 data collection. Data 

collection activities will include teacher 

sampling (for the 120 FACES programs 

not part of fall 2021), parent surveys, 

teacher child reports, staff surveys, and, 

for FACES, classroom observations. 

In the additional 120 programs added 

to FACES in spring 2022, data collection 

will begin with sampling of FACES 

teachers in 240 Head Start centers. 

Study team members will request a list 

of all teachers working with Head Startfunded children. 

As in fall 2021, for the spring 2022 

follow-up data collection, FACES will 

survey the parents of 2,400 Head Start 

children in Regions I–X (FACES 2019) 

and 800 children in Region XI (AIAN 

FACES 2019) and ask their Head Start 

teachers to rate children’s learning skills 

and social and emotional skills. Parents 

of sampled children (2,400 for FACES 

and 800 for AIAN FACES) will complete 

surveys on the web or by telephone 

about their children and family. In all 

202 programs (180 for FACES and 22 for 

AIAN FACES), Head Start teachers will 

rate each sampled child (approximately 

10 children per teacher) using the web 

or paper-and-pencil forms. Teachers, 

program directors, and center directors 

will also complete a survey, also using 

the web or paper-and-pencil forms, 

about themselves and the services and 

instruction in Head Start. 

Respondents: Parents of Head Start 

children; Head Start staff. 

ANNUAL BURDEN ESTIMATES

Instrument 

Number of 

respondents 

(total over 

request period) 

Number of 

responses per 

respondent 

(total over 

request period) 

Average 

burden per 

response 

(in hours) 

Total burden 

(in hours) 

Annual burden 

(in hours) 

FACES 2019 spring 2022 special teacher sampling 

form from Head Start staff ........................................... 240 1 .17 41 14 

FACES 2019 special Head Start parent survey .............. 2,400 1 .58 1,392 464 

FACES 2019 special Head Start teacher child report ..... 240 10 .17 408 136 

FACES 2019 Head Start teacher survey ........................ 720 1 .67 482 161 

FACES 2019 Head Start center director survey ............. 360 1 .58 209 70 

FACES 2019 Head Start program director survey .......... 180 1 .67 121 40 

AIAN FACES 2019 special Head Start parent survey .... 800 1 .58 464 155 


lotter on DSK11XQN23PROD with NOTICES1