[Federal Register Volume 87, Number 87 (Thursday, May 5, 2022)]
[Notices]
[Pages 26760-26762]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-09581]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-265-11, CMS-10544, CMS-10338, and CMS-10599]


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

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

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 the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and 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 June 6, 2022.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
    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' website address at website address at: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

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: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Independent Renal Dialysis Facility Cost Report; Use: Under 
the authority of sections 1815(a)

[[Page 26761]]

and 1833(e) of the Act, CMS requires that providers of services 
participating in the Medicare program submit information to determine 
costs for health care services rendered to Medicare beneficiaries. CMS 
requires that providers follow reasonable cost principles under 
1861(v)(1)(A) of the Act when completing the Medicare cost report 
(MCR). Regulations at 42 CFR 413.20 and 413.24 require that providers 
submit acceptable cost reports on an annual basis and maintain 
sufficient financial records and statistical data, capable of 
verification by qualified auditors.
    ESRD facilities participating in the Medicare program submit these 
cost reports annually to report cost and statistical data used by CMS 
to determine reasonable costs incurred for furnishing dialysis services 
to Medicare beneficiaries and to effect the year-end cost settlement 
for Medicare bad debts. Form Number: CMS-265-11 (OMB control number: 
0938-0236); Frequency: Annually; Affected Public: Private Sector, 
Business or other for-profits, State, Local, or Tribal Governments); 
Number of Respondents: 7,492; Total Annual Responses: 7,492; Total 
Annual Hours: 494,472. (For questions regarding this collection contact 
Keplinger, Jill C. at 410-786-4550.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Good Cause Processes; Use: Section 1851(g)(3)(B)(i) of the 
Act provides that MA organizations may terminate the enrollment of 
individuals who fail to pay basic and supplemental premiums after a 
grace period established by the plan. Section 1860D-1(b)(1)(B)(v) of 
the Act generally directs us to establish rules related to enrollment, 
disenrollment, and termination for Part D plan sponsors that are 
similar to those established for MA organizations under section 1851 of 
the Act. Consistent with these sections of the Act, subpart B in each 
of the Parts C and D regulations sets forth requirements with respect 
to involuntary disenrollment procedures at 42 CFR 422.74 and 423.44, 
respectively. In addition, section 1876(c)(3)(B) establishes that 
individuals may be disenrolled from coverage as specified in 
regulations. Thus, current regulations at 42 CFR 417.460 specify that a 
cost plan, specifically a Health Maintenance Organization (HMO) or 
competitive medical plan (CMP), may disenroll a member who fails to pay 
premiums or other charges imposed by the plan for deductible and 
coinsurance amounts.
    These good cause provisions authorize CMS to reinstate a 
disenrolled individual's enrollment without interruption in coverage if 
the non-payment is due to circumstances that the individual could not 
reasonably foresee or could not control, such as an unexpected 
hospitalization. At its inception, the process of accepting, reviewing, 
and processing beneficiary requests for reinstatement for good cause 
was carried out exclusively by CMS. Form Number: CMS-10544 (OMB control 
number: 0938-1271); Frequency: Annually; Affected Public: Business or 
other for-profits State, Local, or Tribal Governments); Number of 
Respondents: 312; Total Annual Responses: 41,289; Total Annual Hours: 
27,499. (For questions regarding this collection contact Ronke Fabayo 
at (410) 786-4460.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Affordable Care 
Act Internal Claims and Appeals and External Review Procedures for Non-
grandfathered Group Health Plans and Issuers and Individual Market 
Issuers; Use: The information collection requirements ensure that 
claimants receive adequate information regarding the plan's claims 
procedures and the plan's handling of specific benefit claims. 
Claimants need to understand plan procedures and plan decisions in 
order to appropriately request benefits and/or appeal benefit denials. 
The information collected in connection with the HHS-administered 
federal external review process is collected by HHS, and is used to 
provide claimants with an independent external review. Form Number: 
CMS-10338 (OMB control number: 0938-1099); Frequency: Occasionally; 
Affected Public: Private Sector (Business or other for-profit and Not-
for-profit institutions); Number of Respondents: 497,262; Total Annual 
Responses: 517,014,153; Total Annual Hours: 1,198,692. (For policy 
questions regarding this collection contact Laura Byabazaire at 301-
492-4128.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Review Choice 
Demonstration for Home Health Services; Use: Section 402(a)(1)(J) of 
the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J)) 
authorizes the Secretary to ``develop or demonstrate improved methods 
for the investigation and prosecution of fraud in the provision of care 
or services under the health programs established by the Social 
Security Act (the Act).'' Pursuant to this authority, the CMS seeks to 
develop and implement a Medicare demonstration project, which CMS 
believes will help assist in developing improved procedures for the 
identification, investigation, and prosecution of Medicare fraud 
occurring among Home Health Agencies (HHA) providing services to 
Medicare beneficiaries.
    This revised demonstration helps assist in developing improved 
procedures for the identification, investigation, and prosecution of 
potential Medicare fraud. The demonstration helps make sure that 
payments for home health services are appropriate through either pre-
claim or postpayment review, thereby working towards the prevention and 
identification of potential fraud, waste, and abuse; the protection of 
Medicare Trust Funds from improper payments; and the reduction of 
Medicare appeals. CMS has implemented the demonstration in Illinois, 
Ohio, North Carolina, Florida, and Texas with the option to expand to 
other states in the Palmetto/JM jurisdiction. Under this demonstration, 
CMS offers choices for providers to demonstrate their compliance with 
CMS' home health policies. Providers in the demonstration states may 
participate in either 100 percent pre-claim review or 100 percent post 
payment review. These providers will continue to be subject to a review 
method until the HHA reaches the target affirmation or claim approval 
rate. Once an HHA reaches the target pre-claim review affirmation or 
post-payment review claim approval rate, it may choose to be relieved 
from claim reviews, except for a spot check of their claims to ensure 
continued compliance. Providers who do not wish to participate in 
either 100 percent pre-claim or post payment reviews have the option to 
furnish home health services and submit the associated claim for 
payment without undergoing such reviews; however, they will receive a 
25 percent payment reduction on all claims submitted for home health 
services and may be eligible for review by the Recovery Audit 
Contractors.
    The information required under this collection is required by 
Medicare contractors to determine proper payment or if there is a 
suspicion of fraud. Under the pre-claim review option, the HHA sends 
the pre-claim review request along with all required documentation to 
the Medicare contractor for review prior to submitting the final claim 
for payment. If a claim is submitted without a pre-claim review 
decision one file, the Medicare contractor will request the information 
from the HHA to determine if payment is appropriate. For the post 
payment review option, the Medicare contractor

[[Page 26762]]

will also request the information from the HHA provider who submitted 
the claim for payment from the Medicare program to determine if payment 
was appropriate. Form Number: CMS-10599 (OMB control number: 0938-
1311); Frequency: Frequently, until the HHA reaches the target 
affirmation or claim approval threshold and then occasionally; Affected 
Public: Private Sector (Business or other for-profits and Not-for-
profits); Number of Respondents: 3,631; Number of Responses: 1,467,243; 
Total Annual Hours: 7,445,143. (For questions regarding this collection 
contact Jennifer McMullen (410)786-7635.)

    Dated: April 29, 2022.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2022-09581 Filed 5-4-22; 8:45 am]
BILLING CODE 4120-01-P