Agency Information Collection Activities: Proposed Collection; Comment Request, 70927-70928 [2010-29253]
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srobinson on DSKHWCL6B1PROD with NOTICES
Federal Register / Vol. 75, No. 223 / Friday, November 19, 2010 / Notices
786–8680. For all other issues call 410–
786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Advance
Beneficiary Notice of Noncoverage
(ABN); Form Number: CMS–R–131
(OMB#: 0938–0566); Use: Under section
1879 of the Social Security Act, a
physician, provider, practitioner, or
supplier of items or services
participating in the Medicare program,
or taking a claim on assignment, may
bill a Medicare beneficiary for items or
services usually covered under
Medicare, but denied in an individual
case under one of the several statutory
exclusions, if they inform the
beneficiary, prior to furnishing the
service, that Medicare is likely to deny
payment. Sections 42 CFR 411.404(b)
and (c), and 411.408(d)(2) and (f),
require written notice be provided to
inform beneficiaries in advance of
potential liability for payment.
Frequency: Once; Affected Public:
Reporting: Weekly, Monthly, Yearly,
Biennially and Occasionally; Number of
Respondents: 1,326,282; Total Annual
Responses: 43,725,850; Total Annual
Hours: 5,099,309. (For policy questions
regarding this collection contact Evelyn
Blaemire at 410–786–1803. For all other
issues call 410–786–1326.)
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicaid
Payment for Prescription Drugs—
Physicians and Hospital Outpatient
Departments Collecting and Submitting
Drug Identifying Information to State
Medicaid Programs; Use: Section 6002
of the Deficit Reduction Act (DRA) of
2005 added provisions under section
1927 of the Social Security Act to
require physicians in their offices and
hospital outpatient settings or other
entities (e.g., non-profit facilities) to
collect and submit the drug National
Drug Code (NDC) numbers on Medicaid
claims to their State in order for Federal
Financial Participation to be available
for these drugs. Form Number: CMS–
10215 (OMB#: 0938–1026); Frequency:
Weekly; Affected Public: Private Sector:
Business or other for-profits and Notfor-profit institutions; Number of
Respondents: 20,000; Total Annual
Responses: 3,910,000; Total Annual
Hours: 15,836. (For policy questions
regarding this collection contact
Bernadette Leeds at 410–786–9463. For
all other issues call 410–786–1326.)
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare/
VerDate Mar<15>2010
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Jkt 223001
Medicaid Psychiatric Hospital Survey
Data; Use: The CMS–724 form is used to
collect data that is not collected
elsewhere and assists CMS in program
planning and evaluation and in
maintaining an accurate database on
providers participating in the
psychiatric hospital program. Form
Number: CMS–724 (OMB#: 0938–0378);
Frequency: Annually; Affected Public:
Private Sector: Business or other forprofits and Not-for-profit institutions;
Number of Respondents: 500; Total
Annual Responses: 150; Total Annual
Hours: 75. (For policy questions
regarding this collection contact Kelley
Leonette at 410–786–6664. For all other
issues call 410–786–1326.)
5. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: PACE State Plan
Amendment Pre-print; Use: The
Balanced Budget Act of 1997 created
section 1934 of the Social Security Act
that established the Program for the AllInclusive Care for the Elderly (PACE).
The legislation established the PACE
program as a Medicaid State plan option
serving the frail and elderly in the home
and community. Pursuant to the notice
given in 64 FR 66271 (November 24,
1999), if a State elects to offer PACE as
an optional Medicaid benefit, it must
complete a State Plan Amendment
described as Enclosures #3, 4, 5, 6 and
7. The information collected is used by
CMS to affirm that the State elects to
offer PACE an optional State plan
service and the specifications of
eligibility, payment and enrollment for
the program. Form Number: CMS–10227
(OMB#: 0938–1027); Frequency: Once;
Affected Public: State, Local, or Tribal
Governments; Number of Respondents:
36; Total Annual Responses: 12; Total
Annual Hours: 240. (For policy
questions regarding this collection
contact Angela Taube at 410–786–2638.
For all other issues call 410–786–1326.)
6. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicaid State
Program Integrity Assessment (SPIA);
Use: Under the provisions of the Deficit
Reduction Act (DRA) of 2005, the
Congress directed CMS to establish the
Medicaid Integrity Program (MIP), CMS’
first national strategy to combat
Medicaid fraud, waste, and abuse. CMS
has two broad responsibilities under the
MIP: (1) Reviewing the actions of
individuals or entities providing
services or furnishing items under
Medicaid; conducting audits of claims
submitted for payment; identifying
overpayments; and educating providers
and others on payment integrity and
PO 00000
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Sfmt 4703
70927
quality of care; and (2) Providing
effective support and assistance to
States to combat Medicaid fraud, waste,
and abuse.
In order to fulfill the second of these
requirements, CMS developed SPIA.
CMS uses SPIA to collect data on State
Medicaid program integrity activities,
develop reports for each State based on
these data, determine areas to provide
States with technical support and
assistance, and develop measures to
assess States’ performance. Form
Number: CMS–10244 (OMB#: 0938–
1033); Frequency: Annually; Affected
Public: State, Local, or Tribal
Governments; Number of Respondents:
56; Total Annual Responses: 56; Total
Annual Hours: 1,400. (For policy
questions regarding this collection
contact Mary Jo Cook at 410–786–3231.
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
https://www.cms.hhs.gov/Paperwork
ReductionActof1995, or E-mail 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 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 December 20, 2010. OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer. Fax
Number: (202) 395–6974. E-mail:
OIRA_submission@omb.eop.gov.
Dated: November 12, 2010.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2010–29074 Filed 11–18–10; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10334 and CMS–
10339]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
AGENCY:
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19NON1
srobinson on DSKHWCL6B1PROD with NOTICES
70928
Federal Register / Vol. 75, No. 223 / Friday, November 19, 2010 / Notices
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: Extension of a currently
approved collection; Title of
Information Collection: Enrollment
Application for Coverage in the PreExisting Condition Insurance Plan; Use:
The Department of Health and Human
Services (HHS) is requesting an
extension of this information collection
request by the Office of Management
and Budget (OMB). This information
collection request originally received
OMB approval on 6/29/2010. HHS is
now seeking a three-year approval for
this collection. On March 23, 2010, the
President signed into law H.R. 3590, the
Patient Protection and Affordable Care
Act (Affordable Care Act), Public Law
111–148. Section 1101 of the law
establishes a ‘‘temporary high risk health
insurance pool program’’ (which has
been named the Pre-Existing Condition
Insurance Plan, or PCIP) to provide
health insurance coverage to currently
uninsured individuals with pre-existing
conditions.
In order for individuals to be
considered for eligibility into the
federally-run PCIP program, they must
submit a completed enrollment
application to HHS. The enrollment
application is used by HHS or its
designee to obtain information from
potentially eligible individuals applying
for coverage in the PCIP program. PCIP
is also referred to as the temporary
qualified high risk insurance pool
program, as it is called in the Affordable
Care Act, but we have adopted the term
PCIP to better describe the program and
avoid confusion with the existing state
high risk pool programs. The data
collection will be used by HHS to obtain
information from potential eligible
individuals applying for coverage in the
PCIP. Form Number: CMS–10334
VerDate Mar<15>2010
17:02 Nov 18, 2010
Jkt 223001
(OMB#: 0938–1095); Frequency: Once;
Affected Public: Individuals and
households; Number of Respondents:
100,000; Total Annual Responses:
100,000; Total Annual Hours: 92,000.
(For policy questions regarding this
collection contact Laura Dash at 410–
786–8623. For all other issues call 410–
786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Pre-Existing
Health Insurance Plan and Supporting
Regulations; Use: The Department of
Health and Human Services (HHS) is
requesting an extension of this
information collection request by the
Office of Management and Budget
(OMB). This information collection
request originally received OMB
approval on 7/26/2010. HHS is now
seeking a three-year approval for this
collection. On March 23, 2010, the
President signed into law H.R. 3590, the
Patient Protection and Affordable Care
Act (Affordable Care Act), Public Law
111–148. Section 1101 of the law
establishes a ‘‘temporary high risk health
insurance pool program’’ (which has
been named the Pre-Existing Condition
Insurance Plan, or PCIP) to provide
health insurance coverage to currently
uninsured individuals with pre-existing
conditions. The law authorizes HHS to
carry out the program directly or
through contracts with states or private,
non-profit entities.
We are requesting an extension for
this package because this information is
needed to assure that PCIP programs are
established timely and effectively. This
request is being made based on
regulations that have been issued and
contracts which have been executed by
HHS with States or an entity on their
behalf participating in the PCIP
program. PCIP is also referred to as the
temporary qualified high risk insurance
pool program, as it is called in the
Affordable Care Act, but we have
adopted the term PCIP to better describe
the program and avoid confusion with
the existing state high risk pool
programs. Form Number: CMS–10339
(OMB#: 0938–1100); Frequency:
Reporting—On occasion; Affected
Public: State governments; Number of
Respondents: 51; Total Annual
Responses: 2,652; Total Annual Hours:
36,924. (For policy questions regarding
this collection contact Laura Dash at
410–786–8623. 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
at https://www.cms.hhs.gov/Paperwork
PO 00000
Frm 00034
Fmt 4703
Sfmt 4703
ReductionActof1995, or E-mail 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.
In commenting on the proposed
information collections please reference
the document identifier or OMB control
number. To be assured consideration,
comments and recommendations must
be submitted in one of the following
ways by January 18, 2011:
1. Electronically. You may submit
your comments electronically to
https://www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) accepting comments.
2. By regular mail. You may mail
written comments to the following
address: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: Document Identifier/OMB
Control Number Room C4–26–05, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: November 16, 2010.
Martique Jones,
Director, Regulations Development Group
Division-B, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2010–29253 Filed 11–18–10; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare and Medicaid
Services
[Document Identifier: CMS–10356]
Emergency Clearance: Public
Information Collection Requirements
Submitted to the Office of Management
and Budget (OMB)
Center for Medicare and
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 and 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 functions;
AGENCY:
E:\FR\FM\19NON1.SGM
19NON1
]]>Agencies
[Federal Register Volume 75, Number 223 (Friday, November 19, 2010)]
[Notices]
[Pages 70927-70928]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-29253]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10334 and CMS-10339]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
[[Page 70928]]
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: Extension of a currently
approved collection; Title of Information Collection: Enrollment
Application for Coverage in the Pre-Existing Condition Insurance Plan;
Use: The Department of Health and Human Services (HHS) is requesting an
extension of this information collection request by the Office of
Management and Budget (OMB). This information collection request
originally received OMB approval on 6/29/2010. HHS is now seeking a
three-year approval for this collection. On March 23, 2010, the
President signed into law H.R. 3590, the Patient Protection and
Affordable Care Act (Affordable Care Act), Public Law 111-148. Section
1101 of the law establishes a ``temporary high risk health insurance
pool program'' (which has been named the Pre-Existing Condition
Insurance Plan, or PCIP) to provide health insurance coverage to
currently uninsured individuals with pre-existing conditions.
In order for individuals to be considered for eligibility into the
federally-run PCIP program, they must submit a completed enrollment
application to HHS. The enrollment application is used by HHS or its
designee to obtain information from potentially eligible individuals
applying for coverage in the PCIP program. PCIP is also referred to as
the temporary qualified high risk insurance pool program, as it is
called in the Affordable Care Act, but we have adopted the term PCIP to
better describe the program and avoid confusion with the existing state
high risk pool programs. The data collection will be used by HHS to
obtain information from potential eligible individuals applying for
coverage in the PCIP. Form Number: CMS-10334 (OMB: 0938-1095);
Frequency: Once; Affected Public: Individuals and households; Number of
Respondents: 100,000; Total Annual Responses: 100,000; Total Annual
Hours: 92,000. (For policy questions regarding this collection contact
Laura Dash at 410-786-8623. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Pre-Existing
Health Insurance Plan and Supporting Regulations; Use: The Department
of Health and Human Services (HHS) is requesting an extension of this
information collection request by the Office of Management and Budget
(OMB). This information collection request originally received OMB
approval on 7/26/2010. HHS is now seeking a three-year approval for
this collection. On March 23, 2010, the President signed into law H.R.
3590, the Patient Protection and Affordable Care Act (Affordable Care
Act), Public Law 111-148. Section 1101 of the law establishes a
``temporary high risk health insurance pool program'' (which has been
named the Pre-Existing Condition Insurance Plan, or PCIP) to provide
health insurance coverage to currently uninsured individuals with pre-
existing conditions. The law authorizes HHS to carry out the program
directly or through contracts with states or private, non-profit
entities.
We are requesting an extension for this package because this
information is needed to assure that PCIP programs are established
timely and effectively. This request is being made based on regulations
that have been issued and contracts which have been executed by HHS
with States or an entity on their behalf participating in the PCIP
program. PCIP is also referred to as the temporary qualified high risk
insurance pool program, as it is called in the Affordable Care Act, but
we have adopted the term PCIP to better describe the program and avoid
confusion with the existing state high risk pool programs. Form Number:
CMS-10339 (OMB: 0938-1100); Frequency: Reporting--On occasion;
Affected Public: State governments; Number of Respondents: 51; Total
Annual Responses: 2,652; Total Annual Hours: 36,924. (For policy
questions regarding this collection contact Laura Dash at 410-786-8623.
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 at
http:[sol][sol]www.cms.hhs.gov[sol]PaperworkReductionActof1995, or E-
mail 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by January 18, 2011:
1. Electronically. You may submit your comments electronically to
http:[sol][sol]www.regulations.gov. Follow the instructions for
``Comment or Submission'' or ``More Search Options'' to find the
information collection document(s) accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: November 16, 2010.
Martique Jones,
Director, Regulations Development Group Division-B, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2010-29253 Filed 11-18-10; 8:45 am]
BILLING CODE 4120-01-P
