81_FR_66217 81 FR 66031 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

81 FR 66031 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 81, Issue 186 (September 26, 2016)

Page Range66031-66033
FR Document2016-23157

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.

Federal Register, Volume 81 Issue 186 (Monday, September 26, 2016)
[Federal Register Volume 81, Number 186 (Monday, September 26, 2016)]
[Notices]
[Pages 66031-66033]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-23157]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-R-70, CMS-R-72, CMS-R-247, CMS-10062, CMS-
10268, CMS-10615 and CMS-10623]


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

AGENCY: Centers for Medicare & Medicaid Services.

ACTION: Notice.

-----------------------------------------------------------------------

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.

[[Page 66032]]


DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by October 26, 2016.

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_ 
[email protected].
    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 [email protected].
    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: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements in HSQ-110, Acquisition, Protection and 
Disclosure of Peer review Organization Information and Supporting 
Regulations; Use: The Peer Review Improvement Act of 1982 authorizes 
quality improvement organizations (QIOs), formally known as peer review 
organizations (PROs), to acquire information necessary to fulfill their 
duties and functions and places limits on disclosure of the 
information. The QIOs are required to provide notices to the affected 
parties when disclosing information about them. These requirements 
serve to protect the rights of the affected parties. The information 
provided in these notices is used by the patients, practitioners and 
providers to: Obtain access to the data maintained and collected on 
them by the QIOs; add additional data or make changes to existing QIO 
data; and reflect in the QIO's record the reasons for the QIO's 
disagreeing with an individual's or provider's request for amendment. 
Form Number: CMS-R-70 (OMB control number: 0938-0426); Frequency: 
Reporting--On occasion; Affected Public: Business or other for-profits; 
Number of Respondents: 400; Total Annual Responses: 21,200; Total 
Annual Hours: 42,400. (For policy questions regarding this collection 
contact Winsome Higgins at 410-786-1835.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements in 42 CFR 478.18, 478.34, 478.36, 478.42, QIO 
Reconsiderations and Appeals; Use: In the event that a beneficiary, 
provider, physician, or other practitioner does not agree with the 
initial determination of a Quality Improvement Organization (QIO) or a 
QIO subcontractor, it is within that party's rights to request 
reconsideration. The information collection requirements 42 CFR 478.18, 
478.34, 478.36, and 478.42, contain procedures for QIOs to use in 
reconsideration of initial determinations. The information requirements 
contained in these regulations are on QIOs to provide information to 
parties requesting the reconsideration. These parties will use the 
information as guidelines for appeal rights in instances where issues 
are actively being disputed. Form Number: CMS-R-72 (OMB control number: 
0938-0443); Frequency: Reporting--On occasion; Affected Public: 
Individuals or Households and Business or other for-profit 
institutions; Number of Respondents: 2,590; Total Annual Responses: 
5,228; Total Annual Hours: 2,822. (For policy questions regarding this 
collection contact Winsome Higgins at 410-786-1835.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Expanded Coverage 
for Diabetes Outpatient Self-Management Training Services and 
Supporting Regulations; Use: According to the National Health and 
Nutrition Examination Survey (NHANES), as many as 18.7 percent of 
Americans over age 65 are at risk for developing diabetes. The goals in 
the management of diabetes are to achieve normal metabolic control and 
reduce the risk of micro- and macro-vascular complications. Numerous 
epidemiologic and interventional studies point to the necessity of 
maintaining good glycemic control to reduce the risk of the 
complications of diabetes. Despite this knowledge, diabetes remains the 
leading cause of blindness, lower extremity amputations and kidney 
disease requiring dialysis. Diabetes and its complications are primary 
or secondary factors in an estimated 9 percent of hospitalizations 
(Aubert, RE, et al., Diabetes-related hospitalizations and hospital 
utilization. In: Diabetes in America. 2nd ed. National Institutes of 
Health, National Institute of Diabetes and Digestive and Kidney 
Disease, NIH, Pub. No 95-1468-1995: 553-570). Overall, beneficiaries 
with diabetes are hospitalized 1.5 times more often than beneficiaries 
without diabetes. HCFA-3002-F provided for uniform coverage of diabetes 
outpatient self-management training services. These services include 
educational and training services furnished to a beneficiary with 
diabetes by an entity approved to furnish the services. The physician 
or qualified non-physician practitioner treating the beneficiary's 
diabetes would certify that these services are needed as part of a 
comprehensive plan of care. This rule established the quality standards 
that an entity would be required to meet in order to participate in 
furnishing diabetes outpatient self-management training services. It 
set forth payment amounts that have been established in consultation 
with appropriate diabetes organizations. It implements section 4105 of 
the Balanced Budget Act of 1997. Form Number: CMS-R-247 (OMB control 
number: 0938-0818); Frequency: Recordkeeping and Reporting--
Occasionally; Affected Public: Business or other for-profit 
institutions; Number of Respondents: 5,327; Total Annual Responses: 
63,924; Total Annual Hours: 197,542. (For policy questions regarding 
this collection contact Kristin Shifflett at 410-786-4133.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Collection of 
Diagnostic Data from Medicare Advantage Organizations for Risk

[[Page 66033]]

Adjusted Payments; Use: CMS requires hospital inpatient, hospital 
outpatient and physician diagnostic data from Medicare Advantage (MA) 
organizations to continue making payment under the risk adjustment 
methodology. CMS will use the data to make risk adjusted payment under 
Parts C and D. MA and MA-PD plans will use the data to develop their 
Part C and D bids. As required by law, CMS also annually publishes the 
risk adjustment factors for plans and other interested entities in the 
Advance Notice of Methodological Changes for MA Payment Rates (every 
February) and the Announcement of Medicare Advantage Payment Rates 
(every April). Lastly, CMS issues monthly reports to each individual 
plan that contains the CMS Hierarchical Condition Category (HCC) and 
RxHCC models' output and the risk scores and reimbursements for each 
beneficiary that is enrolled in their plan. Form Number: CMS-10062 (OMB 
control number: 0938-0878); Frequency: Quarterly; Affected Public: 
Private sector (Business or other for profit and Not-for-profit 
institutions); Number of Respondents: 691; Total Annual Responses: 
83,000,000; Total Annual Hours: 40,650. (For policy questions regarding 
this collection contact Michael P. Massimini at 410-786-1566.)
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Consolidated 
Renal Operations in a Web Enabled Network (CROWNWeb) Third-party 
Submission Authorization Form; Use: The Consolidated Renal Operations 
in a Web Enabled Network (CROWNWeb) Third-Party Submission 
Authorization form (CWTPSA) is to be completed by ``Facility 
Administrators'' (administrators of CMS-certified dialysis facilities) 
if they intend to authorize a third party (a business with which the 
facility is associated, or an independent vendor) to submit data to us 
to comply with the recently-revised Conditions for Coverage of dialysis 
facilities. The CROWNWeb system is the system used as the collection 
point of data necessary for entitlement of ESRD patients to Medicare 
benefits and for federal government monitoring and assessing of the 
quality and types of care provided to renal patients. The information 
collected through the CWTPSA form will allow us along with our 
contractors to receive data from authorized parties acting on behalf of 
CMS-certified dialysis facilities. Since February 2009, we have 
received 4,160 CWTPSA forms and anticipates that they will continue to 
receive no more than 400 new CWTPSA forms annually to address the 
creation of new facilities under the current participating ``third 
party submitters.'' Form Number: CMS-10268 (OMB control number: 0938-
1052); Frequency: Occasionally; Affected Public: Business or other for-
profits and Not-for-profit institutions; Number of Respondents: 400; 
Total Annual Responses: 400; Total Annual Hours: 34. (For policy 
questions regarding this collection contact Victoria Schlining at 410-
786-6878.)
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Healthy Indiana 
Program (HIP) 2.0 Beneficiaries Survey, Focus Groups, and Informational 
Interviews; Use: The collected information will be used to make 
decisions about the renewal of precedent-setting waivers of Medicaid 
policy that assure important beneficiary protections regarding coverage 
and access to care; e.g., the State of Indiana's non-emergency medical 
transportation waiver which will end or will be extended by no later 
than December 1, 2016. To support CMS decision making, the collection's 
survey effort would provide more detailed information on the Healthy 
Indiana Program (HIP) 2.0 demonstration's beneficiary understanding and 
experiences (current and new enrollees as well as disenrollees/
lockouts). Additional information on other key policies under the 
demonstration, such as the 60-day beneficiary lock-out period, is also 
included in this information collection request.
    This request does not propose any new or revised information 
collection requirements or burden estimates outside of what is 
currently approved by OMB. Rather, it seeks to extend the collection's 
current expiration date of September 30, 2016 (approved under the 
emergency PRA process on March 21, 2016; see 81 FR 17460 dated March 
29, 2106, and 81 FR 26798 dated May 4, 2016). Since the collection has 
already been subject to the public comment process for collection 
activities taking place through September 30, 2016, this ``Extension of 
a currently approved collection'' will only consider comments for 
activities taking place from October 1, 2016, through the end of the 
revised expiration date. The revised expiration date will be made 
available upon OMB approval at reginfo.gov. Form Number: CMS-10615 (OMB 
control number: 0938-1300); Frequency: Once; Affected Public: 
Individuals and households, Private sector (Business or other for-
profits and Not-for-profits institutions), and State, Local, or Tribal 
Governments; Number of Respondents: 5,240; Total Annual Responses: 
5,240; Total Annual Hours: 1,442. (For policy questions regarding this 
collection contact Teresa DeCaro at 202-384-6309.)
    7. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Testing 
Experience and Functional Tools Demonstration: Personal Health Record 
(PHR) User Survey; Use: The PHR user survey is important to the TEFT 
Program Evaluation and understanding the impact of the TEFT PHR on 
Medicaid CB-LTSS beneficiaries. The TEFT evaluation team's approach 
includes monitoring state PHR implementation efforts and fielding a 
follow-up questionnaire to CB-LTSS program participants that asks about 
their experiences using the PHR. The evaluation seeks to measure the 
degree to which the PHR is implemented in an accessible manner for 
Medicaid beneficiaries of CB-LTSS. The survey also is designed to 
assess the user experience of the PHR, including access and usability, 
as well as some measures of user satisfaction and perceived impacts of 
PHR use.
    The information collection request has been revised subsequent to 
the publication of the 60-day Federal Register notice on June 13, 2016 
(81 FR 38187). Details can be found in the package's Supporting 
Statement. While the June 13 Supporting Statement had set out the 
correct number of burden hours, the 60-day Federal Register notice had 
inadvertently set out 192,113 hours. This should have been 206 hours. 
Form Number: CMS-10623 (OMB control number: 0938-New); Frequency: Once; 
Affected Public: Individuals and households; Number of Respondents: 
576; Total Annual Responses: 576; Total Annual Hours: 190. (For policy 
questions regarding this collection contact Kerry Lida at 410-786-
4826.)

     Dated: September 21, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2016-23157 Filed 9-23-16; 8:45 am]
 BILLING CODE 4120-01-P



                                                                               Federal Register / Vol. 81, No. 186 / Monday, September 26, 2016 / Notices                                                66031

                                                  comments should be received within 30                         DTBE is the lead agency for                            populations vulnerable to tuberculosis,
                                                  days of this notice.                                       tuberculosis elimination in the United                    and programmed electronic report entry,
                                                                                                             States. To ensure the elimination of                      which transitioned to the National
                                                  Proposed Project
                                                                                                             tuberculosis in the United States, CDC                    Tuberculosis Indicators Project (NTIP), a
                                                    Aggregate Reports for Tuberculosis                       monitors indicators for key program                       secure web-based system for program
                                                  Program Evaluation (OMB Control                            activities, such as finding tuberculosis                  evaluation data, in 2010. No other
                                                  Number 0920–0457)—Reinstatement                            infections in recent contacts of cases                    federal agency collects this type of
                                                  Without Change of a Previously                             and in other persons likely to be                         national tuberculosis data, and the
                                                  Approved Collection—National Center                        infected and providing therapy for                        Aggregate report of follow-up for
                                                  for HIV/AIDS, Viral Hepatitis, STD, and                    latent tuberculosis infection.                            contacts of tuberculosis, and Aggregate
                                                  TB Prevention (NCHHSTP), Centers for                          In 2000, CDC implemented two                           report of screening and preventive
                                                  Disease Control and Prevention (CDC).                      program evaluation reports for annual                     therapy for tuberculosis infection are
                                                                                                             submission: Aggregate report of follow-                   the only data source about latent
                                                  Background and Brief Description
                                                                                                             up for contacts of tuberculosis, and                      tuberculosis infection for monitoring
                                                    CDC, NCHHSTP, Division of                                Aggregate report of screening and                         national progress toward tuberculosis
                                                  Tuberculosis Elimination (DTBE)                            preventive therapy for tuberculosis                       elimination with these activities.
                                                  proposes a reinstatement without                           infection (OMB No. 0920–0457). The                           CDC provides ongoing assistance in
                                                  change of the Aggregate Reports for                        respondents for these reports were the                    the preparation and utilization of these
                                                  Tuberculosis Program Evaluation,                           68 state and local tuberculosis control                   reports at the local and state levels of
                                                  previously approved under OMB                              programs receiving federal cooperative                    public health jurisdiction. CDC also
                                                  Control Number 0920–0457. This                             agreement funding through DTBE. This                      provides respondents with technical
                                                  request is for a three-year clearance.                     group will also respond to this                           support for NTIP access (Electronic—
                                                  There are no revisions to the report                       collection of information.                                100%, Use of Electronic Signatures).
                                                  forms, data definitions, or reporting                         These Aggregate reports emphasize                         The annual burden to respondents is
                                                  instructions.                                              treatment outcomes, high-priority target                  estimated to be 226 hours.

                                                                                                            ESTIMATED ANNUALIZED BURDEN HOURS
                                                                                                                                                                                                        Average
                                                                                                                                                                                        Number of
                                                                                                                                                                         Number of                    burden per
                                                            Type of respondent                                                 Form name                                              responses per
                                                                                                                                                                        respondents                    response
                                                                                                                                                                                        respondent     (in hours)

                                                  Data clerks and Program Managers                 Follow-up and Treatment of Contacts to               Tuberculosis            100               1         30/60
                                                    (electronic).                                    Cases Form.
                                                  Program Managers (manual) ............           Follow-up and Treatment of Contacts to               Tuberculosis             18               1         30/60
                                                                                                     Cases Form.
                                                  Data clerks (manual) .........................   Follow-up and Treatment of Contacts to               Tuberculosis             18               1             3
                                                                                                     Cases Form.
                                                  Data clerks and Program Managers                 Targeted Testing and Treatment for Latent            Tuberculosis            100               1         30/60
                                                    (electronic).                                    Infection.
                                                  Program Managers (manual) ............           Targeted Testing and Treatment for Latent            Tuberculosis             18               1         30/60
                                                                                                     Infection.
                                                  Data clerks (manual) .........................   Targeted Testing and Treatment for Latent            Tuberculosis             18               1             3
                                                                                                     Infection.



                                                  Leroy A. Richardson,                                       DEPARTMENT OF HEALTH AND                                  publish notice in the Federal Register
                                                  Chief, Information Collection Review Office,               HUMAN SERVICES                                            concerning each proposed collection of
                                                  Office of Scientific Integrity, Office of the                                                                        information, including each proposed
                                                  Associate Director for Science, Office of the              Centers for Medicare & Medicaid                           extension or reinstatement of an existing
                                                  Director, Centers for Disease Control and                  Services                                                  collection of information, and to allow
                                                  Prevention.                                                                                                          a second opportunity for public
                                                                                                             [Document Identifiers: CMS–R–70, CMS–R–
                                                  [FR Doc. 2016–23072 Filed 9–23–16; 8:45 am]                72, CMS–R–247, CMS–10062, CMS–10268,                      comment on the notice. Interested
                                                  BILLING CODE 4163–18–P                                     CMS–10615 and CMS–10623]                                  persons are invited to send comments
                                                                                                                                                                       regarding the burden estimate or any
                                                                                                             Agency Information Collection
                                                                                                                                                                       other aspect of this collection of
                                                                                                             Activities: Submission for OMB
                                                                                                                                                                       information, including any of the
                                                                                                             Review; Comment Request
                                                                                                                                                                       following subjects: (1) The necessity and
                                                                                                             AGENCY: Centers for Medicare &                            utility of the proposed information
                                                                                                             Medicaid Services.                                        collection for the proper performance of
                                                                                                             ACTION: Notice.                                           the agency’s functions; (2) the accuracy
mstockstill on DSK3G9T082PROD with NOTICES




                                                                                                                                                                       of the estimated burden; (3) ways to
                                                                                                             SUMMARY:  The Centers for Medicare &
                                                                                                                                                                       enhance the quality, utility, and clarity
                                                                                                             Medicaid Services (CMS) is announcing
                                                                                                                                                                       of the information to be collected; and
                                                                                                             an opportunity for the public to
                                                                                                                                                                       (4) the use of automated collection
                                                                                                             comment on CMS’ intention to collect
                                                                                                             information from the public. Under the                    techniques or other forms of information
                                                                                                             Paperwork Reduction Act of 1995                           technology to minimize the information
                                                                                                             (PRA), federal agencies are required to                   collection burden.



                                             VerDate Sep<11>2014     19:40 Sep 23, 2016    Jkt 238001   PO 00000   Frm 00037    Fmt 4703   Sfmt 4703   E:\FR\FM\26SEN1.SGM   26SEN1


                                                  66032                     Federal Register / Vol. 81, No. 186 / Monday, September 26, 2016 / Notices

                                                  DATES:  Comments on the collection(s) of                organizations (QIOs), formally known as               Coverage for Diabetes Outpatient Self-
                                                  information must be received by the                     peer review organizations (PROs), to                  Management Training Services and
                                                  OMB desk officer by October 26, 2016.                   acquire information necessary to fulfill              Supporting Regulations; Use: According
                                                  ADDRESSES: When commenting on the                       their duties and functions and places                 to the National Health and Nutrition
                                                  proposed information collections,                       limits on disclosure of the information.              Examination Survey (NHANES), as
                                                  please reference the document identifier                The QIOs are required to provide                      many as 18.7 percent of Americans over
                                                  or OMB control number. To be assured                    notices to the affected parties when                  age 65 are at risk for developing
                                                  consideration, comments and                             disclosing information about them.                    diabetes. The goals in the management
                                                  recommendations must be received by                     These requirements serve to protect the               of diabetes are to achieve normal
                                                  the OMB desk officer via one of the                     rights of the affected parties. The                   metabolic control and reduce the risk of
                                                  following transmissions: OMB, Office of                 information provided in these notices is              micro- and macro-vascular
                                                  Information and Regulatory Affairs,                     used by the patients, practitioners and               complications. Numerous epidemiologic
                                                  Attention: CMS Desk Officer, Fax                        providers to: Obtain access to the data               and interventional studies point to the
                                                  Number: (202) 395–5806 OR Email:                        maintained and collected on them by                   necessity of maintaining good glycemic
                                                  OIRA_s submission@omb.eop.gov.                          the QIOs; add additional data or make                 control to reduce the risk of the
                                                    To obtain copies of a supporting                      changes to existing QIO data; and reflect             complications of diabetes. Despite this
                                                  statement and any related forms for the                 in the QIO’s record the reasons for the               knowledge, diabetes remains the leading
                                                  proposed collection(s) summarized in                    QIO’s disagreeing with an individual’s                cause of blindness, lower extremity
                                                  this notice, you may make your request                  or provider’s request for amendment.                  amputations and kidney disease
                                                  using one of following:                                 Form Number: CMS–R–70 (OMB control                    requiring dialysis. Diabetes and its
                                                    1. Access CMS’ Web site address at                    number: 0938–0426); Frequency:                        complications are primary or secondary
                                                  http://www.cms.hhs.gov/                                 Reporting—On occasion; Affected                       factors in an estimated 9 percent of
                                                  PaperworkReductionActof1995.                            Public: Business or other for-profits;                hospitalizations (Aubert, RE, et al.,
                                                    2. Email your request, including your                 Number of Respondents: 400; Total                     Diabetes-related hospitalizations and
                                                  address, phone number, OMB number,                      Annual Responses: 21,200; Total                       hospital utilization. In: Diabetes in
                                                  and CMS document identifier, to                         Annual Hours: 42,400. (For policy                     America. 2nd ed. National Institutes of
                                                  Paperwork@cms.hhs.gov.                                  questions regarding this collection                   Health, National Institute of Diabetes
                                                    3. Call the Reports Clearance Office at               contact Winsome Higgins at 410–786–                   and Digestive and Kidney Disease, NIH,
                                                  (410) 786–1326.                                         1835.)                                                Pub. No 95–1468–1995: 553–570).
                                                  FOR FURTHER INFORMATION CONTACT:                           2. Type of Information Collection                  Overall, beneficiaries with diabetes are
                                                  Reports Clearance Office at (410) 786–                  Request: Extension of a currently                     hospitalized 1.5 times more often than
                                                  1326.                                                   approved collection; Title of                         beneficiaries without diabetes. HCFA–
                                                                                                          Information Collection: Information                   3002–F provided for uniform coverage
                                                  SUPPLEMENTARY INFORMATION: Under the                    Collection Requirements in 42 CFR
                                                  Paperwork Reduction Act of 1995 (PRA)                                                                         of diabetes outpatient self-management
                                                                                                          478.18, 478.34, 478.36, 478.42, QIO                   training services. These services include
                                                  (44 U.S.C. 3501–3520), federal agencies                 Reconsiderations and Appeals; Use: In
                                                  must obtain approval from the Office of                                                                       educational and training services
                                                                                                          the event that a beneficiary, provider,               furnished to a beneficiary with diabetes
                                                  Management and Budget (OMB) for each                    physician, or other practitioner does not
                                                  collection of information they conduct                                                                        by an entity approved to furnish the
                                                                                                          agree with the initial determination of a             services. The physician or qualified
                                                  or sponsor. The term ‘‘collection of                    Quality Improvement Organization
                                                  information’’ is defined in 44 U.S.C.                                                                         non-physician practitioner treating the
                                                                                                          (QIO) or a QIO subcontractor, it is
                                                  3502(3) and 5 CFR 1320.3(c) and                                                                               beneficiary’s diabetes would certify that
                                                                                                          within that party’s rights to request
                                                  includes agency requests or                                                                                   these services are needed as part of a
                                                                                                          reconsideration. The information
                                                  requirements that members of the public                                                                       comprehensive plan of care. This rule
                                                                                                          collection requirements 42 CFR 478.18,
                                                  submit reports, keep records, or provide                                                                      established the quality standards that an
                                                                                                          478.34, 478.36, and 478.42, contain
                                                  information to a third party. Section                                                                         entity would be required to meet in
                                                                                                          procedures for QIOs to use in
                                                  3506(c)(2)(A) of the PRA (44 U.S.C.                                                                           order to participate in furnishing
                                                                                                          reconsideration of initial
                                                  3506(c)(2)(A)) requires federal agencies                                                                      diabetes outpatient self-management
                                                                                                          determinations. The information
                                                  to publish a 30-day notice in the                                                                             training services. It set forth payment
                                                                                                          requirements contained in these
                                                  Federal Register concerning each                        regulations are on QIOs to provide                    amounts that have been established in
                                                  proposed collection of information,                     information to parties requesting the                 consultation with appropriate diabetes
                                                  including each proposed extension or                    reconsideration. These parties will use               organizations. It implements section
                                                  reinstatement of an existing collection                 the information as guidelines for appeal              4105 of the Balanced Budget Act of
                                                  of information, before submitting the                   rights in instances where issues are                  1997. Form Number: CMS–R–247 (OMB
                                                  collection to OMB for approval. To                      actively being disputed. Form Number:                 control number: 0938–0818); Frequency:
                                                  comply with this requirement, CMS is                    CMS–R–72 (OMB control number:                         Recordkeeping and Reporting—
                                                  publishing this notice that summarizes                  0938–0443); Frequency: Reporting—On                   Occasionally; Affected Public: Business
                                                  the following proposed collection(s) of                 occasion; Affected Public: Individuals or             or other for-profit institutions; Number
                                                  information for public comment:                         Households and Business or other for-                 of Respondents: 5,327; Total Annual
                                                    1. Type of Information Collection                     profit institutions; Number of                        Responses: 63,924; Total Annual Hours:
                                                  Request: Extension of a currently                       Respondents: 2,590; Total Annual                      197,542. (For policy questions regarding
                                                  approved collection; Title of                                                                                 this collection contact Kristin Shifflett
mstockstill on DSK3G9T082PROD with NOTICES




                                                                                                          Responses: 5,228; Total Annual Hours:
                                                  Information Collection: Information                     2,822. (For policy questions regarding                at 410–786–4133.)
                                                  Collection Requirements in HSQ–110,                     this collection contact Winsome Higgins                  4. Type of Information Collection
                                                  Acquisition, Protection and Disclosure                  at 410–786–1835.)                                     Request: Extension of a currently
                                                  of Peer review Organization Information                    3. Type of Information Collection                  approved collection; Title of
                                                  and Supporting Regulations; Use: The                    Request: Extension of a currently                     Information Collection: Collection of
                                                  Peer Review Improvement Act of 1982                     approved collection; Title of                         Diagnostic Data from Medicare
                                                  authorizes quality improvement                          Information Collection: Expanded                      Advantage Organizations for Risk


                                             VerDate Sep<11>2014   19:40 Sep 23, 2016   Jkt 238001   PO 00000   Frm 00038   Fmt 4703   Sfmt 4703   E:\FR\FM\26SEN1.SGM   26SEN1


                                                                            Federal Register / Vol. 81, No. 186 / Monday, September 26, 2016 / Notices                                                  66033

                                                  Adjusted Payments; Use: CMS requires                    CWTPSA forms annually to address the                  and State, Local, or Tribal Governments;
                                                  hospital inpatient, hospital outpatient                 creation of new facilities under the                  Number of Respondents: 5,240; Total
                                                  and physician diagnostic data from                      current participating ‘‘third party                   Annual Responses: 5,240; Total Annual
                                                  Medicare Advantage (MA) organizations                   submitters.’’ Form Number: CMS–10268                  Hours: 1,442. (For policy questions
                                                  to continue making payment under the                    (OMB control number: 0938–1052);                      regarding this collection contact Teresa
                                                  risk adjustment methodology. CMS will                   Frequency: Occasionally; Affected                     DeCaro at 202–384–6309.)
                                                  use the data to make risk adjusted                      Public: Business or other for-profits and
                                                                                                          Not-for-profit institutions; Number of                  7. Type of Information Collection
                                                  payment under Parts C and D. MA and
                                                  MA–PD plans will use the data to                        Respondents: 400; Total Annual                        Request: New collection (Request for a
                                                  develop their Part C and D bids. As                     Responses: 400; Total Annual Hours:                   new OMB control number); Title of
                                                  required by law, CMS also annually                      34. (For policy questions regarding this              Information Collection: Testing
                                                  publishes the risk adjustment factors for               collection contact Victoria Schlining at              Experience and Functional Tools
                                                  plans and other interested entities in the              410–786–6878.)                                        Demonstration: Personal Health Record
                                                  Advance Notice of Methodological                           6. Type of Information Collection                  (PHR) User Survey; Use: The PHR user
                                                  Changes for MA Payment Rates (every                     Request: Extension of a currently                     survey is important to the TEFT
                                                  February) and the Announcement of                       approved collection; Title of                         Program Evaluation and understanding
                                                  Medicare Advantage Payment Rates                        Information Collection: Healthy Indiana               the impact of the TEFT PHR on
                                                  (every April). Lastly, CMS issues                       Program (HIP) 2.0 Beneficiaries Survey,               Medicaid CB–LTSS beneficiaries. The
                                                  monthly reports to each individual plan                 Focus Groups, and Informational                       TEFT evaluation team’s approach
                                                  that contains the CMS Hierarchical                      Interviews; Use: The collected                        includes monitoring state PHR
                                                  Condition Category (HCC) and RxHCC                      information will be used to make                      implementation efforts and fielding a
                                                  models’ output and the risk scores and                  decisions about the renewal of                        follow-up questionnaire to CB–LTSS
                                                  reimbursements for each beneficiary                     precedent-setting waivers of Medicaid                 program participants that asks about
                                                  that is enrolled in their plan. Form                    policy that assure important beneficiary
                                                                                                                                                                their experiences using the PHR. The
                                                  Number: CMS–10062 (OMB control                          protections regarding coverage and
                                                                                                                                                                evaluation seeks to measure the degree
                                                  number: 0938–0878); Frequency:                          access to care; e.g., the State of Indiana’s
                                                                                                          non-emergency medical transportation                  to which the PHR is implemented in an
                                                  Quarterly; Affected Public: Private                                                                           accessible manner for Medicaid
                                                  sector (Business or other for profit and                waiver which will end or will be
                                                                                                          extended by no later than December 1,                 beneficiaries of CB–LTSS. The survey
                                                  Not-for-profit institutions); Number of                                                                       also is designed to assess the user
                                                  Respondents: 691; Total Annual                          2016. To support CMS decision making,
                                                                                                          the collection’s survey effort would                  experience of the PHR, including access
                                                  Responses: 83,000,000; Total Annual                                                                           and usability, as well as some measures
                                                  Hours: 40,650. (For policy questions                    provide more detailed information on
                                                                                                          the Healthy Indiana Program (HIP) 2.0                 of user satisfaction and perceived
                                                  regarding this collection contact
                                                                                                          demonstration’s beneficiary                           impacts of PHR use.
                                                  Michael P. Massimini at 410–786–1566.)
                                                                                                          understanding and experiences (current                  The information collection request
                                                     5. Type of Information Collection                    and new enrollees as well as
                                                  Request: Extension of a currently                                                                             has been revised subsequent to the
                                                                                                          disenrollees/lockouts). Additional                    publication of the 60-day Federal
                                                  approved collection; Title of                           information on other key policies under
                                                  Information Collection: Consolidated                                                                          Register notice on June 13, 2016 (81 FR
                                                                                                          the demonstration, such as the 60-day
                                                  Renal Operations in a Web Enabled                                                                             38187). Details can be found in the
                                                                                                          beneficiary lock-out period, is also
                                                  Network (CROWNWeb) Third-party                                                                                package’s Supporting Statement. While
                                                                                                          included in this information collection
                                                  Submission Authorization Form; Use:                     request.                                              the June 13 Supporting Statement had
                                                  The Consolidated Renal Operations in a                     This request does not propose any                  set out the correct number of burden
                                                  Web Enabled Network (CROWNWeb)                          new or revised information collection                 hours, the 60-day Federal Register
                                                  Third-Party Submission Authorization                    requirements or burden estimates                      notice had inadvertently set out 192,113
                                                  form (CWTPSA) is to be completed by                     outside of what is currently approved by              hours. This should have been 206 hours.
                                                  ‘‘Facility Administrators’’                             OMB. Rather, it seeks to extend the                   Form Number: CMS–10623 (OMB
                                                  (administrators of CMS-certified dialysis               collection’s current expiration date of               control number: 0938-New); Frequency:
                                                  facilities) if they intend to authorize a               September 30, 2016 (approved under                    Once; Affected Public: Individuals and
                                                  third party (a business with which the                  the emergency PRA process on March                    households; Number of Respondents:
                                                  facility is associated, or an independent               21, 2016; see 81 FR 17460 dated March                 576; Total Annual Responses: 576; Total
                                                  vendor) to submit data to us to comply                  29, 2106, and 81 FR 26798 dated May                   Annual Hours: 190. (For policy
                                                  with the recently-revised Conditions for                4, 2016). Since the collection has                    questions regarding this collection
                                                  Coverage of dialysis facilities. The                    already been subject to the public                    contact Kerry Lida at 410–786–4826.)
                                                  CROWNWeb system is the system used                      comment process for collection
                                                  as the collection point of data necessary               activities taking place through                          Dated: September 21, 2016.
                                                  for entitlement of ESRD patients to                     September 30, 2016, this ‘‘Extension of               William N. Parham, III,
                                                  Medicare benefits and for federal                       a currently approved collection’’ will                Director, Paperwork Reduction Staff, Office
                                                  government monitoring and assessing of                  only consider comments for activities                 of Strategic Operations and Regulatory
                                                  the quality and types of care provided                  taking place from October 1, 2016,                    Affairs.
                                                  to renal patients. The information                      through the end of the revised                        [FR Doc. 2016–23157 Filed 9–23–16; 8:45 am]
                                                  collected through the CWTPSA form                       expiration date. The revised expiration
mstockstill on DSK3G9T082PROD with NOTICES




                                                                                                                                                                BILLING CODE 4120–01–P
                                                  will allow us along with our contractors                date will be made available upon OMB
                                                  to receive data from authorized parties                 approval at reginfo.gov. Form Number:
                                                  acting on behalf of CMS-certified                       CMS–10615 (OMB control number:
                                                  dialysis facilities. Since February 2009,               0938–1300); Frequency: Once; Affected
                                                  we have received 4,160 CWTPSA forms                     Public: Individuals and households,
                                                  and anticipates that they will continue                 Private sector (Business or other for-
                                                  to receive no more than 400 new                         profits and Not-for-profits institutions),


                                             VerDate Sep<11>2014   19:40 Sep 23, 2016   Jkt 238001   PO 00000   Frm 00039   Fmt 4703   Sfmt 9990   E:\FR\FM\26SEN1.SGM   26SEN1



Document Created: 2018-02-09 13:22:41
Document Modified: 2018-02-09 13:22:41
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesComments on the collection(s) of information must be received by the OMB desk officer by October 26, 2016.
ContactReports Clearance Office at (410) 786- 1326.
FR Citation81 FR 66031 

2025 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR