81_FR_75619 81 FR 75409 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

81 FR 75409 - 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 210 (October 31, 2016)

Page Range75409-75411
FR Document2016-26242

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 210 (Monday, October 31, 2016)
[Federal Register Volume 81, Number 210 (Monday, October 31, 2016)]
[Notices]
[Pages 75409-75411]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-26242]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10622, CMS-339, CMS-460, CMS-R-64, CMS-379, 
CMS-10311, CMS-1490, CMS-10137, and CMS-10237]


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

AGENCY: Centers for Medicare & Medicaid Services, HHS.

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.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by November 30, 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: 
[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: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Evaluation of the CMS Quality Improvement Organizations: Reducing 
Healthcare-Acquired Conditions in Nursing Homes; Use: As mandated by 
Sections 1152-1154 of the Social Security Act, CMS directs the QIO 
program, one of the largest federal programs dedicated to improving 
health quality for Medicare beneficiaries. In the 11th SOW, CMS 
restructured the QIO program to funded Quality Innovation Networks 
(QIN)-QIOs, Beneficiary and Family-Centered Care (BFCC) organizations, 
National Coordinating Centers (NCCs), Program Collaboration Centers 
(PCCs), and the Strategic Innovation Engine (SIE). In the current SOW, 
14 QIN-QIOs coordinate the work of 53 QIOs nationwide including all 50 
states and other U.S. territories.
    CMS evaluates the quality and effectiveness of the QIO program as 
authorized in Part B of Title XI of the Social Security Act. CMS 
created the Independent Evaluation Center (IEC) to provide CMS and its 
stakeholders with an independent and objective program evaluation of 
the 11th SOW. Evaluation activities will focus on analyzing how well 
the QIO program is achieving the three aims of better care, better 
health, and lower cost as well as the effectiveness of the new QIO 
program structure. One of the QIN-QIOs' tasks to achieve these three 
aims is to support participating nursing homes in their efforts to 
improve quality of care and health outcomes among residents. According 
to the 2013 CMS Nursing Home Data Compendium, more than 15,000 nursing 
homes participated in Medicare and Medicaid programs with more than 1.4 
million beneficiaries resided in U.S. nursing homes. These residents 
and their families rely on nursing homes to provide reliable, safe, 
high quality care. However, cognitive and functional impairments, pain, 
incontinence, antipsychotic drug use, and healthcare associated 
conditions (HAC), such as pressure ulcers and falls, remain areas of 
concern.
    This information collection is to provide data to assess QIN-QIOs 
efforts aimed at addressing these HACs in nursing homes. QIN-QIOs are 
responsible for recruiting nursing homes to participate in the program. 
We will conduct an annual survey of administrators of nursing homes 
participating in the QIN-QIO program (intervention group) and 
administrators at nursing homes that are not participating in the QIN-
QIO program (comparison group). Our proposed survey assesses progress 
towards the goals of the QIN-QIO SOW, including activities and 
strategies to increase mobility among residents, reduce infections, 
reduce use of inappropriate antipsychotic medication among long-term 
stay residents.
    We plan to conduct qualitative interviews with nursing home 
administrators. This interview will supplement the Nursing Home Survey 
and provide more in-depth contextual information about the QIN-QIO 
program implementation within at nursing homes, including: (i) Their 
experience with, and perceived success of QIN-QIO collaboratives; (ii) 
their satisfaction with the QIN-QIO Collaborative and QIO support; 
(iii) perceived value and impact of QIO program; and (iv) drivers and 
barriers to QIN-QIO involvement and success.

[[Page 75410]]

    Information from QIO leadership and/or state/territory task leads 
will be collected by interviews and focus groups. Interviews with 
Nursing Home Task leaders at the QIN and QIO will be conducted in-
person during site visits and/or over the phone. We will conduct focus 
groups with QIO-level Directors during the annual CMS Quality 
conference. The purpose of the interviews and focus groups is to 
examine: (i) QIO processes for recruiting nursing homes, peer coaches, 
and beneficiaries to participate in the program; (ii) strengths and 
challenges of QIN-QIO activities related to nursing homes; (iii) 
partnership and coordination with other QIN-QIO tasks; and (iv) overall 
lessons learned. We will also conduct qualitative interviews with 
nursing home peer coaches. Subsequent to the 60-day notice Federal 
Register notice, the survey has been revised by adding questions and 
rewording questions. Form Number: CMS-10622 (OMB control number: 0938-
NEW); Frequency: Annually; Affected Public: Business or other For-
profits and Not-for Profits institutions; Number of Respondents: 856; 
Total Annual Responses: 856; Total Annual Hours: 255. (For policy 
questions regarding this collection contact Robert Kambic at 410-786-
1515.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Provider Cost 
Report Reimbursement Questionnaire; Use: The information collected in 
this form (Exhibits 1 and 2) is authorized under Sections 1815(a) and 
1833(e) of the Social Security Act, 42 U.S.C. 1395g. Regulations at 42 
CFR 413.20 and 413.24 require providers to submit financial and 
statistical records to verify the cost data disclosed on their annual 
Medicare cost report. Providers participating in the Medicare program 
are reimbursed for furnishing covered services to eligible 
beneficiaries on the basis of an annual cost report (filed with the 
provider's MAC) in which the proper reimbursement is computed. 
Consequently, it is necessary to collect this documentation of 
providers' costs and activities that supports the Medicare cost report 
data in order to ensure proper Medicare reimbursement to providers. 
Form Number: CMS-339 (OMB control number: 0938-0301); Frequency: 
Yearly; Affected Public: Private sector (Business or other For-
profits); Number of Respondents: 2,273; Total Annual Responses: 2,273; 
Total Annual Hours: 15,911. (For policy questions regarding this 
collection contact Christine Dobrzycki at 410-786-3389.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Participation Agreement for Physicians and Suppliers; Use: Section 
1842(h) of the Social Security Act permits physicians and suppliers to 
voluntarily participate in Medicare Part B by agreeing to take 
assignment on all claims for services to Medicare beneficiaries. The 
law also requires that the Secretary provide specific benefits to the 
physicians, suppliers and other persons who choose to participate. The 
CMS-460 is the agreement by which the physician or supplier elects to 
participate in Medicare. Form Number: CMS-460 (OMB control number: 
0938-0373); Frequency: Yearly; Affected Public: Private sector 
(Business or other For-profits); Number of Respondents: 120,000; Total 
Annual Responses: 120,000; Total Annual Hours: 30,000. (For policy 
questions regarding this collection contact Mark Baldwin at 410-786-
8139.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Indirect Medical 
Education and Supporting Regulations; Use: Section 1886(d)(5)(B) of the 
Social Security Act requires additional payments to be made under the 
Medicare Prospective Payment System (PPS) for the indirect medical 
educational costs a hospital incurs in connection with interns and 
residents (IRs) in approved teaching programs. In addition, Title 42, 
Part 413, sections 75 through 83 implement section 1886(d) of the Act 
by establishing the methodology for Medicare payment of the cost of 
direct graduate medical educational activities. These payments, which 
are adjustments (add-ons) to other payments made to a hospital under 
PPS, are largely determined by the number of full-time equivalent (FTE) 
IRs that work at a hospital during its cost reporting period. In 
Federal fiscal year (FY) 2015, the estimated Medicare program payments 
for indirect medical education (IME) costs amounted to $8.38 billion. 
Medicare program payments for direct graduate medical education (GME) 
are also based upon the number of FTE-IRs that work at a hospital. In 
FY 2015, the estimated Medicare program payments for GME costs amounted 
to $3.1 billion. Form Number: CMS-R-64 (OMB control number: 0938-0456); 
Frequency: Yearly; Affected Public: Private sector (Business or other 
For-profits); Number of Respondents: 1,245; Total Annual Responses: 
1,245; Total Annual Hours: 2,490. (For policy questions regarding this 
collection contact Milton Jacobson at 410-786-7553.)
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Financial 
Statement of Debtor; Use: Section 1893(f)(1)) of the Social Security 
Act and 42 CFR 401.607 provides the authority for collection of this 
information. Section 42 CFR 405.607 requires that, CMS recover amounts 
of claims due from debtors including interest where appropriate by 
direct collections in lump sums or in installments. In addition, the 
DOJ Final Rule, the Federal Claims Collection Standards, which was 
published as 32 CFR parts 900-904, on November 22, 2000, in the Federal 
Register, Section 32 CFR 900.1 stipulates that, standards for Federal 
agency use in the administrative collection, offset, compromise, and 
the suspension or termination of collection activity. Section 32 CFR 
901.8(a) states that, Agencies should obtain financial statements from 
debtors who represent that they are unable to pay the debt in one lump 
sum. Form Number: CMS-379 (OMB control number: 0938-0270); Frequency: 
Yearly; Affected Public: Business or other for-profits; Number of 
Respondents: 500; Total Annual Responses: 500; Total Annual Hours: 
1,000. (For policy questions regarding this collection contact Anita 
Crosier at 410-786-0217.)
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Program/
Home Health Prospective Payment System Rate Update for Calendar Year 
2010: Physician Narrative Requirement and Supporting Regulation; Use: 
Section (o) of the Act (42 U.S.C. 1395 x) specifies certain 
requirements that a home health agency must meet to participate in the 
Medicare program. To qualify for Medicare coverage of home health 
services a Medicare beneficiary must meet each of the following 
requirements as stipulated in Sec.  409.42: be confined to the home or 
an institution that is not a hospital, SNF, or nursing facility as 
defined in sections 1861(e)(1), 1819(a)(1) or 1919 of Act; be under the 
care of a physician as described in Sec.  409.42(b); be under a plan of 
care that meets the requirements specified in Sec.  409.43; the care 
must be furnished by or under arrangements made by a participating HHA, 
and the beneficiary must be in need of skilled services as described in 
Sec.  409.42(c). Subsection 409.42(c) of our regulations

[[Page 75411]]

requires that the beneficiary need at least one of the following 
services as certified by a physician in accordance with Sec.  424.22: 
Intermittent skilled nursing services and the need for skilled services 
which meet the criteria in Sec.  409.32; Physical therapy which meets 
the requirements of Sec.  409.44(c), Speech-language pathology which 
meets the requirements of Sec.  409.44(c); or have a continuing need 
for occupational therapy that meets the requirements of Sec.  
409.44(c), subject to the limitations described in Sec.  409.42(c)(4). 
On March 23, 2010, the Affordable Care Act of 2010 (Pub. L., 111-148) 
was enacted. Section 6407(a) (amended by section 10605) of the 
Affordable Care Act amends the requirements for physician certification 
of home health services contained in Sections 1814(a)(2)(C) and 
1835(a)(2)(A) by requiring that, prior to certifying a patient as 
eligible for Medicare's home health benefit, the physician must 
document that the physician himself or herself or a permitted non-
physician practitioner has had a face-to-face encounter (including 
through the use of tele-health services, subject to the requirements in 
section 1834(m) of the Act)'', with the patient. The Affordable Care 
Act provision does not amend the statutory requirement that a physician 
must certify a patient's eligibility for Medicare's home health 
benefit, (see Sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act. Form 
Number: CMS-10311 (OMB control number: 0938-1083); Frequency: Yearly; 
Affected Public: Business or other For-profits; Number of Respondents: 
345,600; Total Annual Responses: 345,600; Total Annual Hours: 28,800. 
(For policy questions regarding this collection contact Hillary 
Loeffler at 410-786-0456.)
    7. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Patient's Request for Medicare Payment; Use: The Form CMS-1490S form 
provides beneficiaries with a relatively easy form to use when filing 
their claims. Without the collection of this information, claims for 
reimbursement relating to the provision of Part B medical services/
supplies could not be acted upon. This would result in a nationwide 
paralysis of the operation of the Federal Government's Part B Medicare 
program, and major problems for the patients/beneficiaries inflicting 
severe physical and financial hardship on beneficiaries. This form was 
explicitly developed for easy use by beneficiaries who file their own 
claims. The CMS-1490S form can be obtained from any Social Security 
office or Medicare Administrative Contractors or CMS. When the CMS-
1490S is used, the beneficiary must attach to it his/her bills from 
physicians or suppliers. The form is, therefore, designed specifically 
to aid beneficiaries who cannot get assistance from their physicians or 
suppliers for completing claim forms. The form is currently approved 
under 0938-1197; however, we are submitting for approval as a 
standalone information collection request. Once a new OMB control 
number is issued, we will remove the burden for the CMS-1490S that is 
currently approved under OMB control number 0938-1197. Form Number: 
CMS-1490 (OMB control number: 0938-NEW); Frequency: Occasionally 
Affected Public: Individuals and Households; Number of Respondents: 
167,839; Total Annual Responses: 167,839; Total Annual Hours: 83,920. 
(For policy questions regarding this collection contact Sumita Sen at 
410-786-5755.)
    8. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Solicitation for 
Applications for Medicare Prescription Drug Plan 2018 Contracts; Use: 
Coverage for the prescription drug benefit is provided through 
contracted prescription drug (PD) plans or through Medicare Advantage 
(MA) plans that offer integrated prescription drug and health care 
coverage (MA-PD plans). Cost Plans that are regulated under Section 
1876 of the Social Security Act, and Employer Group Waiver Plans may 
also provide a Part D benefit. Organizations wishing to provide 
services under the Prescription Drug Benefit Program must complete an 
application, negotiate rates, and receive final approval from CMS. 
Existing Part D Sponsors may also expand their contracted service area 
by completing the Service Area Expansion application. Form Number: CMS-
10137 (OMB control number: 0938-0936); Frequency: Yearly; Affected 
Public: Private sector (Business or other For-profits and Not-for-
profit institutions); Number of Respondents: 463; Total Annual 
Responses: 160; Total Annual Hours: 1,565. (For policy questions 
regarding this collection contact Arianne Spaccarelli at 410-786-5715.)
    9. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Applications for 
Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver 
Plans to Provide Part C Benefits; Use: This information collection 
includes the process for organizations wishing to provide healthcare 
services under MA and/or MA-PD plans must complete an application 
annually, file a bid, and receive final approval from CMS. The 
application process has two options for applicants that include: 
Request for new MA product or request for expanding the service area of 
an existing product. This collection process is the only mechanism for 
MA and/or MA-PD organizations to complete the required application 
process. CMS utilizes the application process as the means to review, 
assess and determine if applicants are compliant with the current 
requirements for participation in the Medicare Advantage program and to 
make a decision related to contract award. Form Number: CMS-10237 (OMB 
control number: 0938-0935); Frequency: Yearly; Affected Public: Private 
sector (Business or other For-profits and Not-for-profit institutions); 
Number of Respondents: 310; Total Annual Responses: 310; Total Annual 
Hours: 10,941. (For policy questions regarding this collection contact 
Marcella Watts at 410-786-5724.)

    Dated: October 26, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2016-26242 Filed 10-28-16; 8:45 am]
BILLING CODE 4120-01-P



                                                                             Federal Register / Vol. 81, No. 210 / Monday, October 31, 2016 / Notices                                          75409

                                                   Dated: October 25, 2016.                             Attention: CMS Desk Officer, Fax                      including all 50 states and other U.S.
                                                William N. Parham, III,                                 Number: (202) 395–5806 OR, Email:                     territories.
                                                Director, Paperwork Reduction Staff, Office             OIRA_submission@omb.eop.gov.                             CMS evaluates the quality and
                                                of Strategic Operations and Regulatory                    To obtain copies of a supporting                    effectiveness of the QIO program as
                                                Affairs.                                                statement and any related forms for the               authorized in Part B of Title XI of the
                                                [FR Doc. 2016–26122 Filed 10–28–16; 8:45 am]            proposed collection(s) summarized in                  Social Security Act. CMS created the
                                                BILLING CODE 4120–01–P                                  this notice, you may make your request                Independent Evaluation Center (IEC) to
                                                                                                        using one of following:                               provide CMS and its stakeholders with
                                                                                                          1. Access CMS’ Web site address at                  an independent and objective program
                                                DEPARTMENT OF HEALTH AND                                http://www.cms.hhs.gov/                               evaluation of the 11th SOW. Evaluation
                                                HUMAN SERVICES                                          PaperworkReductionActof1995.                          activities will focus on analyzing how
                                                                                                          2. Email your request, including your               well the QIO program is achieving the
                                                Centers for Medicare & Medicaid                         address, phone number, OMB number,                    three aims of better care, better health,
                                                Services                                                and CMS document identifier, to                       and lower cost as well as the
                                                [Document Identifiers: CMS–10622, CMS–                  Paperwork@cms.hhs.gov.                                effectiveness of the new QIO program
                                                339, CMS–460, CMS–R–64, CMS–379, CMS–                     3. Call the Reports Clearance Office at             structure. One of the QIN–QIOs’ tasks to
                                                10311, CMS–1490, CMS–10137, and CMS–                    (410) 786–1326.                                       achieve these three aims is to support
                                                10237]                                                  FOR FURTHER INFORMATION CONTACT:                      participating nursing homes in their
                                                                                                        Reports Clearance Office at (410) 786–                efforts to improve quality of care and
                                                Agency Information Collection                           1326.                                                 health outcomes among residents.
                                                Activities: Submission for OMB                                                                                According to the 2013 CMS Nursing
                                                Review; Comment Request                                 SUPPLEMENTARY INFORMATION:     Under the
                                                                                                                                                              Home Data Compendium, more than
                                                                                                        Paperwork Reduction Act of 1995 (PRA)
                                                AGENCY: Centers for Medicare &                                                                                15,000 nursing homes participated in
                                                                                                        (44 U.S.C. 3501–3520), federal agencies               Medicare and Medicaid programs with
                                                Medicaid Services, HHS.                                 must obtain approval from the Office of
                                                ACTION: Notice.
                                                                                                                                                              more than 1.4 million beneficiaries
                                                                                                        Management and Budget (OMB) for each                  resided in U.S. nursing homes. These
                                                                                                        collection of information they conduct                residents and their families rely on
                                                SUMMARY:    The Centers for Medicare &
                                                                                                        or sponsor. The term ‘‘collection of                  nursing homes to provide reliable, safe,
                                                Medicaid Services (CMS) is announcing
                                                                                                        information’’ is defined in 44 U.S.C.                 high quality care. However, cognitive
                                                an opportunity for the public to
                                                                                                        3502(3) and 5 CFR 1320.3(c) and                       and functional impairments, pain,
                                                comment on CMS’ intention to collect
                                                                                                        includes agency requests or                           incontinence, antipsychotic drug use,
                                                information from the public. Under the
                                                                                                        requirements that members of the public               and healthcare associated conditions
                                                Paperwork Reduction Act of 1995
                                                                                                        submit reports, keep records, or provide              (HAC), such as pressure ulcers and falls,
                                                (PRA), federal agencies are required to
                                                                                                        information to a third party. Section                 remain areas of concern.
                                                publish notice in the Federal Register
                                                                                                        3506(c)(2)(A) of the PRA (44 U.S.C.                      This information collection is to
                                                concerning each proposed collection of
                                                                                                        3506(c)(2)(A)) requires federal agencies              provide data to assess QIN–QIOs efforts
                                                information, including each proposed
                                                                                                        to publish a 30-day notice in the                     aimed at addressing these HACs in
                                                extension or reinstatement of an existing
                                                                                                        Federal Register concerning each                      nursing homes. QIN–QIOs are
                                                collection of information, and to allow
                                                                                                        proposed collection of information,                   responsible for recruiting nursing homes
                                                a second opportunity for public
                                                                                                        including each proposed extension or                  to participate in the program. We will
                                                comment on the notice. Interested
                                                                                                        reinstatement of an existing collection               conduct an annual survey of
                                                persons are invited to send comments
                                                                                                        of information, before submitting the                 administrators of nursing homes
                                                regarding the burden estimate or any
                                                                                                        collection to OMB for approval. To                    participating in the QIN–QIO program
                                                other aspect of this collection of
                                                                                                        comply with this requirement, CMS is                  (intervention group) and administrators
                                                information, including any of the
                                                                                                        publishing this notice that summarizes                at nursing homes that are not
                                                following subjects: (1) The necessity and
                                                                                                        the following proposed collection(s) of               participating in the QIN–QIO program
                                                utility of the proposed information
                                                                                                        information for public comment:                       (comparison group). Our proposed
                                                collection for the proper performance of                  1. Type of Information Collection
                                                the agency’s functions; (2) the accuracy                                                                      survey assesses progress towards the
                                                                                                        Request: New collection (Request for a                goals of the QIN–QIO SOW, including
                                                of the estimated burden; (3) ways to                    new OMB control number); Title of
                                                enhance the quality, utility, and clarity                                                                     activities and strategies to increase
                                                                                                        Information Collection: Evaluation of                 mobility among residents, reduce
                                                of the information to be collected; and                 the CMS Quality Improvement
                                                (4) the use of automated collection                                                                           infections, reduce use of inappropriate
                                                                                                        Organizations: Reducing Healthcare-                   antipsychotic medication among long-
                                                techniques or other forms of information                Acquired Conditions in Nursing Homes;
                                                technology to minimize the information                                                                        term stay residents.
                                                                                                        Use: As mandated by Sections 1152–                       We plan to conduct qualitative
                                                collection burden.                                      1154 of the Social Security Act, CMS                  interviews with nursing home
                                                DATES: Comments on the collection(s) of                 directs the QIO program, one of the                   administrators. This interview will
                                                information must be received by the                     largest federal programs dedicated to                 supplement the Nursing Home Survey
                                                OMB desk officer by November 30,                        improving health quality for Medicare                 and provide more in-depth contextual
                                                2016.                                                   beneficiaries. In the 11th SOW, CMS                   information about the QIN–QIO
                                                ADDRESSES: When commenting on the                       restructured the QIO program to funded                program implementation within at
                                                proposed information collections,                       Quality Innovation Networks (QIN)–                    nursing homes, including: (i) Their
sradovich on DSK3GMQ082PROD with NOTICES




                                                please reference the document identifier                QIOs, Beneficiary and Family-Centered                 experience with, and perceived success
                                                or OMB control number. To be assured                    Care (BFCC) organizations, National                   of QIN–QIO collaboratives; (ii) their
                                                consideration, comments and                             Coordinating Centers (NCCs), Program                  satisfaction with the QIN–QIO
                                                recommendations must be received by                     Collaboration Centers (PCCs), and the                 Collaborative and QIO support; (iii)
                                                the OMB desk officer via one of the                     Strategic Innovation Engine (SIE). In the             perceived value and impact of QIO
                                                following transmissions: OMB, Office of                 current SOW, 14 QIN–QIOs coordinate                   program; and (iv) drivers and barriers to
                                                Information and Regulatory Affairs,                     the work of 53 QIOs nationwide                        QIN–QIO involvement and success.


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                                                75410                        Federal Register / Vol. 81, No. 210 / Monday, October 31, 2016 / Notices

                                                   Information from QIO leadership and/                 contact Christine Dobrzycki at 410–786–               Responses: 1,245; Total Annual Hours:
                                                or state/territory task leads will be                   3389.)                                                2,490. (For policy questions regarding
                                                collected by interviews and focus                         3. Type of Information Collection                   this collection contact Milton Jacobson
                                                groups. Interviews with Nursing Home                    Request: Extension of a currently                     at 410–786–7553.)
                                                Task leaders at the QIN and QIO will be                 approved collection; Title of                            5. Type of Information Collection
                                                conducted in-person during site visits                  Information Collection: Medicare                      Request: Extension of a currently
                                                and/or over the phone. We will conduct                  Participation Agreement for Physicians                approved collection; Title of
                                                focus groups with QIO-level Directors                   and Suppliers; Use: Section 1842(h) of                Information Collection: Financial
                                                during the annual CMS Quality                           the Social Security Act permits                       Statement of Debtor; Use: Section
                                                conference. The purpose of the                          physicians and suppliers to voluntarily               1893(f)(1)) of the Social Security Act
                                                interviews and focus groups is to                       participate in Medicare Part B by                     and 42 CFR 401.607 provides the
                                                examine: (i) QIO processes for recruiting               agreeing to take assignment on all                    authority for collection of this
                                                nursing homes, peer coaches, and                        claims for services to Medicare                       information. Section 42 CFR 405.607
                                                                                                        beneficiaries. The law also requires that             requires that, CMS recover amounts of
                                                beneficiaries to participate in the
                                                                                                        the Secretary provide specific benefits               claims due from debtors including
                                                program; (ii) strengths and challenges of
                                                                                                        to the physicians, suppliers and other                interest where appropriate by direct
                                                QIN–QIO activities related to nursing
                                                                                                        persons who choose to participate. The                collections in lump sums or in
                                                homes; (iii) partnership and                            CMS–460 is the agreement by which the                 installments. In addition, the DOJ Final
                                                coordination with other QIN–QIO tasks;                  physician or supplier elects to                       Rule, the Federal Claims Collection
                                                and (iv) overall lessons learned. We will               participate in Medicare. Form Number:                 Standards, which was published as 32
                                                also conduct qualitative interviews with                CMS–460 (OMB control number: 0938–                    CFR parts 900–904, on November 22,
                                                nursing home peer coaches. Subsequent                   0373); Frequency: Yearly; Affected                    2000, in the Federal Register, Section
                                                to the 60-day notice Federal Register                   Public: Private sector (Business or other             32 CFR 900.1 stipulates that, standards
                                                notice, the survey has been revised by                  For-profits); Number of Respondents:                  for Federal agency use in the
                                                adding questions and rewording                          120,000; Total Annual Responses:                      administrative collection, offset,
                                                questions. Form Number: CMS–10622                       120,000; Total Annual Hours: 30,000.                  compromise, and the suspension or
                                                (OMB control number: 0938–NEW);                         (For policy questions regarding this                  termination of collection activity.
                                                Frequency: Annually; Affected Public:                   collection contact Mark Baldwin at 410–               Section 32 CFR 901.8(a) states that,
                                                Business or other For-profits and Not-for               786–8139.)                                            Agencies should obtain financial
                                                Profits institutions; Number of                            4. Type of Information Collection                  statements from debtors who represent
                                                Respondents: 856; Total Annual                          Request: Extension of a currently                     that they are unable to pay the debt in
                                                Responses: 856; Total Annual Hours:                     approved collection; Title of                         one lump sum. Form Number: CMS–379
                                                255. (For policy questions regarding this               Information Collection: Indirect Medical              (OMB control number: 0938–0270);
                                                collection contact Robert Kambic at                     Education and Supporting Regulations;                 Frequency: Yearly; Affected Public:
                                                410–786–1515.)                                          Use: Section 1886(d)(5)(B) of the Social              Business or other for-profits; Number of
                                                   2. Type of Information Collection                    Security Act requires additional                      Respondents: 500; Total Annual
                                                Request: Extension of a currently                       payments to be made under the                         Responses: 500; Total Annual Hours:
                                                approved collection; Title of                           Medicare Prospective Payment System                   1,000. (For policy questions regarding
                                                Information Collection: Provider Cost                   (PPS) for the indirect medical                        this collection contact Anita Crosier at
                                                                                                        educational costs a hospital incurs in                410–786–0217.)
                                                Report Reimbursement Questionnaire;
                                                                                                        connection with interns and residents                    6. Type of Information Collection
                                                Use: The information collected in this
                                                                                                        (IRs) in approved teaching programs. In               Request: Extension of a currently
                                                form (Exhibits 1 and 2) is authorized
                                                                                                        addition, Title 42, Part 413, sections 75             approved collection; Title of
                                                under Sections 1815(a) and 1833(e) of
                                                                                                        through 83 implement section 1886(d)                  Information Collection: Medicare
                                                the Social Security Act, 42 U.S.C. 1395g.
                                                                                                        of the Act by establishing the                        Program/Home Health Prospective
                                                Regulations at 42 CFR 413.20 and                        methodology for Medicare payment of                   Payment System Rate Update for
                                                413.24 require providers to submit                      the cost of direct graduate medical                   Calendar Year 2010: Physician Narrative
                                                financial and statistical records to verify             educational activities. These payments,               Requirement and Supporting
                                                the cost data disclosed on their annual                 which are adjustments (add-ons) to                    Regulation; Use: Section (o) of the Act
                                                Medicare cost report. Providers                         other payments made to a hospital                     (42 U.S.C. 1395 x) specifies certain
                                                participating in the Medicare program                   under PPS, are largely determined by                  requirements that a home health agency
                                                are reimbursed for furnishing covered                   the number of full-time equivalent (FTE)              must meet to participate in the Medicare
                                                services to eligible beneficiaries on the               IRs that work at a hospital during its                program. To qualify for Medicare
                                                basis of an annual cost report (filed with              cost reporting period. In Federal fiscal              coverage of home health services a
                                                the provider’s MAC) in which the                        year (FY) 2015, the estimated Medicare                Medicare beneficiary must meet each of
                                                proper reimbursement is computed.                       program payments for indirect medical                 the following requirements as stipulated
                                                Consequently, it is necessary to collect                education (IME) costs amounted to                     in § 409.42: be confined to the home or
                                                this documentation of providers’ costs                  $8.38 billion. Medicare program                       an institution that is not a hospital,
                                                and activities that supports the                        payments for direct graduate medical                  SNF, or nursing facility as defined in
                                                Medicare cost report data in order to                   education (GME) are also based upon                   sections 1861(e)(1), 1819(a)(1) or 1919 of
                                                ensure proper Medicare reimbursement                    the number of FTE–IRs that work at a                  Act; be under the care of a physician as
                                                to providers. Form Number: CMS–339
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                                                                                                        hospital. In FY 2015, the estimated                   described in § 409.42(b); be under a plan
                                                (OMB control number: 0938–0301);                        Medicare program payments for GME                     of care that meets the requirements
                                                Frequency: Yearly; Affected Public:                     costs amounted to $3.1 billion. Form                  specified in § 409.43; the care must be
                                                Private sector (Business or other For-                  Number: CMS–R–64 (OMB control                         furnished by or under arrangements
                                                profits); Number of Respondents: 2,273;                 number: 0938–0456); Frequency: Yearly;                made by a participating HHA, and the
                                                Total Annual Responses: 2,273; Total                    Affected Public: Private sector (Business             beneficiary must be in need of skilled
                                                Annual Hours: 15,911. (For policy                       or other For-profits); Number of                      services as described in § 409.42(c).
                                                questions regarding this collection                     Respondents: 1,245; Total Annual                      Subsection 409.42(c) of our regulations


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                                                                             Federal Register / Vol. 81, No. 210 / Monday, October 31, 2016 / Notices                                                75411

                                                requires that the beneficiary need at                   office or Medicare Administrative                     provide healthcare services under MA
                                                least one of the following services as                  Contractors or CMS. When the CMS–                     and/or MA–PD plans must complete an
                                                certified by a physician in accordance                  1490S is used, the beneficiary must                   application annually, file a bid, and
                                                with § 424.22: Intermittent skilled                     attach to it his/her bills from physicians            receive final approval from CMS. The
                                                nursing services and the need for skilled               or suppliers. The form is, therefore,                 application process has two options for
                                                services which meet the criteria in                     designed specifically to aid beneficiaries            applicants that include: Request for new
                                                § 409.32; Physical therapy which meets                  who cannot get assistance from their                  MA product or request for expanding
                                                the requirements of § 409.44(c), Speech-                physicians or suppliers for completing                the service area of an existing product.
                                                language pathology which meets the                      claim forms. The form is currently                    This collection process is the only
                                                requirements of § 409.44(c); or have a                  approved under 0938–1197; however,                    mechanism for MA and/or MA–PD
                                                continuing need for occupational                        we are submitting for approval as a                   organizations to complete the required
                                                therapy that meets the requirements of                  standalone information collection                     application process. CMS utilizes the
                                                § 409.44(c), subject to the limitations                 request. Once a new OMB control                       application process as the means to
                                                described in § 409.42(c)(4). On March                   number is issued, we will remove the                  review, assess and determine if
                                                23, 2010, the Affordable Care Act of                    burden for the CMS–1490S that is                      applicants are compliant with the
                                                2010 (Pub. L., 111–148) was enacted.                    currently approved under OMB control                  current requirements for participation in
                                                Section 6407(a) (amended by section                     number 0938–1197. Form Number:                        the Medicare Advantage program and to
                                                10605) of the Affordable Care Act                       CMS–1490 (OMB control number:                         make a decision related to contract
                                                amends the requirements for physician                   0938–NEW); Frequency: Occasionally                    award. Form Number: CMS–10237
                                                certification of home health services                   Affected Public: Individuals and                      (OMB control number: 0938–0935);
                                                contained in Sections 1814(a)(2)(C) and                 Households; Number of Respondents:                    Frequency: Yearly; Affected Public:
                                                1835(a)(2)(A) by requiring that, prior to               167,839; Total Annual Responses:                      Private sector (Business or other For-
                                                certifying a patient as eligible for                    167,839; Total Annual Hours: 83,920.                  profits and Not-for-profit institutions);
                                                Medicare’s home health benefit, the                     (For policy questions regarding this                  Number of Respondents: 310; Total
                                                physician must document that the                        collection contact Sumita Sen at 410–                 Annual Responses: 310; Total Annual
                                                physician himself or herself or a                       786–5755.)                                            Hours: 10,941. (For policy questions
                                                permitted non-physician practitioner                       8. Type of Information Collection                  regarding this collection contact
                                                has had a face-to-face encounter                        Request: Revision of a currently                      Marcella Watts at 410–786–5724.)
                                                (including through the use of tele-health               approved collection; Title of                            Dated: October 26, 2016.
                                                services, subject to the requirements in                Information Collection: Solicitation for
                                                                                                                                                              William N. Parham, III,
                                                section 1834(m) of the Act)’’, with the                 Applications for Medicare Prescription
                                                                                                                                                              Director, Paperwork Reduction Staff, Office
                                                patient. The Affordable Care Act                        Drug Plan 2018 Contracts; Use: Coverage               of Strategic Operations and Regulatory
                                                provision does not amend the statutory                  for the prescription drug benefit is                  Affairs.
                                                requirement that a physician must                       provided through contracted
                                                                                                                                                              [FR Doc. 2016–26242 Filed 10–28–16; 8:45 am]
                                                certify a patient’s eligibility for                     prescription drug (PD) plans or through
                                                                                                                                                              BILLING CODE 4120–01–P
                                                Medicare’s home health benefit, (see                    Medicare Advantage (MA) plans that
                                                Sections 1814(a)(2)(C) and 1835(a)(2)(A)                offer integrated prescription drug and
                                                of the Act. Form Number: CMS–10311                      health care coverage (MA–PD plans).                   DEPARTMENT OF HEALTH AND
                                                                                                        Cost Plans that are regulated under                   HUMAN SERVICES
                                                (OMB control number: 0938–1083);
                                                                                                        Section 1876 of the Social Security Act,
                                                Frequency: Yearly; Affected Public:
                                                                                                        and Employer Group Waiver Plans may                   Food and Drug Administration
                                                Business or other For-profits; Number of
                                                                                                        also provide a Part D benefit.
                                                Respondents: 345,600; Total Annual                                                                            [Docket No. FDA–2016–N–3083]
                                                                                                        Organizations wishing to provide
                                                Responses: 345,600; Total Annual
                                                                                                        services under the Prescription Drug                  Report on the Performance of Drug
                                                Hours: 28,800. (For policy questions
                                                                                                        Benefit Program must complete an                      and Biologics Firms in Conducting
                                                regarding this collection contact Hillary
                                                                                                        application, negotiate rates, and receive
                                                Loeffler at 410–786–0456.)                                                                                    Postmarketing Requirements and
                                                                                                        final approval from CMS. Existing Part
                                                   7. Type of Information Collection                                                                          Commitments; Availability
                                                                                                        D Sponsors may also expand their
                                                Request: New collection (Request for a                  contracted service area by completing                 AGENCY:    Food and Drug Administration,
                                                new OMB control number); Title of                       the Service Area Expansion application.               HHS.
                                                Information Collection: Patient’s                       Form Number: CMS–10137 (OMB                           ACTION:   Notice of availability.
                                                Request for Medicare Payment; Use: The                  control number: 0938–0936); Frequency:
                                                Form CMS–1490S form provides                            Yearly; Affected Public: Private sector               SUMMARY:   Under the Federal Food,
                                                beneficiaries with a relatively easy form               (Business or other For-profits and Not-               Drug, and Cosmetic Act (the FD&C Act),
                                                to use when filing their claims. Without                for-profit institutions); Number of                   the Food and Drug Administration (FDA
                                                the collection of this information,                     Respondents: 463; Total Annual                        or Agency) is required to report
                                                claims for reimbursement relating to the                Responses: 160; Total Annual Hours:                   annually in the Federal Register on the
                                                provision of Part B medical services/                   1,565. (For policy questions regarding                status of postmarketing requirements
                                                supplies could not be acted upon. This                  this collection contact Arianne                       (PMRs) and postmarketing
                                                would result in a nationwide paralysis                  Spaccarelli at 410–786–5715.)                         commitments (PMCs) required of, or
                                                of the operation of the Federal                            9. Type of Information Collection                  agreed upon by, holders of approved
                                                Government’s Part B Medicare program,                                                                         drug and biological products. This
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                                                                                                        Request: Revision of a currently
                                                and major problems for the patients/                    approved collection; Title of                         notice is the Agency’s report on the
                                                beneficiaries inflicting severe physical                Information Collection: Applications for              status of the studies and clinical trials
                                                and financial hardship on beneficiaries.                Part C Medicare Advantage, 1876 Cost                  that applicants have agreed to, or are
                                                This form was explicitly developed for                  Plans, and Employer Group Waiver                      required to, conduct. A supplemental
                                                easy use by beneficiaries who file their                Plans to Provide Part C Benefits; Use:                report entitled ‘‘Supplementary Report:
                                                own claims. The CMS–1490S form can                      This information collection includes the              Performance of Drug and Biologics
                                                be obtained from any Social Security                    process for organizations wishing to                  Firms in Conducting Postmarketing


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Document Created: 2018-02-02 12:13:20
Document Modified: 2018-02-02 12:13:20
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 November 30, 2016.
ContactReports Clearance Office at (410) 786- 1326.
FR Citation81 FR 75409 

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