Agency Information Collection Activities: Proposed Collection; Comment Request
| Published date | 31 January 2019 |
| Citation | 84 FR 731 |
| Record Number | 2019-00433 |
| Section | Notices |
| Court | Centers For Medicare & Medicaid Services |
Federal Register, Volume 84 Issue 21 (Thursday, January 31, 2019)
[Federal Register Volume 84, Number 21 (Thursday, January 31, 2019)]
[Notices]
[Pages 731-734]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-00433]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10330, CMS-10673, CMS-906, CMS-10433, CMS-276
and CMS-10694 and CMS-P-0015A]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, Department of Health
and Human Services.
ACTION: Notice.
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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (the 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 60 days for public
comment on the proposed action. Interested persons are invited to send
comments regarding our burden estimates or any other aspect of this
collection of information, including the necessity and utility of the
proposed information collection for the proper performance of the
agency's functions, the accuracy of the estimated burden, ways to
enhance the quality, utility, and clarity of the information to be
collected, and the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
DATES: Comments must be received by April 1, 2019.
ADDRESSES: When commenting, please reference the document identifier or
OMB control number. To be assured consideration, comments and
recommendations must be submitted in any one of the following ways:
1. Electronically. You may send your comments electronically to
http://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) that are accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number ___, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' website address at website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION:
Contents
This notice sets out a summary of the use and burden associated
with the following information collections. More detailed information
can be found in each collection's supporting statement and associated
materials (see ADDRESSES).
CMS-10330 Enrollment Opportunity Notice Relating to Lifetime Limits;
Required Notice of Rescission of Coverage; and Disclosure Requirements
for Patient Protection under the Affordable Care Act
CMS-10379 Rate Increase Disclosure and Review Requirements (45 CFR part
154)
CMS-10673 Medicare Advantage Qualifying Payment Arrangement Incentive
(MAQI) Demonstration
CMS-906 The Fiscal Soundness Reporting Requirements
CMS-276 Prepaid Health Plan Cost Report
CMS-10694 Testing of Web Survey Design and Administration for CMS
Experience of Care Surveys
CMS-P-0015A Medicare Current Beneficiary Survey
Under the 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 requires federal agencies
to publish a 60-day notice in the Federal Register concerning each
proposed collection of information, including each proposed extension
or reinstatement of an existing
[[Page 732]]
collection of information, before submitting the collection to OMB for
approval. To comply with this requirement, CMS is publishing this
notice.
Information Collection
1. Type of Information Collection Request: Extension; Title of
Information Collection: Enrollment Opportunity Notice Relating to
Lifetime Limits; Required Notice of Rescission of Coverage; and
Disclosure Requirements for Patient Protection under the Affordable
Care Act; Use: Sections 2712 and 2719A of the Public Health Service
Act, as added by the Affordable Care Act, and the interim final
regulations titled ``Patient Protection and Affordable Care Act:
Preexisting Condition Exclusions, Lifetime and Annual Limits,
Rescissions, and Patient Protections'' (75 FR 37188, June 28, 2010)
contain rescission notice, and patient protection disclosure
requirements that are subject to the Paperwork Reduction Act of 1995.
The rescission notice will be used by health plans to provide advance
notice to certain individuals that their coverage may be rescinded as a
result of fraud or intentional misrepresentation of material fact. The
patient protection notification will be used by health plans to inform
certain individuals of their right to choose a primary care provider or
pediatrician and to use obstetrical/gynecological services without
prior authorization.
The related provisions are finalized in the final regulations
titled ``Final Rules under the Affordable Care Act for Grandfathered
Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits,
Rescissions, Dependent Coverage, Appeals, and Patient Protections''.
The final regulations also require that, if State law prohibits balance
billing, or a plan or issuer is contractually responsible for any
amounts balanced billed by an out-of-network emergency services
provider, a plan or issuer must provide a participant, beneficiary or
enrollee adequate and prominent notice of their lack of financial
responsibility with respect to amounts balanced billed in order to
prevent inadvertent payment by the individual. Form Number: CMS-10330
(OMB control number: 0938-1094); Frequency: Occasionally; Affected
Public: Private Sector, State, Local, or Tribal Governments; Number of
Respondents: 920; Total Annual Responses: 71,268; Total Annual Hours:
524. (For policy questions regarding this collection contact Usree
Bandyopadhyay at 410-786-6650.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare
Advantage Qualifying Payment Arrangement Incentive (MAQI)
Demonstration; Use: The Centers for Medicare & Medicaid Services (CMS)
is testing a demonstration, under Section 402 of the Social Security
Amendments of 1967 (as amended), entitled the Medicare Advantage
Qualifying Payment Arrangement Incentive (MAQI) Demonstration (``the
Demonstration''). The MAQI demonstration tests whether providing
exclusions from the Merit-based Incentive Payment System (MIPS)
reporting requirements, payment adjustments, and performance feedback
(collectively, the ``MIPS exclusions'') for eligible clinicians who
participate to a sufficient degree in certain payment arrangements with
Medicare Advantage Organizations (MAOs) (combined with participation,
if any, in Advanced Alternative Payment Models (APMs) with Medicare
Fee-for-Service (FFS)) will increase or maintain participation in
payment arrangements with MAOs similar to Advanced APMs and change the
manner in which clinicians deliver care.
Clinicians may currently participate in one of two paths of the
Quality Payment Program (QPP): (1) MIPS, which adjusts Medicare
payments based on combined performance on measures of quality, cost,
improvement activities, and advancing care information, or (2) Advanced
Alternative Payment Models with Medicare (Advanced APMs), under which
eligible clinicians may earn an incentive payment for sufficient
participation in certain payment arrangements with Medicare fee-for-
service (FFS) and other payers, and starting in the 2019 performance
period, with other payers such as Medicare Advantage, commercial
payers, and Medicaid managed care. To participate in the Advanced APM
path of QPP for a given year and earn an incentive payment, eligible
clinicians must meet the criteria of Qualifying APM Participants (QPs);
in addition to earning an APM incentive payment, QPs are excluded from
the MIPS reporting requirements and payment adjustment.
An eligible clinician that does not meet the criteria to be a QP
for a given year will be subject to MIPS for that year unless the
clinician meets certain other MIPS exclusion criteria, such as being
newly enrolled in Medicare or meeting the low volume threshold for
Medicare FFS patients, payments and services. The MAQI Demonstration
allows participating eligible clinicians to have the opportunity to
receive the MIPS exclusions for a given year if they participate to a
sufficient degree in certain Qualifying Payment Arrangements with MAOs
(and Advanced APMs with Medicare FFS) during the performance period for
that year, without requiring them to be QPs or otherwise meet the MIPS
exclusion criteria of QPP. Under this Demonstration, clinicians are not
required to have a minimum amount of participation in an Advanced APM
with Medicare FFS in order to receive the MIPS exclusions for a year,
but if they did have participation in Advanced APMs with Medicare FFS,
that participation will also be counted towards the thresholds that
trigger the provision of MIPS exclusions under the demonstration.
The first performance period for the Demonstration was 2018 and the
Demonstration will last up to five years. Clinicians who meet the
definition of an eligible clinician under QPP, as defined under 42 CFR
414.1305, are eligible to participate in the MAQI Demonstration.
Participation will last the duration of the Demonstration, unless
participation is voluntarily or involuntarily terminated under the
terms and conditions of the Demonstration. Demonstration participants
will have the opportunity to submit the required documentation and be
evaluated for the MIPS exclusions each year. If Demonstration
participants submit information, but do not meet the conditions of the
Demonstration, their participation in the Demonstration will not be
terminated, but they will not receive the MIPS exclusions. Therefore,
unless they become QPs or are excluded from MIPS for other reasons, the
participating clinicians will be subject to MIPS and will face the MIPS
payment adjustments for the applicable year.
In order to conduct an evaluation and effectively implement the
MAQI Demonstration, CMS must collect information from Demonstration
participants on (a) payment arrangements with MAOs and (b) Medicare
Advantage (MA) payments and patient counts. CMS requires a new
collection of this information as this information is not already
available through other sources. The information collected in these
forms will allow CMS to evaluate whether the payment arrangement(s)
that clinicians have with MAOs meet the Qualifying Payment Arrangement
criteria, and determine whether a clinician's MAO and FFS APM patient
population or payments meet demonstration thresholds. Both of these
areas are also requirements for review and data collection under QPP
(i.e. the Eligible Clinician-Initiated Other Payer Advanced APM
Determination form and All-Payer QP
[[Page 733]]
Submission form), and therefore similar forms have been prepared and
reviewed under the QPP.
Given these similarities in forms, burden estimates for the MAQI
Demonstration PRA package were derived from burden analyses and
formulation done in conjunction with the QPP forms; more specifically
the estimated burden associated with the submission of payment
arrangement information for Other Payer Advanced APM Determinations.
CMS estimates the total hour burden per respondent for the MAQI
demonstration to be 15 hours or less, to match the hours listed in the
equivalent QPP forms. Full detail of how these estimates were derived
can be found in the published (83 FR 59452).
Based on public comments, we have revised the collection
instruments to include modifications to allow Taxpayer Identification
Numbers (TIN) level participation and greater functionality for
organization/authorized representatives to submit on behalf of their
clinicians. Form Number: CMS-10673 (OMB control number: 0938-1354;
Frequency: Annually; Affected Public: Business or other for-profit and
Not-for-profit institutions; Number of Respondents: 100,000; Total
Annual Responses: 100,000; Total Annual Hours: 1,500,000. (For policy
questions regarding this collection contact John Amoh at
john.amoh@cms.hhs.gov.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: The Fiscal
Soundness Reporting Requirements; Use: All contracting organizations
must submit audited annual financial statements one time per year. In
addition, to the audited annual submission, Health Plans with a
negative net worth and/or a net loss and the amount of that loss is
greater than one-half of the organization's total net worth must file
quarterly financial statements for fiscal soundness monitoring. Part D
organizations are required to submit three (3) quarterly financial
statements. Lastly, PACE organizations are required to file four (4)
quarterly financial statements for the first three (3) years in the
program. After the first three (3) years, PACE organizations with a
negative net worth and/or a net loss and the amount of that loss is
greater than one-half of the organization's total net worth must submit
quarterly financial statements for fiscal soundness monitoring. CMS is
responsible for overseeing the ongoing financial performance for all
Medicare Health Plans, PDPs, and PACE organizations. Specifically, CMS
needs the requested information collected in order to establish that
contracting entities within those programs maintain fiscally sound
operations. Form Number: CMS-906 (OMB control number: 0938-0469);
Frequency: Yearly; Affected Public: Business or other for-profits, Not-
for profits institutions; Number of Respondents: 767; Total Annual
Responses: 1589; Total Annual Hours: 530. (For policy questions
regarding this collection contact Christa Zalewski at 410-786-1971.)
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Information
Collection Requirements for Compliance with Individual and Group Market
Reforms under Title XXVII of the Public Health Service Act; Use:
Sections 2723 and 2761 of the Public Health Service Act (PHS Act)
direct the Centers for Medicare and Medicaid Services (CMS) to enforce
a provision (or provisions) of title XXVII of the PHS Act (including
the implementing regulations in parts 144, 146, 147, and 148 of title
45 of the Code of Federal Regulations) with respect to health insurance
issuers when a state has notified CMS that it has not enacted
legislation to enforce or that it is not otherwise enforcing a
provision (or provisions) of the group and individual market reforms
with respect to health insurance issuers, or when CMS has determined
that a state is not substantially enforcing one or more of those
provisions. Section 2723 of the PHS Act directs CMS to enforce an
applicable provision (or applicable provisions) of title XXVII of the
PHS Act (including the implementing regulations in parts 146 and 147 of
title 45 of the Code of Federal Regulations) with respect to group
health plans that are non-Federal governmental plans. This collection
of information includes requirements that are necessary for CMS to
conduct compliance review activities.
The Department of the Treasury, the Department of Labor, and the
Department of Health and Human Services (collectively, the Departments)
issued proposed regulations titled ``Health Reimbursement Arrangements
and Other Account-Based Group Health Plans'' under section 2711 of the
PHS Act and the health nondiscrimination provisions of HIPAA, Public
Law 104-191 (HIPAA nondiscrimination provisions.) The proposed
regulations are intended to expand the usability of health
reimbursement arrangements and other account-based group health plans
(collectively referred to as HRAs). In general, the proposed
regulations would expand the usability of HRAs by eliminating the
current prohibition on integrating HRAs with individual health
insurance coverage, thereby permitting employers to offer HRAs to
employees enrolled in individual health insurance coverage. Under the
proposed regulations employees would be permitted to use amounts in an
HRA integrated with individual health insurance coverage to pay
expenses for medical care (including premiums for individual health
insurance coverage), subject to certain requirements. This collection
includes the requirements related to substantiation of individual
health insurance coverage by an HRA prior to making reimbursements and
the notice that HRAs would be required to provide to each participant.
Form Number: CMS-10430 (OMB control number: 0938-0702); Frequency:
Annually; Affected Public: State Governments, Private Sector, State or
local governments; Number of Respondents: 2,785; Total Annual
Responses: 298,175; Total Annual Hours: 7,737. (For policy questions
regarding this collection contact Usree Bandyopadhyay at 410-786-6650.)
5. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection:
Prepaid Health Plan Cost Report; Use: Health Maintenance Organizations
and Competitive Medical Plans (HMO/CMPs) contracting with the Secretary
under Section 1876 of the Social Security Act are required to submit a
budget and enrollment forecast, semi-annual interim report, 4th Quarter
interim report (CMS has waived this annual submission), and a final
certified cost report in accordance with 42 CFR 417.572-417.576. The
submission, receipt and processing of the cost reports is imperative to
determine if MCOs are paid on a reasonable basis for the covered
services furnished to Medicare enrollees. CMS reviews the data
submitted within the cost reports to establish monthly payment rates,
monitor interim rates, and determine the final reimbursement. Health
Care Prepayment Plans (HCPPs) contracting with the Secretary under
Section 1833 of the Social Security Act are required to submit a budget
and enrollment forecast, semi-annual interim report, and final cost
report in accordance with 42 CFR 417.808 and 42 CFR 417.810. Form
Number: CMS-276 (OMB control number: 0938-0165); Frequency: Quarterly;
Affected Public: Businesses or other for-profits, Not-for-profit
institutions; Number of Respondents: 57; Total Annual Responses: 67;
Total Annual Hours: 1,800. (For policy
[[Page 734]]
questions regarding this collection, contact Bilal Farrakh at 410-786-
4456.)
6. Type of Information Collection Request: New collection (Request
for a new OMB control number); Title of Information Collection: Testing
of Web Survey Design and Administration for CMS Experience of Care
Surveys; Use: This collection is a new generic clearance request which
encompasses an array of research activities to add web administration
protocols to a series of surveys conducted by the Centers for Medicare
& Medicaid Services (CMS). This request seeks burden hours to allow CMS
and its contractors to conduct cognitive in-depth interviews, focus
groups, pilot tests, and usability studies to support a variety of
methodological studies around web modes of data collection for programs
such as the Emergency Department Experience of Care (EDPEC), Fee-for-
Service (FFS) Consumer Assessment of Healthcare Providers and Systems
(CAHPS), Hospital CAHPS (HCAHPS), Medicare Advantage and Prescription
Drug (MA & PDP) CAHPS, Home Health (HH) CAHPS, Hospice CAHPS, In-Center
Hemodialysis (ICH) CAHPS, the Health Outcomes Survey (HOS), and the
Medicare Advantage and Part D Plan Disenrollment Reasons surveys.
Providers. Form Number: CMS-10694 (OMB control number: 0938-New);
Frequency: Yearly; Affected Public: Business or other for-profits, Not-
for-Profit Institutions; Number of Respondents: 75,250; Total Annual
Responses: 75,250; Total Annual Hours: 17,000. (For policy, questions
regarding this collection contact Elizabeth H. Goldstein at 410-786-
6665.)
7. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare Current
Beneficiary Survey; Use: CMS is the largest single payer of health care
in the United States. The agency plays a direct or indirect role in
administering health insurance coverage for more than 120 million
people across the Medicare, Medicaid, CHIP, and Exchange populations. A
critical aim for CMS is to be an effective steward, major force, and
trustworthy partner in supporting innovative approaches to improving
quality, accessibility, and affordability in healthcare. CMS also aims
to put patients first in the delivery of their health care needs.
The Medicare Current Beneficiary Survey (MCBS) is the most
comprehensive and complete survey available on the Medicare population
and is essential in capturing data not otherwise collected through our
operations. The MCBS is an in-person, nationally-representative,
longitudinal survey of Medicare beneficiaries that we sponsor and is
directed by the Office of Enterprise Data and Analytics (OEDA). The
survey captures beneficiary information whether aged or disabled,
living in the community or facility, or serviced by managed care or
fee-for-service. Data produced as part of the MCBS are enhanced with
our administrative data (e.g. fee-for-service claims, prescription drug
event data, enrollment, etc.) to provide users with more accurate and
complete estimates of total health care costs and utilization. The MCBS
has been continuously fielded for more than 26 years, encompassing over
1 million interviews and more than 100,000 survey participants.
Respondents participate in up to 11 interviews over a four year period.
This gives a comprehensive picture of health care costs and utilization
over a period of time.
The MCBS continues to provide unique insight into the Medicare
program and helps CMS and our external stakeholders better understand
and evaluate the impact of existing programs and significant new policy
initiatives. In the past, MCBS data have been used to assess potential
changes to the Medicare program. For example, the MCBS was instrumental
in supporting the development and implementation of the Medicare
prescription drug benefit by providing a means to evaluate prescription
drug costs and out-of-pocket burden for these drugs to Medicare
beneficiaries. Beginning in 2020, this proposed revision to the
clearance will add a few new measures to existing questionnaire
sections. The revisions will result in a slight decrease in respondent
burden of 4%, due to fewer projected completed cases each round. Form
Number: CMS-P-0015A (OMB control number: 0938-0568); Frequency:
Occasionally; Affected Public: Business or other for-profits and Not-
for-profit institutions; Number of Respondents: 13,656; Total Annual
Responses: 35,998; Total Annual Hours: 42,610. (For policy questions
regarding this collection contact William Long at 410-786-7927.)
Dated: January 28, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2019-00433 Filed 1-30-19; 8:45 am]
BILLING CODE 4120-01-P
