[Federal Register Volume 85, Number 108 (Thursday, June 4, 2020)]
[Notices]
[Pages 34450-34451]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-12002]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-10717, CMS-10468 and CMS-R-267]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
ACTION: Notice.
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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of
information, including each proposed extension or reinstatement of an
existing collection of information, and to allow a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate or any other aspect of this
collection of information, including the necessity and utility of the
proposed information collection for the proper performance of the
agency's functions, the accuracy of the estimated burden, ways to
enhance the quality, utility, and clarity of the information to be
collected, and the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
DATES: Comments on the collection(s) of information must be received by
the OMB desk officer by July 6, 2020.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' website address at 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 [email protected].
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. The term ``collection of
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and
includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-day notice in the Federal Register
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, before submitting the collection to OMB for approval. To
comply with this requirement, CMS is publishing this notice that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: New Collection; Title of
Information Collection: Medicare Part C and Part D Program Audit and
Industry-Wide Part C Timeliness Monitoring Project (TMP) Protocols;
Use: Under the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 and implementing regulations at 42 CFR parts
422 and 423, Medicare Part D plan sponsors and Medicare Advantage
organizations are required to comply with all Medicare Parts C and D
program requirements. CMS' annual audit plan ensures that we evaluate
Sponsoring organizations' compliance with these requirements by
conducting program audits that focus on high-risk areas that have the
greatest potential for beneficiary harm. As such, CMS has developed the
following audit protocols for use by Sponsoring organizations to
prepare for their audit:
Compliance Program Effectiveness (CPE)
Part D Formulary and Benefit Administration (FA)
Part D Coverage Determinations, Appeals, and Grievances (CDAG)
Part C Organization Determinations, Appeals, and Grievances
(ODAG)
Special Needs Plans Care Coordination (SNPCC)
CMS generally conducts program audits at the parent organization
level in an effort to reduce burden and, for routine audits, subjects
each Sponsoring organization to all applicable program area protocols.
For example, if a Sponsoring organization does not offer a special
needs plan, or an accrediting organization has deemed a special needs
plan compliant with CMS regulations and standards, CMS would not apply
the SNPCC protocol. Likewise, CMS would not apply the ODAG audit
protocol to an organization that offers only a standalone prescription
drug plan since that organization does not offer the MA benefit.
Conversely, ad hoc audits resulting from referral may be limited in
scope and, therefore, all program area protocols may not be applied.
In addition, as part of the robust program audit process, CMS also
requires sponsoring organizations that have undergone a program audit
and found to have deficiencies to undergo a validation audit to ensure
correction. The validation audit uses the same audit protocols, but
only tests the elements where deficiencies were found as opposed to re-
administering the entire audit. Finally, CMS conducts annual industry-
wide timeliness monitoring of all Part C organizations by using a
subset of the ODAG protocol. However, Sponsoring organizations that
successfully submitted all of their Part C data in response to a
program audit in the prior year are excluded from submitting new data
for the timeliness monitoring effort in the year following their
program audit.
The information gathered during this program audit will be used by
the Medicare Parts C and D Oversight and Enforcement Group (MOEG)
within the Center for Medicare (CM) and CMS
[[Page 34451]]
Regional Offices to assess Sponsoring organizations' compliance with
Medicare program requirements. If outliers or other data anomalies are
detected, MOEG requires audited organizations to provide impact
analyses to better understand and report the scope of the
noncompliance. These MA and Part D organizations then receive their
audit results, are required to implement corrective actions, and to
demonstrate correction of all conditions cited in the final audit
report by undergoing a validation audit. If the validation audit
demonstrates substantial correction of the conditions, MOEG will
communicate its decision to close the audit in a letter to the MA and
Part D organization. Any new or isolated issues of non-compliance that
remain will be referred to the CMS Account Manager for follow-up.
Regional Offices will work in collaboration with MOEG and other
divisions within CMS for resolution. Form Number: CMS-10717 (OMB
control number: 0938-New); Frequency: Yearly; Affected Public: Private
Sector, Business or other for-profits, Not-for-profits institutions;
Number of Respondents: 190; Total Annual Responses: 179; Total Annual
Hours: 36,082. (For policy questions regarding this collection contact
Kellie Simons at 410-786-0886.)
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Essential Health Benefits in Alternative Benefit Plans, Eligibility
Notices, Fair Hearing and Appeal Processes, and Premiums and Cost
Sharing; Exchanges: Eligibility and Enrollment; Use: The Exchanges,
which became operational on January 1, 2014, enhanced competition in
the health insurance market, expanded access to affordable health
insurance for millions of Americans, and provided consumers with a
place to easily compare and shop for health insurance coverage. The
reporting requirements and data collection in Medicaid, Children's
Health Insurance Programs, and Exchanges: Essential Health Benefits in
Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal
Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and
Enrollment (CMS-2334-F) address: (1) Standards related to notices, (2)
procedures for the verification of enrollment in an eligible employer-
sponsored plan and eligibility for qualifying coverage in an eligible
employer-sponsored plan; and (3) other eligibility and enrollment
provisions to provide detail necessary for state implementation. The
submission seeks OMB approval of the information collection
requirements associated with selected provisions in 45 CFR parts 155,
156 and 157. Form Number: CMS-10468 (OMB control number: 0938-1207);
Frequency: Annually; Affected Public: Individuals, Households and
Private Sector; Number of Respondents: 1,522; Total Annual Responses:
9,533; Total Annual Hours: 103,710. (For policy questions regarding
this collection contact Anne Pesto at 410-786-3492.)
3. Type of Information Collection Request: Revision with change of
a currently approved collection; Title of Information Collection:
Medicare Plus Choice Program Requirements Referenced in 42 CFR 422.000-
422.700; Use: The information collection requirements are mandated by
42 CFR part 422. Section 4001 of the Balanced Budget Act of 1997 (BBA)
added sections 1851 through 1859 to the Social Security Act to
establish the Managed Care program. The Medicare, Medicaid, and SCHIP
Benefits Improvement Act and Protection Act of 2000, Public Law 106-554
added requirements to the Managed Care program. The Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L.
108-173) created the Medicare Advantage program.
A major goal of the Medicare Advantage program is to provide ease
of access for Original Medicare beneficiaries who wish to enroll in a
Medicare Advantage program. Certain populations of beneficiaries such
as the dually eligible population (those beneficiaries enrolled in both
Medicaid and Medicare) have grown since the program was created and
these populations require more flexibilities.
MA organizations (formerly M+C organizations) and potential MA
organizations (applicants) use the information collected based on the
regulations at 42 CFR part 422 to comply with the application
requirements and the MA contract requirements. CMS uses the information
collected based on the regulations at 42 CFR part 422 to approve
contract applications, monitor compliance with contract requirements,
make proper payment to MA organizations, determine compliance with the
new prescription drug benefit requirements established by the MMA, and
to ensure that correct information is disclosed to Medicare
beneficiaries, both potential enrollees and enrollees.
Information supplied by organizations is used to determine
eligibility for contracting with CMS, for determining compliance with
contract requirements, and for calculating proper payment to the
organizations. Information supplied by Medicare beneficiaries is used
to determine eligibility to enroll in the M+C organization and to
determine proper payment to the organization that enrolled the
beneficiary. Separate OMB approval was sought for each form as
required.
The information collection request also incorporates the new
minimum criteria for dual eligible special needs plans (D-SNPs) to
integrate Medicare and Medicaid benefits detailed in Section 50311(b)
of the Bipartisan Budget Act of 2018 and set forth in in Final rule
(CMS-4185-F, RIN 0938-AT59) for CY2020 and 2021. The integration
requirements improve care coordination, quality of care, and
beneficiary satisfaction while reducing administrative burden. Form
Number: CMS-R-267 (OMB control number: 0938-0753); Frequency: Yearly;
Affected Public: State, Local, or Tribal Governments; Number of
Respondents: 6,727,508; Total Annual Responses: 6,750,814; Total Annual
Hours: 1,848,180. (For policy questions regarding this collection
contact Marna Metcalf Akbar at 410-786-8251.)
Dated: May 29, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2020-12002 Filed 6-3-20; 8:45 am]
BILLING CODE 4120-01-P