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–10340 Collection of Encounter Data From
Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833
Health Care Prepayment Plans (HCPPS), and Pace Organizations
CMS–10380 Reporting Requirements for Grants to
States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective
Rate Review Program Under the Paperwork Reduction Act (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 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 of a
currently approved collection; Title of Information Collection: Collection of
Encounter Data from Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS,
Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations;
Use:
CMS collects encounter
data or data on each item or service delivered to enrollees of Medicare
Advantage (MA) plans offered by MA organizations. MA organizations currently
obtain this data from providers. CMS collects this information using standard
transaction forms and code sets.
CMS will use the data for determining risk
adjustment factors for payment, updating the risk adjustment model, calculating
Medicare DSH percentages, Medicare coverage purposes, and quality review and improvement
activities.
The data is also used to verify the accuracy and
validity of the costs claimed on cost reports.
For PACE organizations, encounter data would serve
the same purpose it does related to the MA program and would be submitted in a
similar manner.
Form Number: CMS–10340
(OCN: 0938– 1152); Frequency: Weekly; Affected Public: Private sector (business
or other for-profits); Number of Respondents: 683; Total Annual Responses: 516,493,635;
Total Annual Hours: 34,433 (For policy questions regarding this collection
contact Michael Massimini at 410–786–1566).
2. Type of Information Collection
Request: Revision of a
currently approved collection; Title of Information Collection: Reporting Requirements
for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV
and Effective Rate Review Program; Use: Under the section 1003 of the Affordable
Care Act (ACA) (section 2794 of the Public Health Service Act), the Secretary,
in conjunction with the states and territories, is required to establish a
process for the annual review, beginning with the 2010 plan year, of
unreasonable increases in premiums for health insurance coverage.
Section 2794(c)
requires the Secretary to establish the Rate Review Grant Program to assist
states to implement this provision. In
addition, section 2794(c) requires the Rate Review Grant Program to assist
states in the establishment and enhancement of ‘‘Data Centers’’ that collect,
analyze, and disseminate health care pricing data to the public.
Concurrent with this
information collection request, HHS released Cycle IV of the Rate Review
Grants, ‘‘Grants to States to Support
Health Insurance Rate Review and Increase Transparency in the Pricing of Medical
Services.’’
The purpose of Cycle IV of the Rate Review Grant Program is to
continue the rate review successes of Cycles I, II, and III, as well as to
provide greater support to Data Centers, thereby enhancing medical pricing
transparency. States and territories that apply for funds are required to
complete the grant application.
States and territories that are awarded funds
under this funding opportunity are required to provide the Secretary with rate
review data, four quarterly reports, and one annual report per year until the
end of the grant period detailing the state’s progression towards a more
comprehensive and effective rate review process. A final report is due at the
end of the grant period.
This information
collection is required for effective monitoring of grantees and to fulfill
statutory requirements under section 2794(b)(1)(A) of the ACA that requires grantees,
as a condition of receiving a grant authorized under section 2794(c), to report
to the Secretary information about premium increases.
On May 23, 2011, CMS
published a final rule with comment period (76 FR 29964) to implement the
annual review of unreasonable increases in premiums for health insurance
coverage called for by section 2794. Under the regulation, if CMS determines
that a state has an Effective Rate Review Program in a given market, using the
criteria set forth in the rule, CMS will adopt that state’s determinations
regarding whether rate increases in that market are unreasonable, provided that
the state reports its final determinations to CMS and explains the bases of its
determinations.
The final
rule titled ‘‘Patient Protection and Affordable Care Act; Health Insurance
Market Rules; Rate Review’’ (78 FR 13406, February 27, 2013) amends the standards
under the Effective Rate Review Program. Currently, CMS relies on publicly available information and annual
calls with individual states to obtain the information needed to evaluate
whether a state has begun to or continues to satisfy the Effective Rate Review Program
criteria. CMS is proposing to instead
collect the information in writing from all states that would like to request
effective status.
Form Number: CMS–10380
(OCN: 0938–1121); Frequency: Annually and On occasion; Affected Public: Public
Sector and State and Territory Governments; Number of Respondents: 50; Total
Annual Responses: 553; Total Annual Hours: 20,951. (For policy questions
regarding this collection contact Susie Lorden at 301–492–4162.)
Dated: May 28, 2014.
Martique Jones, Deputy Director,
Regulations Development Group, Office of Strategic Operations and Regulatory
Affairs.
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