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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
DOCUMENT ID: [Document Identifier: CMS-R-262, CMS-10142, CMS-10175 and CMS-R-218]
NOTICE: NOTICES
SUBJECT CATEGORY: Agency Information Collection Activities: Proposed Collection; Comment Request
DOCUMENT SUMMARY:
Agency: Centers for Medicare & Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid Services (CMS) is publishing the following summary of proposed collections for public comment. Interested persons are invited to send comments regarding this 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.
1. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: CY 2010 Plan Benefit Package (PBP) and Formulary Submission for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) Use: Under the Medicare Modernization Act (MMA), Medicare Advantage (MA) and Prescription Drug Plan (PDP) organizations are required to submit plan benefit packages for all Medicare beneficiaries residing in their service area. The plan benefit package submission consists of the formulary file, Plan Benefit Package (PBP) software, and supporting documentation as necessary. MA and PDP organizations will generate a formulary to illustrate their list of drugs, including information on prior authorization, step therapy, tiering, and quantity limits. Additionally, the PBP software will be used to describe their organization's plan benefit packages, including information on premiums, cost sharing, authorization rules, and supplemental benefits. CMS uses the formulary and PBP data to review and approve the plan benefit packages proposed by each MA and PDP organization.
CMS requires that MA and PDP organizations submit a completed
formulary and PBP as part of the annual bidding process. During this
process, organizations prepare their proposed plan benefit packages for
the upcoming contract year and submit them to CMS for review and
approval. Based on operational changes and policy clarifications to the
Medicare program and continued input and feedback by the industry, CMS
has made the necessary changes to the plan benefit package submission.
Form Number: CMSR262 (OMB
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: CY 2010 Bid
Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription
Drug Plans (PDP). Use: Under the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), and implementing
regulations at 42 CFR, Medicare Advantage organizations (MAO) and
Prescription Drug Plans (PDP) are required to submit an actuarial
pricing ``bid'' for each plan offered to Medicare beneficiaries for
approval by CMS. MAOs and PDPs use the Bid Pricing Tool (BPT) software
to develop their actuarial pricing bid. The information provided in the
BPT is the basis for the plan's enrollee premiums and CMS payments for
each contract year. The tool collects data such as medical expense
development (from claims data and/or manual rating), administrative
expenses, profit levels, and projected plan enrollment information. By statute,
[[Page 60297]]
completed BPTs are due to CMS by the first Monday of June each year.
CMS reviews and analyzes the information provided on the Bid Pricing
Tool. Ultimately, CMS decides whether to approve the plan pricing
(i.e., payment and premium) proposed by each organization. Form Number:
CMS10142 (OMB
3. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Certification Statement for Electronic File Interchange
Organizations (EFIOs) Use: Health care providers can currently obtain a
National Provider Identifier (NPI) via a paper application or over the
Internet through the National Plan and Provider Enumeration System
(NPPES). These applications must be submitted individually, on a per
provider basis. The Electronic File Interchange (EFI) process allows
providerdesignated electronic file interchange organizations (EFIOs)
to capture multiple providers' NPI application information on a single
electronic file for submission to NPPES. This process is also referred
to as ``bulk enumeration.'' To ensure that the EFIO has the authority
to act on behalf of each provider and complies with other Federal
requirements, an authorized official of the EFIO must sign a
certification statement and mail it to the Centers for Medicare and
Medicaid Services (CMS). Form Number: CMS10175 (OMB
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Information
Collection Requirements contained in 45 CFR Part 162; HIPAA Standards
for Electronic Transactions. Use: We are revising the currently
approved information collection request to include the information
collection requirements contained in CMS0009P (73 FR 49742). In the
aforementioned regulation, we update the adopted standards for
electronic transactions and propose the adoption of a new standard
transaction for Medicaid subrogation for retail pharmacy claims. The
use of these updated and additional standards would improve the
Medicare and Medicaid programs and other Federal health programs as
well as private health programs, and the effectiveness and efficiency
of the health care industry in general, by simplifying the
administration of the system and fostering and increase in EDI for
exchanging healthcare information. Increased advances in technology and
improvements in healthcare business processes have fostered development
of updated EDI standards to facilitate efficient and effective flow of
administrative operations. Adopting an updated version of the standards
and a new standard for Medicaid subrogation would greatly improve EDI
standardization for healthcare transactions. Form Number: CMSR218
(OMB
To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS' Web site at http://www.cms.hhs.gov/PaperworkReductionActof1995, or E mail your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@cms.hhs.gov, or call the Reports Clearance Office on (410) 7861326.
In commenting on the proposed information collections please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in one of the following ways by December 9, 2008:
1. Electronically. You may submit 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) 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 C42605, 7500 Security Boulevard,
Baltimore, Maryland 212441850.
Dated: October 2, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.
[FR Doc. E824093 Filed 10908; 8:45 am]
BILLING CODE 412001P
SUMMARY: Agency Information Collection Activities; Proposals, Submissions, and Approvals,
DOCUMENT BODY 2:
Agency: Centers for Medicare & Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid Services (CMS) is publishing the following summary of proposed collections for public comment. Interested persons are invited to send comments regarding this 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.
1. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: CY 2010 Plan Benefit Package (PBP) and Formulary Submission for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP) Use: Under the Medicare Modernization Act (MMA), Medicare Advantage (MA) and Prescription Drug Plan (PDP) organizations are required to submit plan benefit packages for all Medicare beneficiaries residing in their service area. The plan benefit package submission consists of the formulary file, Plan Benefit Package (PBP) software, and supporting documentation as necessary. MA and PDP organizations will generate a formulary to illustrate their list of drugs, including information on prior authorization, step therapy, tiering, and quantity limits. Additionally, the PBP software will be used to describe their organization's plan benefit packages, including information on premiums, cost sharing, authorization rules, and supplemental benefits. CMS uses the formulary and PBP data to review and approve the plan benefit packages proposed by each MA and PDP organization.
CMS requires that MA and PDP organizations submit a completed
formulary and PBP as part of the annual bidding process. During this
process, organizations prepare their proposed plan benefit packages for
the upcoming contract year and submit them to CMS for review and
approval. Based on operational changes and policy clarifications to the
Medicare program and continued input and feedback by the industry, CMS
has made the necessary changes to the plan benefit package submission.
Form Number: CMSR262 (OMB
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: CY 2010 Bid
Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription
Drug Plans (PDP). Use: Under the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA), and implementing
regulations at 42 CFR, Medicare Advantage organizations (MAO) and
Prescription Drug Plans (PDP) are required to submit an actuarial
pricing ``bid'' for each plan offered to Medicare beneficiaries for
approval by CMS. MAOs and PDPs use the Bid Pricing Tool (BPT) software
to develop their actuarial pricing bid. The information provided in the
BPT is the basis for the plan's enrollee premiums and CMS payments for
each contract year. The tool collects data such as medical expense
development (from claims data and/or manual rating), administrative
expenses, profit levels, and projected plan enrollment information. By statute,
[[Page 60297]]
completed BPTs are due to CMS by the first Monday of June each year.
CMS reviews and analyzes the information provided on the Bid Pricing
Tool. Ultimately, CMS decides whether to approve the plan pricing
(i.e., payment and premium) proposed by each organization. Form Number:
CMS10142 (OMB
3. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Certification Statement for Electronic File Interchange
Organizations (EFIOs) Use: Health care providers can currently obtain a
National Provider Identifier (NPI) via a paper application or over the
Internet through the National Plan and Provider Enumeration System
(NPPES). These applications must be submitted individually, on a per
provider basis. The Electronic File Interchange (EFI) process allows
providerdesignated electronic file interchange organizations (EFIOs)
to capture multiple providers' NPI application information on a single
electronic file for submission to NPPES. This process is also referred
to as ``bulk enumeration.'' To ensure that the EFIO has the authority
to act on behalf of each provider and complies with other Federal
requirements, an authorized official of the EFIO must sign a
certification statement and mail it to the Centers for Medicare and
Medicaid Services (CMS). Form Number: CMS10175 (OMB
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Information
Collection Requirements contained in 45 CFR Part 162; HIPAA Standards
for Electronic Transactions. Use: We are revising the currently
approved information collection request to include the information
collection requirements contained in CMS0009P (73 FR 49742). In the
aforementioned regulation, we update the adopted standards for
electronic transactions and propose the adoption of a new standard
transaction for Medicaid subrogation for retail pharmacy claims. The
use of these updated and additional standards would improve the
Medicare and Medicaid programs and other Federal health programs as
well as private health programs, and the effectiveness and efficiency
of the health care industry in general, by simplifying the
administration of the system and fostering and increase in EDI for
exchanging healthcare information. Increased advances in technology and
improvements in healthcare business processes have fostered development
of updated EDI standards to facilitate efficient and effective flow of
administrative operations. Adopting an updated version of the standards
and a new standard for Medicaid subrogation would greatly improve EDI
standardization for healthcare transactions. Form Number: CMSR218
(OMB
To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS' Web site at http://www.cms.hhs.gov/PaperworkReductionActof1995, or E mail your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@cms.hhs.gov, or call the Reports Clearance Office on (410) 7861326.
In commenting on the proposed information collections please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in one of the following ways by December 9, 2008:
1. Electronically. You may submit 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) 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 C42605, 7500 Security Boulevard,
Baltimore, Maryland 212441850.
Dated: October 2, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.
[FR Doc. E824093 Filed 10908; 8:45 am]
BILLING CODE 412001P
Common CFR Searches
14 CFR Part 39 40 CFR Part 52 14 CFR Part 71 33 CFR Part 165 50 CFR Part 679 47 CFR Part 73 26 CFR Part 1 40 CFR Part 180 33 CFR Part 117 50 CFR Part 17 44 CFR Part 67 50 CFR Part 648 14 CFR Part 97 40 CFR Part 63 33 CFR Part 100 50 CFR Part 622 50 CFR Part 660 44 CFR Part 65 26 CFR Part 301 39 CFR Part 111 40 CFR Part 300 6 CFR Part 5 40 CFR Part 271 47 CFR Part 64 40 CFR Parts 52 and 81 50 CFR Part 665 10 CFR Part 50 44 CFR Part 64 49 CFR Part 571 39 CFR Part 3020