Notice2021-25816
Agency Information Collection Activities: Proposed Collection; Comment Request
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
November 26, 2021
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
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.
Full Text
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<title>Federal Register, Volume 86 Issue 225 (Friday, November 26, 2021)</title>
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[Federal Register Volume 86, Number 225 (Friday, November 26, 2021)]
[Notices]
[Pages 67473-67475]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-25816]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10599, CMS-10433, CMS-10330 and CMS-10780]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, Health and Human
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 (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 January 25, 2022.
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
<a href="http://www.regulations.gov">http://www.regulations.gov</a>. 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 <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html">https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html</a>.
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-10599 Review Choice Demonstration for Home Health Services
CMS-10433 Continuation of Data Collection to Support QHP Certification
and other Financial Management and Exchange Operations
CMS-10330 Notice of Rescission of Coverage and Disclosure Requirements
for Patient Protection under the Affordable Care Act
CMS-10780 Requirements Related to Surprise Billing: Qualifying Payment
Amount, Notice and Consent, and Disclosure on Patient Protections
Against Balance Billing, and State Law Opt-in
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
[[Page 67474]]
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: Revision of a currently
approved collection; Title of Information Collection: Review Choice
Demonstration for Home Health Services; Use: Section 402(a)(1)(J) of
the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J))
authorizes the Secretary to ``develop or demonstrate improved methods
for the investigation and prosecution of fraud in the provision of care
or services under the health programs established by the Social
Security Act (the Act).'' Pursuant to this authority, the CMS seeks to
develop and implement a Medicare demonstration project, which CMS
believes will help assist in developing improved procedures for the
identification, investigation, and prosecution of Medicare fraud
occurring among Home Health Agencies (HHA) providing services to
Medicare beneficiaries.
This revised demonstration helps assist in developing improved
procedures for the identification, investigation, and prosecution of
potential Medicare fraud. The demonstration helps make sure that
payments for home health services are appropriate through either pre-
claim or postpayment review, thereby working towards the prevention and
identification of potential fraud, waste, and abuse; the protection of
Medicare Trust Funds from improper payments; and the reduction of
Medicare appeals. CMS has implemented the demonstration in Illinois,
Ohio, North Carolina, Florida, and Texas with the option to expand to
other states in the Palmetto/JM jurisdiction. Under this demonstration,
CMS offers choices for providers to demonstrate their compliance with
CMS' home health policies. Providers in the demonstration states may
participate in either 100 percent pre-claim review or 100 percent
postpayment review. These providers will continue to be subject to a
review method until the HHA reaches the target affirmation or claim
approval rate. Once a HHA reaches the target pre-claim review
affirmation or post-payment review claim approval rate, it may choose
to be relieved from claim reviews, except for a spot check of their
claims to ensure continued compliance. Providers who do not wish to
participate in either 100 percent pre-claim or postpayment reviews have
the option to furnish home health services and submit the associated
claim for payment without undergoing such reviews; however, they will
receive a 25 percent payment reduction on all claims submitted for home
health services and may be eligible for review by the Recovery Audit
Contractors.
The information required under this collection is required by
Medicare contractors to determine proper payment or if there is a
suspicion of fraud. Under the pre-claim review option, the HHA sends
the pre-claim review request along with all required documentation to
the Medicare contractor for review prior to submitting the final claim
for payment. If a claim is submitted without a pre-claim review
decision one file, the Medicare contractor will request the information
from the HHA to determine if payment is appropriate. For the
postpayment review option, the Medicare contractor will also request
the information from the HHA provider who submitted the claim for
payment from the Medicare program to determine if payment was
appropriate. Form Number: CMS-10599 (OMB control number: 0938-1311);
Frequency: Frequently, until the HHA reaches the target affirmation or
claim approval threshold and then occasionally; Affected Public:
Private Sector (Business or other for-profits and Not-for-profits);
Number of Respondents: 3,631; Number of Responses: 1,467,243; Total
Annual Hours: 744,5143. (For questions regarding this collection
contact Jennifer McMullen (410)786-7635.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Continuation of
Data Collection to Support QHP Certification and other Financial
Management and Exchange Operations; Use: As directed by the rule
Establishment of Exchanges and Qualified Health Plans; Exchange
Standards for Employers (77 FR 18310) (Exchange rule), each Exchange is
responsible for the certification and offering of Qualified Health
Plans (QHPs). To offer insurance through an Exchange, a health
insurance issuer must have its health plans certified as QHPs by the
Exchange. A QHP must meet certain necessary minimum certification
standards, such as network adequacy, inclusion of Essential Community
Providers (ECPs), and non-discrimination. The Exchange is responsible
for ensuring that QHPs meet these minimum certification standards as
described in the Exchange rule under 45 CFR 155 and 156, based on the
Patient Protection and Affordable Care Act (PPACA), as well as other
standards determined by the Exchange. Issuers can offer individual and
small group market plans outside of the Exchanges that are not QHPs.
Form Number: CMS-10433 (OMB control number: 0938-1187); Frequency:
Annually; Affected Public: Private sector, State, Local, or Tribal
Governments, Business or other for-profits; Number of Respondents:
2,925; Number of Responses: 2,925; Total Annual Hours: 71,660. (For
questions regarding this collection, contact Nicole Levesque at (617)
565-3138).
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: 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 (PHS Act), as added by the Affordable
Care Act, contain rescission notice, and patient protection disclosure
requirements that are subject to the Paperwork Reduction Act of 1995.
The No Surprises Act, enacted as part of the Consolidated
Appropriations Act, 2021, amended section 2719A of the PHS Act to
sunset when the new emergency services protections under the No
Surprises Act take effect. The provisions of section 2719A of the PHS
Act will no longer apply with respect to plan years beginning on or
after January 1, 2022. The No Surprises Act re-codified the patient
protections related to choice of health care professional under section
2719A of the PHS Act in newly added section 9822 of the Internal
Revenue Code, section 722 of the Employee Retirement Income Security
Act, and section 2799A-7 of the PHS Act and extended the applicability
of these provisions to grandfathered health plans for plan years
beginning on or after January 1, 2022. 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 2015 final regulations titled
``Final Rules under the Affordable Care Act for Grandfathered Plans,
Preexisting Condition Exclusions,
[[Page 67475]]
Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals,
and Patient Protections'' (80 FR 72192, November 18, 2015) and 2021
interim final regulations titled ``Requirements Related to Surprise
Billing; Part I'' (86 FR 36872, July 13, 2021). The 2015 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. Plans and issuers will not be required to
provide this notice for plan years beginning on or after January 1,
2022. Form Number: CMS-10330 (OMB control number: 0938-1094);
Frequency: On Occasion; Affected Public: State, Local, or Tribal
Governments, Private Sector; Number of Respondents: 2,277; Total Annual
Responses: 15,752; Total Annual Hours: 814. (For policy questions
regarding this collection, contact Usree Bandyopadhyay at (410) 786-
6650.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Requirements
Related to Surprise Billing: Qualifying Payment Amount, Notice and
Consent, Disclosure on Patient Protections Against Balance Billing, and
State Law Opt-in; Use: On December 27, 2020, the Consolidated
Appropriations Act, 2021 (Pub. L. 116-260), which included the No
Surprises Act, was signed into law. The No Surprises Act provides
federal protections against surprise billing and limits out-of-network
cost sharing under many of the circumstances in which surprise medical
bills arise most frequently. The 2021 interim final regulations
``Requirements Related to Surprise Billing; Part I'' (86 FR 36872, 2021
interim final regulations) issued by the Departments of Health and
Human Services, the Department of Labor, the Department of Treasury,
and the Office of Personnel Management, implement provisions of the No
Surprises Act that apply to group health plans, health insurance
issuers offering group or individual health insurance coverage, and
carriers in the Federal Employees Health Benefits (FEHB) Program that
provide protections against balance billing and out-of-network cost
sharing with respect to emergency services, non-emergency services
furnished by nonparticipating providers at certain participating health
care facilities, and air ambulance services furnished by
nonparticipating providers of air ambulance services. The 2021 interim
final regulations prohibit nonparticipating providers, emergency
facilities, and providers of air ambulance services from balance
billing participants, beneficiaries, and enrollees in certain
situations unless they satisfy certain notice and consent requirements.
The No Surprises Act and the 2021 interim final regulations require
group health plans and issuers of health insurance coverage to provide
information about qualifying payment amounts to nonparticipating
providers and facilities and to provide disclosures on patient
protections against balance billing to participants, beneficiaries and
enrollees. Self-insured plans opting in to a specified state law are
required to provide a disclosure to participants. Certain
nonparticipating providers and nonparticipating emergency facilities
may provide participants, beneficiaries, and enrollees with notice and
obtain their consent to waive balance billing protections, provided
certain requirements are met. In addition, certain providers and
facilities are required to provide disclosures on patient protections
against balance billing to participants, beneficiaries and enrollees.
Form Number: CMS-10780 (OMB control number: 0938-1401); Frequency: On
Occasion; Affected Public: Individuals, State, Local, or Tribal
Governments, Private Sector; Number of Respondents: 2,494,683; Total
Annual Responses: 58,696,352; Total Annual Hours: 4,933,110. (For
policy questions regarding this collection, contact Usree Bandyopadhyay
at 410-786-6650.)
Dated: November 22, 2021.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2021-25816 Filed 11-24-21; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on November 26, 2021.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.