[Federal Register Volume 76, Number 242 (Friday, December 16, 2011)]
[Notices]
[Pages 78265-78267]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32290]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-10180, CMS-R-199, CMS-10379 and CMS-10418]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
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: Extension of a currently
approved collection; Title of Information Collection: Children's Health
Insurance Program (CHIP) Report on Payables and Receivables; Use:
Collection of CHIP data and the calculation of the CHIP Incurred But
Not Reported (IBNR) estimate are pertinent to CMS' financial audit. The
CFO auditors have reported the lack of an estimate for CHIP IBNR
payables and receivables as a reportable condition in the FY 2005 audit
of CMS's financial statements. It is essential that CMS
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collect the necessary data from State agencies in FY 2006, so that CMS
continues to receive an unqualified audit opinion on its financial
statements. Program expenditures for the CHIP have increased since its
inception; as such, CHIP receivables and payables may materially impact
the financial statements. The CHIP Report on Payables and Receivables
will provide the information needed to calculate the CHIP IBNR. Form
Number: CMS-10180 (OMB: 0938-0988); Frequency: Reporting--
Annually; Affected Public: State, Local or Tribal governments; Number
of Respondents: 56; Total Annual Responses: 56; Total Annual Hours:
392. (For policy questions regarding this collection contact Michele
Myers at (410) 786-7911. For all other issues call (410) 786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid Report
on Payables and Receivables; Use: The Chief Financial Officers (CFO)
Act of 1990, as amended by the Government Management Reform Act (GMRA)
of 1994, requires government agencies to produce auditable financial
statements. Because the Centers for Medicare & Medicaid Services (CMS)
fulfills its mission through its contractors and the States; these
entities are the primary source of information for the financial
statements. There are three basic categories of data: expenses,
payables, and receivables. The CMS-64 is used to collect data on
Medicaid expenses. The CMS-R-199 collects Medicaid payable and
receivable accounting data from the States. Form Number: CMS-R-199
(OMB: 0938-0697); Frequency: Reporting--Annually; Affected
Public: State, Local or Tribal governments; Number of Respondents: 56;
Total Annual Responses: 56; Total Annual Hours: 336. (For policy
questions regarding this collection contact Michele Myers at (410) 786-
7911. For all other issues call (410) 786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Rate Increase
Disclosure and Review Reporting Requirements (45 CFR Part 154). Use:
Under the Section 1003 of the Affordable Care Act (Section 2794 of the
Public Health Service Act), The Secretary, in conjunction with the
States, 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 directs the
Secretary to ensure the public disclosure of information of
unreasonable rate increases and justification for those increases.
On December 23, 2010, CMS published a proposed rate review
regulation in the Federal Register for public comment (Rate Increase
Disclosure and Review Rule, 75 FR 81004). CMS revised the proposed rule
based on the public comments and published the final rate review
regulation in the Federal Register on May 19, 2011. The final rule
defines the unreasonable rate review process and issuer reporting and
disclosure requirements (Rate Increase Disclosure and Review Rule, 76
FR 29964). The regulation establishes the following reporting
requirements:
The Preliminary Justification: This data collection is
required of all health insurance issuers for all rate increases that
exceed the ``subject to review''' reporting threshold as defined in the
rule. This information will be posted on an HHS Web site.
Rate Review Final Determination: This data collection
requires States with effective rate review programs and CMS to report
their review findings and unreasonable rate increase determinations on
all rate increases that are subject to review. This information will be
posted on an HHS Web site.
The Final Justification for an Unreasonable Rate Increase:
This data collection is required of health insurance issuers that elect
to implement a rate increase that is determined to be unreasonable
based on State or CMS review. This information will be posted on the
Health Insurance Issuer's Web site and on a CMS Web site.
1. Preliminary Justification
The Preliminary Justification consists of three parts, Part I: Rate
Increase Summary, Part II: Written Explanation of the Rate Increase,
and Part III: Rate Filing Documentation. Issuers must complete Parts I
and II for all rate increases that exceed the reporting threshold as
defined in the rule. As described in the preamble of the rule, this
information would be collected to provide consumers with basic
information on all rate increases that are subject to review under the
rate review program.
Under the rule, ``subject to review'' rate increases would be
reviewed by either States or CMS, depending on whether a State has an
effective rate review program. Issuers would only be required to submit
Part III of the Preliminary Justification when CMS is conducting the
review of a rate increase that is ``subject to review.'' Accordingly,
Part III requires health insurance issuers to provide detailed rate
data that would be used for the purposes of conducting thorough
actuarial reviews and for making determinations about whether rate
increases are unreasonable.
This Notice contains the following information about the
Preliminary Justification:
Preliminary Justification Issuer Instructions: health
insurance issuer instructions for completing all three parts of the
Preliminary Justification.
Part I Worksheet: a standardized Excel worksheet that must
be used to complete Part I of the Preliminary Justification.
Sample Internet display of the Rate Review Consumer
Disclosure: Information provided in the Preliminary Justification would
be posted on an HHS Web site. This sample display shows how the
information contained in the Part I Worksheet would be displayed to
consumers.
2. Rate Review Final Determination
Under the rule, States and CMS would have to provide a Rate Review
Final Determination at the close of their review of all ``subject to
review'' rate increases. The Rate Review Final Determination must
provide the State's or CMS' determination on whether a rate increase is
``unreasonable.'' Section 154.301(a)(3) of the rule provides a list of
actuarial review elements that must be taken into account as part of
the rate review process. The Final Determination must provide a brief
statement explaining how the review of elements set forth in Sec.
154.301(a)(3) caused the State or CMS to arrive at its determination
that the rate is unreasonable.
The Rate Review Final Determination will be entered into a data
entry text box in the Rate Review Data Collection System. CMS is
estimating that this statement would be approximately a paragraph in
length. There is no specific form or set of instructions associated
with this reporting requirement, apart from the reporting requirements
provided in the rule. The information provided in the Rate Review Final
Determination will be posted as part of the rate review consumer
disclosure information on an HHS Web site.
3. Final Justification for an Unreasonable Rate Increase
The rule states that if a health insurance issuer implements a rate
increase determined by CMS or a State to be unreasonable, the health
insurance issuer must provide a Final Justification for an Unreasonable
Rate Increase. In the Final Justification, issuers would
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have to provide a short statement about why they are electing to
implement an unreasonable rate increase. This statement would be
entered into a data entry text box in the Rate Review Data Collection
System and would not need to be more than a paragraph or two in length.
There is no form or instructions associated with this statement apart
from the requirements provided in the regulation.
The Final Justification Statement will be posted on an HHS Web site
in the same location as the Preliminary Justification and Rate Review
Final Determination. Additionally, health insurance issuers
implementing rate increases that were determined to be unreasonable,
must post all of this information--the Preliminary Justification, the
Rate Review Final Determination, and the Final Justification Statement
on their Web sites for a period of 3 years.
In addition to the aforementioned requirements, we revised the
information collection request as a result of an amendment to the
regulation discussed in the final rule that published September 6, 2011
(76 FR 54969). The amendment to the rate review final rule updated the
applicability of the rate review requirements to include products that
would be considered part of the individual or small group market had
they not been sold through associations, including those that are
consider to be large group products under State law or have been
otherwise excluded from State's existing definitions for individual and
small group products. This change resulted in an increase in the total
number of rate increases that are subject to the rate review reporting
requirements. The amendment did not propose any changes to the
information that issuers must submit for each rate increase. Thus,
burden associated with each rate increase submission remains unchanged
from the final rate review rule. The revised association product
reporting requirements took effect on November 1, 2011. CMS received a
6 month Emergency PRA approval for the revised association reporting
requirements on October 31, 2011 (OMB-0938-1141). CMS is now requesting
a 3-year OMB approval of these collection requirements. Form Number:
CMS-10379 (OCN: 0938-1141); Frequency: Annually; Affected Public:
Private Sector and States; Number of Respondents: 452; Number of
Responses: 3,571; Total Annual Hours: 14,630. (For policy questions
regarding this collection, contact Sally McCarty at (301) 492-4489. For
all other issues call (410) 786-1326.)
4. Type of Information Collection Request: New information
collection; Title of Information Collection: Medical Loss Ratio Annual
Reporting and Rebate Calculation; Use: Under Section 2718 of the
Affordable Care Act and implementing regulations at 45 CFR Part 158 (75
FR 74864, December 1, 2010 (Interim Final Rule); 75 FR 82277, December
30, 2010 (Technical Correction); and 76 FR 76574, December 7, 2011
(Final Rule with comment period)), a health insurance issuer (issuer)
offering group or individual health insurance coverage must submit a
report to the Secretary concerning the amount the issuer spends each
year on claims, quality improvement expenses, non-claims costs, Federal
and State taxes and licensing and regulatory fees, and the amount of
earned premium. An issuer must provide an annual rebate to enrollees if
the amount it spends on certain costs compared to its premium revenue
(excluding Federal and States taxes and licensing and regulatory fees)
does not meet a certain ratio, referred to as the medical loss ratio
(MLR). An interim final rule (IFR) implementing the MLR was published
on December 1, 2010 (75 FR 74865) and modified by technical corrections
on December 30, 2010 (75 FR 82277), which added Part 158 to Title 45 of
the Code of Federal Regulations. The IFR is effective January 1, 2011.
A final rule regarding selected provisions of the interim final rule
was published on December 7, 2011 (76 FR 76574) and an interim final
rule regarding an issue not included in issuers' reporting requirements
(distribution of rebates by non-federal governmental plans) was also
published on December 7, 2011 (76 FR 76596). Each issuer is required to
submit MLR data annually, including information about any rebates it
must provide, on a form prescribed by CMS for each large group market,
small group market, and individual market within each State in which
the issuer conducts business. Data is to be submitted electronically
through CMS' Health Insurance Oversight System (HIOS). Additionally,
each issuer is required to maintain for a period of seven years all
documents, records and other evidence that support the data included in
each issuer's annual report to the Secretary. Form Number: CMS-10418;
Frequency: Annually; Affected Public: Private Sector: Business or other
for-profits and not-for-profit institutions; Number of Respondents:
527; Number of Responses: 5,530; Total Annual Hours: 352,563. (For
policy questions regarding this collection, contact Carol Jimenez at
(301) 492-4457. For all other issues, call (410) 786-1326.)
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995,
or Email your request, including your address, phone number, OMB
number, and CMS document identifier, to [email protected], or call
the Reports Clearance Office on (410) 786-1326.
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 February 14, 2012:
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 C4-26-05, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: December 13, 2011.
Martique Jones,
Director, Regulations Development Group, Division B Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2011-32290 Filed 12-15-11; 8:45 a.m.]
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