[Federal Register Volume 81, Number 68 (Friday, April 8, 2016)]
[Notices]
[Pages 20643-20646]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-08106]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-317, CMS-319, CMS-10166, CMS-10178, and CMS-
10184]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
[[Page 20644]]
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 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.
DATES: Comments must be received by June 7, 2016.
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
http://www.regulations.gov. 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' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
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: Reports Clearance Office at (410) 786-
1326.
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-317 State Medicaid Eligibility Quality Control Sampling Plan
CMS-319 State Medicaid Eligibility Quality Control Sample Selection
Lists
CMS-10166 Payment Error Rate Measurement in Medicaid and the State
Children's Health Insurance Program
CMS-10178 Medicaid and State Children's Health Insurance Plan (SCHIP)
Managed Care
CMS-10184 Payment Error Rate Measurement--State Medicaid and SCHIP
Eligibility
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 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.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: State Medicaid
Eligibility Quality Control (MEQC) Sample Plans; Use: The Medicaid
Eligibility Quality Control (MEQC) system is based on monthly State
reviews of Medicaid and Medicaid expansion under Title XXI cases by
States performing the traditional sampling process identified through
statistically reliable statewide samples of cases selected from the
eligibility files. These reviews are conducted to determine whether or
not the sampled cases meet applicable State Title XIX or XXI
eligibility requirements when applicable. The reviews are also used to
assess beneficiary liability, if any, and to determine the amounts paid
to provide Medicaid services for these cases. In the MEQC system,
sampling is the only practical method of validating eligibility of the
total caseload and determining the dollar value of eligibility
liability errors. Any attempt to make such validations and
determinations by reviewing every case would be an enormous and
unwieldy undertaking. In 1993, CMS implemented MEQC pilots in which
States could focus on special studies, targeted populations, geographic
areas or other forms of oversight with CMS approval. States must submit
a sampling plan, or pilot proposal to be approved by CMS before
implementing their pilot program. The Children's Health Insurance
Program Reauthorization Act (CHIPRA) was enacted February 4, 2009.
Sections 203 and 601 of the CHIPRA relate to MEQC. Section 203 of the
CHIPRA establishes an error rate measurement with respect to the
enrollment of children under the express lane eligibility option. The
law directs States not to include children enrolled using the express
lane eligibility option in data or samples used for purposes of
complying with the MEQC requirements. Section 601 of the CHIPRA, among
other things, requires a new final rule for the Payment Error Rate
Measurement (PERM) program and aims to harmonize the PERM and MEQC
programs and provides States with the option to apply PERM data
resulting from its eligibility reviews for meeting MEQC requirements
and vice versa, with certain conditions. We review, either directly or
through its contractors, of the sampling plans helps to ensure States
are using valid statistical methods for sample selection. The
collection of information is also necessary to implement provisions
from the Children's Health Insurance Program Reauthorization Act of
2009 (CHIPRA) (Pub. L. 111-3) with regard to the Medicaid Eligibility
Quality Control (MEQC) and Payment Error Rate Measurement (PERM)
programs. Form Number: CMS-317 (OMB control number: 0938-0146);
Frequency: Semi-Annually Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 10; Total Annual Responses: 20;
Total Annual Hours: 480. (For policy questions regarding this
collection contact Bridgett Rider at 410-786-2602.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of
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Information Collection: State Medicaid Eligibility Quality Control
(MEQC) Sample Selection Lists; Use: The MEQC system is based on monthly
State reviews of Medicaid and Medicaid expansion under Title XXI cases
by States performing the traditional sampling process identified
through statistically reliable statewide samples of cases selected from
the eligibility files. These reviews are conducted to determine whether
or not the sampled cases meet applicable State Title XIX or XXI
eligibility requirements when applicable. The reviews are also used to
assess beneficiary liability, if any, and to determine the amounts paid
to provide Medicaid services for these cases. In the MEQC system,
sampling is the only practical method of validating eligibility of the
total caseload and determining the dollar value of eligibility
liability errors. Any attempt to make such validations and
determinations by reviewing every case would be an enormous and
unwieldy undertaking. At the beginning of each month, State agencies
still performing the traditional sample are required to submit sample
selection lists which identify all of the cases selected for review in
the States' samples. The sample selection lists contain identifying
information on Medicaid beneficiaries such as: State agency review
number, beneficiary's name and address, the name of the county where
the beneficiary resides, Medicaid case number, etc. The submittal of
the sample selection lists is necessary for Regional Office validation
of State reviews. Without these lists, the integrity of the sampling
results would be suspect and the Regional Offices would have no data on
the adequacy of the States' monthly sample draw or review completion
status. The authority for collecting this information is Section
1903(u) of the Social Security Act. The specific requirement for
submitting sample selection lists is described in regulations at 42 CFR
431.814(h). Regional Office staff review the sample selection lists to
determine that States are sampling a sufficient number of cases for
review. Form Number: CMS-319 (OMB control number: 0938-0147);
Frequency: Monthly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 10; Total Annual Responses: 120;
Total Annual Hours: 960. (For policy questions regarding this
collection contact Bridgett Rider at 410-786-2602.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Payment Error
Rate Measurement in Medicaid & Children's Health Insurance Program
(CHIP); Use: The Improper Payments Information Act (IPIA) of 2002 as
amended by the Improper Payments Elimination and Recovery Improvement
Act (IPERIA) of 2012 requires CMS to produce national error rates for
Medicaid and Children's Health Insurance Program (CHIP). To comply with
the IPIA, CMS will engage a Federal contractor to produce the error
rates in Medicaid and CHIP. The error rates for Medicaid and CHIP are
calculated based on the reviews on three components of both Medicaid
and CHIP program. They are: Fee-for-service claims medical reviews and
data processing reviews, managed care claims data-processing reviews,
and eligibility reviews. Each of the review components collects
different types of information, and the state-specific error rates for
each of the review components will be used to calculate an overall
state-specific error rate, and the individual state-specific error
rates will be used to produce a national error rate for Medicaid and
CHIP. The states will be requested to submit, at their option, test
data which include full claims details to the contractor prior to the
quarterly submissions to detect potential problems in the dataset to
and ensure the quality of the data. These states will be required to
submit quarterly claims data to the contractor who will pull a
statistically valid random sample, each quarter, by strata, so that
medical and data processing reviews can be performed. State-specific
error rates will be based on these review results. We need to collect
the fee-for-service claims data, medical policies, and other
information from states as well as medical records from providers in
order for the contractor to sample and review adjudicated claims in
those states selected for medical reviews and data processing reviews.
Based on the reviews, state-specific error rates will be calculated
which will serve as part of the basis for calculating national Medicaid
and CHIP error rates. Form Number: CMS-10166 (OMB control number: 0938-
0974); Frequency: Annually, Quarterly; Affected Public: State, Local,
or Tribal Governments; Number of Respondents: 34; Total Annual
Responses: 34; Total Annual Hours: 56,100. (For policy questions
regarding this collection contact Bridgett Rider at 410-786-2602.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid and
Children's Health Insurance (CHIP) Managed Care Claims and Related
Information; Use: The Payment Error Rate Measurement (PERM) program
measures improper payments for Medicaid and the State Children's Health
Insurance Program (SCHIP). The program was designed to comply with the
Improper Payments Information Act (IPIA) of 2002 and the Office of
Management and Budget (OMB) guidance. Although OMB guidance requires
error rate measurement for SCHIP, 2009 SCHIP legislation temporarily
suspended PERM measurement for this program and changed to Children's
Health Insurance Program (CHIP) effective April 01, 2009. See
Children's Health Insurance Program Reauthorization Act of 2009
(CHIPRA) Public Law 111-3 for more details. There are two phases of the
PERM program, the measurement phase and the corrective action phase.
The PERM measures improper payments in Medicaid and CHIP and produces
State and national-level error rates for each program. The error rates
are based on reviews of Medicaid and CHIP fee-for-service (FFS) and
managed care payments made in the Federal fiscal year under review.
States conduct eligibility reviews and report eligibility related
payment error rates also used in the national error rate calculation.
We created a 17 State rotation cycle so that each State will
participate in PERM once every three years. Following is the list of
States in which we will measure improper payments over the next three
years in Medicaid. We need to collect capitation payment information
from the selected States so that the federal contractor can draw a
sample and review the managed care capitation payments. We will also
collect State managed care contracts, rate schedules and updates to the
contracts and rate schedules. This information will be used by the
Federal contractor when conducting the managed care claims reviews.
Sections 1902(a)(6) and 2107(b)(1) of the Social Security Act grants
CMS authority to collect information from the States. The IPIA requires
us to produce national error rates in Medicaid and CHIP fee-for-
service, including the managed care component. The State-specific
Medicaid managed care and CHIP managed care error rates will be based
on reviews of managed care capitation payments in each program and will
be used to produce national Medicaid managed care and CHIP managed care
error rates. Form Number: CMS-10178 (OMB control number: 0938-0994);
Frequency: Occasionally; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 34; Total Annual
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Responses: 28,050; Total Annual Hours: 28,050. (For policy questions
regarding this collection contact Bridgett Rider at 410-786-2602.)
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Eligibility Error
Rate Measurement in Medicaid and the Children's Health Insurance
Program; Use: The Improper Payments Information Act (IPIA) of 2002
requires CMS to produce national error rates for Medicaid and the
Children's Health Insurance Program (CHIP). To comply with the IPIA,
CMS will use a national contracting strategy to produce error rates for
Medicaid and CHIP fee-for-service and managed care improper payments.
The federal contractor will review States on a rotational basis so that
each State will be measured for improper payments, in each program,
once and only once every three years. Subsequent to the first
publication, we determined that we will measure Medicaid and CHIP in
the same State. Therefore, States will measure Medicaid and CHIP
eligibility in the same year measured for fee-for-service and managed
care. We believe this approach will advantage States through economies
of scale (e.g. administrative ease and shared staffing for both
programs reviews). We also determined that interim case completion
timeframes and reporting are critical to the integrity of the reviews
and to keep the reviews on schedule to produce a timely error rate.
Lastly, the sample sizes were increased slightly in order to produce an
equal sample size per strata each month. Periodically, CMS will conduct
Federal re-reviews of States' PERM files to ensure the accuracy of
States' review findings and the validity of the review process. CMS
will select a random subsample of Medicaid and CHIP cases from the
sample selection lists provided by each State. States will submit all
pertinent information related to the review of each sampled case that
is selected by CMS. Form Number: CMS-10184 (OMB control number: 0938-
1012); Frequency: Annually, Quarterly Affected Public: State, Local, or
Tribal Governments; Number of Respondents: 34; Total Annual Responses:
1,583; Total Annual Hours: 946,164. (For policy questions regarding
this collection contact Bridgett Rider at 410-786-2602.)
Dated: April 5, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2016-08106 Filed 4-7-16; 8:45 am]
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