[Federal Register Volume 70, Number 165 (Friday, August 26, 2005)]
[Notices]
[Pages 50357-50358]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-17100]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10166]
Agency Information Collection Activities: Submission for OMB
Review; 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), Department of Health and Human Services, 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 function; (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: New Collection; Title of
Information Collection: Payment Error Rate Measurement in Medicaid and
State Children's Health Insurance Program (SCHIP); Form No.: CMS-10166
(OMB 0938-NEW); Use: The information collected will be used
by CMS for, among other purposes, estimating improper payments in
Medicaid and SCHIP as required by the Improper Payments Information Act
(IPIA) of 2002. To implement the IPIA in Medicaid and SCHIP, CMS will
use a national contracting strategy to produce Medicaid and SCHIP error
rates. CMS plans to adopt this approach based on a recommendation that
CMS hire a Federal contractor to perform payment error rate
measurement. This recommendation was made during public comment on the
proposed rule entitled ``Medicaid Program and State Children's Health
Insurance Program (SCHIP): Payment Error Rate Measurement'' which
published on August 27, 2004 (69 FR 52620), that contained provisions
for all states to produce error rates in Medicaid and SCHIP.
The new error measurement methodology will rely on a Federal
contractor to conduct medical and data processing reviews using
generally the same methodologies developed during the past pilot
projects and produce State-specific and national Medicaid and SCHIP
error rates based on reviews conducted each Federal fiscal year (FY).
We expect to begin measuring improper payments made in Medicaid fee-
for-service in FY 2006. We have not yet determined the best method to
measure improper payments made in Medicaid and SCHIP managed care.
However, under the national contracting strategy, we expect the Federal
contractor will implement these reviews and States will submit the same
information listed below except for medical policies. (Managed care
claims are not subject to medical reviews so there is no burden to
providers to submit medical records.) Similarly, we are considering the
best approach to measure improper payments based on eligibility errors
within the confines of current law and with minimal budgetary impact.
It is possible that States will be required to conduct at least part of
the eligibility tests. However, this notice is not intended to address
the cost or burden estimates associated with either the managed care or
eligibility reviews in Medicaid or SCHIP.
Initially, based on States' annual medical expenditures from the
previous year, the Federal contractor will group all States into three
equal strata of small, medium and large and select a random sample of
an estimated 18 States to be reviewed for each program. (However, CMS
may revise its sampling methodology in the future and may use a
methodology to select States that will ensure each State is selected at
least every three years but that no State is sampled more than once
every three years. The error rates produced by this selection
methodology will provide the State with a State-specific error rate
estimated to be within 3% precision at the 95% confidence level. ) The
States selected for review would submit to the Federal contractor,
annual expenditures, quarterly stratified claims data, medical policies
(which include State statutes, regulations, individual Medicaid
Provider Manual and Administrative Directives as well as other
information that the contractor may need to determine errors in the
medical reviews), and other information so that the contractor can
determine the specific State sample sizes and conduct medical and data
processing reviews on the sampled claims. In addition, the contractor
will request medical records from providers whose claims were sampled;
the medical records are needed to support the medical reviews. CMS is
not requiring States and providers to use a specific form, e.g.,
facsimile, or electronic to transmit the information. Based on the
reviews, the contractor will calculate State-specific error rates which
will serve as the basis for calculating national Medicaid and SCHIP
error rates. Each State reviewed also will submit a corrective action
plan to CMS that outlines its plans to develop, implement and monitor
corrective actions designed to address error causes for purposes of
reducing the State's error rate. Frequency: Reporting--On occasion and
quarterly; Affected Public: State, Local or Tribal Government; Number
of Respondents: 36; Total Annual Responses: 5076; Total Annual Hours:
58,680.
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/regulations/pra/, or E-mail 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.
Written comments and recommendations for the proposed information
collections must be mailed within 30 days of this notice directly to
the OMB desk officer: OMB Human Resources and Housing Branch,
Attention: Katherine Astrich, New Executive Office Building, Room
10235, Washington, DC 20503.
[[Page 50358]]
Dated: August 24, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-17100 Filed 8-25-05; 8:45 am]
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