[Federal Register Volume 90, Number 54 (Friday, March 21, 2025)]
[Notices]
[Pages 13368-13370]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-04887]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-40B, CMS-10797, CMS-4040, CMS-R-262 and CMS-
10796]
Agency Information Collection Activities: Submission for OMB
Review; 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 (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 a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate 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 on the collection(s) of information must be received by
the OMB desk officer by April 21, 2025.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to www.reginfo.gov/public/do/
[[Page 13369]]
PRAMain. Find this particular information collection by selecting
``Currently under 30-day Review--Open for Public Comments'' or by using
the search function.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, please access
the CMS PRA website by copying and pasting the following web address
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(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 (44 U.S.C. 3506(c)(2)(A)) requires
Federal agencies to publish a 30-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 that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Application for Enrollment in Medicare Part B (Medical
Insurance); Use: Medicare Part B is a voluntary program, financed from
premium payments by enrollees, together with contributions from funds
appropriated by the Federal Government. The Social Security Act (the
Act) at section 226(a) provides that individuals who are age 65 or
older and eligible for, or entitled to, Social Security or Railroad
Retirement Board (RRB) benefits shall be entitled to premium-free Part
A upon filing an application for such benefits. Section 1836 of the Act
permits individuals with Medicare premium-free Part A to enroll in Part
B.
The CMS-40B provides the necessary information to determine
eligibility and to process the beneficiary's request for enrollment for
Medicare Part B coverage. This form is only used for enrollment by
beneficiaries who already have Part A, but not Part B. Form CMS-40B is
completed by the person with Medicare or occasionally by an SSA
representative using information provided by the Medicare enrollee
during an in-person interview. The form is owned by CMS, but not
completed by CMS staff. SSA processes Medicare enrollments on behalf of
CMS. Form Number: CMS-40B (OMB control number: 0938-1230); Frequency:
Once; Affected Public: Individuals and Households; Number of
Respondents: 1,184,546; Total Annual Responses: 1,184,546; Total Annual
Hours: 292,820. (For policy questions regarding this collection contact
Carla Patterson at 410-786-8911 or [email protected].)
2. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Application for Medicare Part A and Part B Special
Enrollment Period (Exceptional Circumstances); Use: Section 1837(m) of
the Social Security Act (the Act) provides authority for the Secretary
of the Department of Health and Human Services to establish SEPs for
individuals who are eligible to enroll in Medicare and meet such
exceptional conditions as the Secretary may provide.
CMS provides SEPs for individuals experiencing an exceptional
circumstance to enroll in Medicare premium Part A and Part B. To
utilize these SEPs, an individual would have to submit an enrollment
request via the form CMS-10797. The form is used by individuals who
have missed an enrollment period due to an exceptional circumstance to
enroll in Part A and/or Part B. Individuals complete the form and
submit it to SSA to complete the enrollment.
The application form provides the necessary information to
determine eligibility and to process the beneficiary's request for
enrollment in premium Part A or Part B due to an exceptional
circumstance. The form is only used for enrollment by beneficiaries who
could not enroll during another enrollment period due to an exceptional
circumstance. Form Number: CMS-10797 (OMB control number: 0938-1426);
Frequency: Once; Affected Public: Individuals and Households, Business
or other for-profits, Not-for-profits institutions; Number of
Respondents: 34,612; Total Annual Responses: 34,612; Total Annual
Hours: 19,901. (For policy questions regarding this collection contact
Carla Patterson at 410-786-8911 or [email protected].)
3. Type of Information Collection Request: Reinstatement with
changes of a previously approved collection; Title of Information
Collection: Request for Enrollment in Supplementary Medical Insurance
(SMI); Use: Section 1836 of the Social Security Act, and CMS
regulations at 42 CFR 407.10, provide the eligibility requirements for
enrollment in Part B for individuals aged 65 and older who are not
entitled to premium-free Part A. The individual must be a resident of
the United States, and either a U.S. Citizen or an alien lawfully
admitted for permanent residence that has lived in the U.S. continually
for 5 years.
Part B is a voluntary program and is financed from premium payments
by enrollees together with contributions from funds appropriated by the
Federal Government. All individuals age 65 or older who are entitled to
Part A can enroll in Part B. There are some individuals, age 65 and
over who are not entitled to or eligible for premium-free Part A. These
individuals may, however, enroll in Part B only.
The CMS-4040 solicits the information that is used to determine
entitlement for individuals who meet the requirements in section 1836
as well as the entitlement of the applicant or their spouses to an
annuity paid by OPM for premium deduction purposes. The application
follows the application questions and requirements used by SSA. This is
done not only for consistency purposes but to comply with other Title
II and Title XVIII requirements because eligibility to Title II
benefits and free Part A under Title XVIII must be ruled out in order
to qualify for enrollment in Part B only. Form Number: CMS-4040 (OMB
control number: 0938-0245); Frequency: Once; Affected Public:
Individuals and Households, Business or other for-profits, Not-for-
profits institutions; Number of Respondents: 48,642; Total Annual
Responses: 48,642; Total Annual Hours: 12,161. (For policy questions
regarding this collection contact Carla Patterson at 410-786-8911 or
[email protected].)
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: CMS Plan Benefit
Package (PBP) and Formulary CY 2026; 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
[[Page 13370]]
submission consists of the Plan Benefit Package (PBP) software,
formulary file, and supporting documentation, as necessary. MA and PDP
organizations use the PBP software to describe their organization's
plan benefit packages, including information on premiums, cost sharing,
authorization rules, and supplemental benefits. They also generate a
formulary to describe their list of drugs, including information on
prior authorization, step therapy, tiering, and quantity limits.
CMS requires that MA and PDP organizations submit a completed PBP
and formulary 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. CMS uses this data to review and approve the benefit packages
that the plans will offer to Medicare beneficiaries. This allows CMS to
review the benefit packages in a consistent way across all submitted
bids during with incredibly tight timeframes. This data is also used to
populate data on Medicare Plan Finder, which allows beneficiaries to
access and compare Medicare Advantage and Prescription Drug plans. Form
Number: CMS-R-262 (OMB control number: 0938-0763); Frequency: Annually;
Affected Public: Public sector (Individuals and Households), Private
sector (Business or other for-profits and Not-for-profit institutions);
Number of Respondents: 785; Total Annual Responses: 8,337; Total Annual
Hours: 46,026. (For policy questions regarding this collection contact
Kristy Holtje at 410-786-2209 or [email protected].)
5. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Dual Eligible
Special Needs Plan Contract with the State Medicaid Agency; Use:
Special needs plans (SNPs) are Medicare Advantage (MA) plans created by
the Medicare Prescription Drug, Improvement, and Modernization Act of
2003 (Pub. L. 108-173) that are specifically designed to provide
targeted care and limit enrollment to special needs individuals. Under
section 1859(b)(6) of the Act, D-SNPs restrict enrollment to
individuals entitled to medical assistance under a State plan under
title XIX of the Social Security Act (hereinafter referred to as the
Act).
Section 1859(f)(3)(D) of the Act and 42 CFR 422.107 established the
requirement for D-SNPs to have contracts with State Medicaid agencies
in addition to other contracting requirements that that apply to all MA
plans. MA organizations with D-SNPs and States use the information in
the contract to provide benefits, or arrange for the provision of
Medicaid benefits, to which an enrollee is entitled. CMS reviews the D-
SNP contract with the State Medicaid agency to ensure that it meets the
minimum contract requirements at Sec. 422.107(c)&(d). CMS uses the
attestations and matrices in the appendices of this package to identify
the types of D-SNPs an MA organization(s) offers and the location of
the contract requirements in the document. Form Number: CMS-10796 (OMB
control number: 0938-1410); Frequency: Annually; Affected Public:
Public sector (Individuals and Households), Private sector (Business or
other for-profits and Not-for-profit institutions); Number of
Respondents: 886; Total Annual Responses: 893; Total Annual Hours:
17,403. (For policy questions regarding this collection contact Marla
Rothouse at 410-786-8063 or [email protected].)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-04887 Filed 3-20-25; 8:45 am]
BILLING CODE 4120-01-P