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PRA Listing

Information collections available for public comment.


CMS Form Number Date Subject
CMS-10407 2014-11-24 Summary of Benefits and Coverage Uniform Glossary
CMS-R-305 2014-12-19 External Quality Review of Medicaid MCOs and Supporting Regulations
CMS-10260 2014-01-29 Medicare Advantage and Prescription Drug Program: Marketing Provisions
CMS-10320 2014-02-03 Health Care Reform Insurance Web Portal Requirements
CMS-367 2014-04-11 Medicaid Drug Program Monthly and Quarterly Drug Reporting Format
CMS-10239 2013-12-20 Critical Access Hospitals Conditions of Participation and Supporting Regulations
CMS-10221 2015-01-16 Site Investigation for Independent Diagnostic Testing Facilities (IDTFs)
CMS-10328 2014-05-02 Medicare Self-Referral Disclosure Protocol
CMS-R-185 2014-07-18 Granting and Withdrawal of Deeming Authority to Private Nonprofit Accreditation Organizations and of State Exemption Under State Laboratory Programs and Supporting Regulations
CMS-1880 and CMS-1882 2014-11-17 Certification as a Supplier of Portable X-Ray and Portable X-Ray Survey Report Form and Supporting Regulations
CMS-18F5 2014-02-14 Application for Hospital Insurance and Supporting Regulations
CMS-R-297 2014-01-02 Request for Employment Information
CMS-R-263 2015-01-16 Site Investigation for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
CMS-R-153 2014-03-17 Medicaid Drug Use Review Program
CMS-10054 2014-04-30 Recognition of Payment for New Technology Services for New Technology Ambulatory Payment Classification (APC) Groups Under the Outpatient Prospective Payment System and Supporting Regulations in 42 CFR Part 419
CMS-1856 and CMS-1893 2014-06-09 Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services, and Outpatient Physical Therapy — Speech Pathology Survey Report
CMS-10237 2014-10-03 Part C—Medicare Advantage and 1876 Cost Plan Expansion Application
CMS-10346 2014-02-28 Appeals of Quality Bonus Payment Determinations
CMS-10224 2014-03-25 Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification Request Process
CMS-10209 2014-04-02 Medicare Advantage Chronic Care Improvement Program and Quality Improvement Project Reporting Tools
CMS-10291 2014-11-21 State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Web site and Hotline
CMS-10396 2014-04-11 Medication Therapy Management Program Improvements
CMS-10203 2014-05-16 Medicare Health Outcomes Survey (HOS)
CMS-10416 2014-03-07 Blueprint for Approval of Affordable State-based and State Partnership Insurance ExchangesBlueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges
CMS-10249 2015-01-09 Administrative Requirements for Section 6071 of the Deficit Reduction Act
CMS-R-235 2014-06-27 Data Use Agreement
CMS-10252 2014-06-13 Data Use Agreement Certificate of Disposition
CMS-10380 2014-06-02 Cycle I, II, and III - “Grants to Support States in Health Insurance Rate Review and Pricing Transparency” Reporting
CMS-209 2014-11-28 Laboratory Personnel Report (CLIA) and Supporting Regulations
CMS-R-246 2014-12-12 Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
CMS-10418 2014-03-21 Annual Medical Loss Ratio (MLR) and Rebate Calculation Report and MLR Rebate Notices
CMS-64 2014-04-11 Medicaid Program Budget Report
CMS-21B 2014-04-25 Quarterly Children’s Health Insurance Program (CHIP) Statement of Expenditures for the Title XXI Program) and CMS–21B (State Children’s Health Insurance Program Budget Report for the Title XXI Program State Plan Expenditures)
CMS-37 2014-04-11 Medicaid Program Budget Report
CMS-10398 2014-10-20 Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions
CMS-R-148 2014-06-20 Limitations on Provider Related Donations and Health Care Related Taxes; Limitation on Payment to Disproportionate Share Hospitals
CMS-R-308 2014-01-23 State Children's Health Insurance Program and Supporting Regulations
CMS-R-268 2014-06-13 MS Interactive Survey Tool
CMS-21 2014-04-25 Quarterly Children’s Health Insurance Program (CHIP) Statement of Expenditures for the Title XXI Program) and CMS–21B (State Children’s Health Insurance Program Budget Report for the Title XXI Program State Plan Expenditures)
CMS-R-21 2014-06-20 Withholding Medicare Payments to Recover Medicaid Overpayments and Supporting Regulations in 42 CFR 447.31
CMS-437 2014-04-04 Supporting Statement for State Survey Agency Work Sheets for Verifying Exclusions from the Prospective Payment System And Supporting Regulations
CMS-724 2013-12-27 Medicare/Medicaid Psychiatric Hospital Survey Data
CMS-R-216 2014-01-17 Procedures for Advisory Opinions Concerning Physicians’ Referrals and Supporting Regulations
CMS-372(S) 2015-01-16 Annual Report on Home and Community Based Services Waivers
CMS–10422 2014-11-17 Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410
CMS-10436 2013-04-26 Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration
CMS-10433 2014-07-30 Establishment of Qualified Health Plans and American Health Benefit Exchanges
CMS-10419 2014-10-31 Transparency Reports and Reporting of Physician Ownership or Investment Interests (CMS-1612-F; RIN 0938-AS12)
CMS-10401 2014-05-16 Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment
CMS-10459 2014-08-22 Coverage of Certain Preventive Services Under the Affordable Care Act
CMS-10463 2014-04-11 Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Exchanges
CMS-10371 2014-11-07 Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges
CMS-R-245 2014-11-24 Medicare and Medicaid Programs OASIS Collection Requirements as Part of the CoPs for HHAs and Supporting Regulations
CMS-10488 2014-08-05 Health Insurance Marketplace Consumer Experience Surveys: Enrollee Satisfaction Survey and Marketplace Survey Data Collection
CMS–10490 2013-10-24 Program Integrity and Additional State Information Collections
CMS-10485 2014-01-29 Evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration: Provider Survey
CMS-10495 2014-05-05 Registration, Attestation, Dispute & Resolution, Assumptions Document and Data Retention Requirements for Open Payments
CMS–10492 2014-09-29 Data Submission for the Federally-facilitated Exchange User Fee Adjustment
CMS-10500 2015-01-16 Outpatient/Ambulatory Surgery Patient Experience of Care Survey (O/ASPECS)
CMS-40B 2014-01-02 Application for Enrollment in Medicare the Medical Insurance Program
CMS-L-564 2014-01-02 Request for Employment Information
CMS-10502 2014-03-10 LTCH Quality Reporting Program: Program Evaluation
CMS-10503 2014-03-10 Inpatient Rehabilitation Facilities (IRF) Quality Reporting Program
CMS-10504 2014-03-10 Hospice Quality Reporting Program: Program Evaluation
CMS-10509 2014-04-18 Prospective Evaluation of Evidence-Based Community Wellness and Prevention Programs
CMS-10512 2014-02-07 Direct Service Workforce Resource Center CC Survey Instrument
CMS-10120 2014-02-14 1932(a) State Plan Amendment Template, State Plan Requirements, and Supporting Regulations
CMS-10510 2014-06-27 Basic Health Program Report for Health Insurance Exchange Premium
CMS-10225 2014-03-10 Disclosures Required of Certain Hospitals and Critical Access Hospitals Regarding Physician Ownership
CMS-10277 2014-06-02 Hospice Conditions of Participation and Supporting Regulations
CMS-102 & 105 2014-01-29 CLIA Budget Workload Reports and Supporting Regulations
CMS-10515 2014-01-31 Payment Collections Operations Contingency Plan
CMS-10462 2014-03-25 Community First Choice Option Evaluation
CMS-R-53 2014-02-14 Imposition of Cost Sharing Charges Under Medicaid and Supporting Regulations
CMS-10518 2014-06-02 Application for Participation in the Intravenous Immune Globulin (IVIG) Demonstration
CMS-10519 2014-03-17 Physician Quality Reporting System and the Electronic Prescribing Incentive Program Data Assessment, Accuracy and Improper Payments Identification Support
CMS-10520 2014-03-21 Marketplace Quality Standards
CMS-370 and CMS-377 2014-04-02 CMS-370 -- Health Insurance Benefits Agreement and CMS-377 -- Ambulatory Surgical Center (ASC) Request for Certification or Update of Certification Information
CMS-10332 2014-06-13 Disclosure for the In-Office Ancillary Services Exception
CMS-10521 2014-07-25 Improving Quality of Care in Medicaid and CHIP through Increased Access to Preventive Services, State Survey
CMS-304 and CMS-304A 2014-05-02 Reconciliation of State Invoice and Prior Quarter Adjustment Statement
CMS-368/R-144 2014-05-02 Medicaid Drug Rebate Program Forms
CMS-718-721 2014-05-16 Business Proposal Forms for Quality Improvement Organizations (QIO)
CMS-10525 2014-05-23 Health Plan Monitoring System Level I and Level II Data Entry for the Program of All-Inclusive Care for the Elderly
CMS-10527 2014-09-02 Annual Eligibility Redetermination, Product Discontinuance and Renewal Notices
CMS-10526 2014-12-09 Cost Sharing Reduction Reconciliation
CMS-10535 2014-12-05 Employer Notification to HHS of its Objection to Providing Coverage for Contraceptive Services
CMS-10529 2014-10-20 Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP
CMS-10536 2014-12-19 Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template
CMS-10532 2015-01-05 Risk Corridors Transitional Policy
CMS-10537 2014-08-29 National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey)
CMS-10522 2014-07-11 Executive Summary Form for Research Identifiable Data
CMS-10538 2014-10-03 Prior Authorization Form for Beneficiaries Enrolled in Hospice
CMS-10530 2014-11-17 Ambulatory Surgical Center Quality Reporting (ASCQR) Program
CMS-10540 2014-11-26 Quality Improvement Strategy Plan Template and Quality Improvement Strategy Reporting Template
CMS-10448 2014-11-26 Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection
CMS-10541 2014-11-26 Summary of Benefits and Coverage Plan Variations
CMS-10542 2014-11-28 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey Mode Experiment
CMS-10543 2014-11-28 Emergency Department Patient Experience of Care (EDPEC) Survey Mode Experiment
CMS-10341 2014-12-12 Affordable Care Act Information and Collection Requirements for Section 1115 Demonstration Projects
CMS-10241 2014-12-19 Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings
CMS-224-14 2014-12-19 Federally Qualified Health Center Cost Report Form
CMS-10545 2015-01-09 Outcome and Assessment Information Set OASIS-C1/ICD-10
CMS-10549 2015-01-30 Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS)