[Federal Register: February 7, 2003 (Volume 68, Number 26)]
[Notices]
[Page 6489-6490]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07fe03-80]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifiers: CMS-R-289, CMS-10082, CMS 1763, and CMS-4040 and
4040-SP]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare and Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (HCFA)), 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 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: Revision of a currently
approved collection; Title of Information Collection: Medicare
Lifestyle Modification Program Demonstration and Addendum; Form No.:
CMS-R-289 (OMB 0938-0777); Use: This demonstration focuses on
Medicare sponsored, lifestyle modification programs designed to
reverse, reduce, or ameliorate the progression of cardiovascular
disease (CAD) of Medicare beneficiaries at risk for invasive treatment
procedures. This demonstration tests the feasibility and cost
effectiveness of providing payment for cardiovascular lifestyle
modification program services to Medicare beneficiaries; Frequency: On
occasion, Weekly, Monthly, Quarterly; Affected Public: Individuals or
Households, and Not-for-profit Institutions; Number of Respondents: 44;
Total Annual Responses: 17,996; Total Annual Hours: 2,999.
(2) Type of Information Collection Request: New collection; Title
of Information Collection: Survey of States Performance Measurement
Reporting Capability; Form No.: CMS-10082 (OMB 0938-NEW); Use:
Because of the wide variability of Medicaid and SCHIP financing and
service delivery approaches, there is little common ground from which
to develop uniform reporting on performance measures by states. While
CMS has decided on the first seven measures to be used, the ability of
states to calculate those measures using HEDIS directly or HEDIS
specifications (e.g., when calculating measures from fee-for-service
claims data) is highly variable. Current efforts are focused on
assessing the capability of each state to report on the selected
measures and on helping states to make necessary adjustments in order
to be able to report measures uniformly so that state-to-state
comparisons can be made. To accomplish this, states will be requested
to report available numerator and denominator data for the seven core
HEDIS measures via a survey instrument created for this purpose. The
data will be requested for each state's Medicaid and SCHIP programs by
delivery system; Frequency: Once; Affected Public: State, local, and
tribal government; Number of Respondents: 51; Total Annual Responses:
51; Total Annual Hours: 2,360.
(3) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection: Request
for Termination of Premium+Hospital and/or Supplementary Medical
Insurance; Form No.: CMS-1763 (OMB 0938-0025); Use: The CMS-
1763 is used by beneficiaries to request voluntary termination from
Premium Hospital Insurance (premium-HI) and/or Supplementary Medicare
Insurance (SMI); Frequency: One time only; Affected Public: Individuals
or Households, Federal Government, State, local, and tribal government;
Number of Respondents: 14,000; Total Annual Responses: 14,000; Total
Annual Hours: 5,833.
(4) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection: Request
for Enrollment in Supplemental Medicare Insurance and Supporting
Regulations in 42 CR 407.10 and 401.11; Form No.: CMS-4040 and 4040-SP
(OMB 0938-0245); Use: The CMS 4040 is used to establish
entitlement to Supplemental Medical Insurance (Part B) by beneficiaries
not eligible under Part A of the Title XVIII or Title II of the Social
Security Act. The CMS-4040SP is also included in this renewal;
Frequency: One time only; Affected Public:
[[Page 6490]]
Individuals or Households, Federal Government, State, local, and tribal
government; Number of Respondents: 10,000; Total Annual Responses:
10,000; Total Annual Hours: 2,500.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS's
Web Site address at http://cms.hhs.gov/regulations/pra/default.asp, or
E-mail your request, including your address, phone number, OMB number,
and CMS document identifier, to Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 60 days of this notice directly to the CMS Paperwork Clearance
Officer designated at the following address: CMS, Office of Strategic
Operations and Regulatory Affairs, Division of Regulations Development
and Issuances, Attention: Dawn Willinghan, Room: C5-14-03, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: January 30, 2003.
John P. Burke, III,
CMS Reports Clearance Officer, Office of Strategic Operations and
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-2999 Filed 2-6-03; 8:45 am]
BILLING CODE 4120-03-P