[Federal Register: January 25, 2005 (Volume 70, Number 15)]
[Notices]
[Page 3531-3532]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25ja05-30]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-8003, CMS-10060, CMS-287, CMS-R-245, CMS-21/
CMS-21B, CMS-64, and CMS-R-209]
Agency Information Collection Activities: Proposed Collection;
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) 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: Extension of a currently
approved collection; Title of Information Collection: Home and
Community-Based Waiver Requests and Supporting Regulations in 42 CFR
440.180 and 441.300-.310; Use: Under a Secretarial waiver, States may
offer a wide array of home and community-based services to individuals
who would otherwise require institutionalization. States requesting a
waiver must provide certain assurances, documentation and cost &
utilization estimates which are reviewed, approved and maintained for
the purpose of identifying/verifying States' compliance with such
statutory and regulatory requirements; Form Number: CMS-8003
(OMB: 0938-0449); Frequency: Other: When a State requests a
waiver or amendment to a waiver; Affected Public: State, Local or
Tribal Government; Number of Respondents: 50; Total Annual Responses:
132; Total Annual Hours: 7,930.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Quality
Assessment and Performance Improvement (QAPI) Project Completion Report
and Supporting Regulations in 42 CFR 422.152; Use: This project
completion report derives from the Quality Improvement System for
Managed Care (QISMC) Standards and Guidelines as required by the
Balanced Budget Act of 1997 (as amended by Balanced Budget Refinement
Act of 1999) and the related regulations, 42 CFR 422.152. These
regulations established QISMC as a requirement for Medicare+Choice
(M+C) Organizations by requiring improved health outcomes for enrolled
beneficiaries. The provisions of QISMC specify that M+C organizations
will implement and evaluate quality improvement projects. The form
submitted herein will permit M+C organizations to report their
completed projects to CMS in a standardized fashion for evaluation by
CMS of the M+C Organization's compliance with regulatory provisions.
This form will improve consistency and reliability in the CMS
evaluation process, as well as provide a standardized structure for
public use and review; Form Number: CMS-10060 (OMB: 0938-
0873); Frequency: Annually; Affected Public: Business or other for-
profit and Not-for-profit institutions; Number of Respondents: 155;
Total Annual Responses: 155; Total Annual Hours: 620.
3. Type of Information Request: Revision of a currently approved
collection; Title of Information Collection: Home Office Cost Statement
and Supporting Regulations in 42 CFR 413.17 and 413.20; Use: Home
Office Cost Statement, is filed annually by Chain Home Offices to
report the information necessary for the determination of Medicare
reimbursement to components of chain organizations. Many providers of
service participating in Medicare are reimbursed, at least partially,
on the basis of the lesser of reasonable cost or customary services for
services furnished to eligible beneficiaries. When providers obtain
services, supplies or facilities from an organization related to the
provider by common ownership or control, 42 CFR 413.17 requires that
the provider include in its costs, the costs incurred by the related
organization in furnishing such services, supplies or facilities.
Revisions to this form include the addition of columns for more
detailed reporting and the elimination of other columns that were
deemed unnecessary; Form Number: CMB-287 (OMB 0938-0202);
Frequency: Annually; Affected Public: Not-for-profit institutions and
Business or other for-profit; Number of Respondents: 1,231; Total
Annual Responses: 1,231; Total Annual Hours: 573,646.
4. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Medicare and Medicaid
Programs; OASIS Collection Requirements as Part of the COPs for HHAs
and Supporting Regulations in 42 CFR, Sections 484.55, 484.205,
484.245, and 484.250; Use: This collection requires HHAs to use a
standard core assessment data set, the OASIS, to collect information
and to evaluate adult non-maternity patients. In addition, data from
the OASIS will be used for purposes of case-mix adjusting patients
under home health PPS, and will facilitate the production of necessary
case-mix information at relevant time intervals in the patient's home
health stay. Modifications were previously made to the OASIS forms to
allow for the preservation of masking of personally identifiable
information for the non-Medicare/non-Medicaid individuals; Form Number:
CMS-R-245 (OMB 0938-0760); Frequency: Other: Upon patient
assessment; Affected Public: Business or other for-profit, Not-for-
profit institutions, Federal Government, and State, Local or Tribal
Gov.; Number of Respondents: 7,582; Total Annual Responses: 10,156,569;
Total Annual Hours: 8,556,995.
5. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Quarterly Children's
Health Insurance Program (CHIP) Statement of Expenditures for Title
XXI; Use: States use forms CMS-21 and CMS-21B to report budget,
expenditure, and related statistical information required for
[[Page 3532]]
implementation of the Children's Health Insurance Program. The
information provided by these forms is used by CMS to prepare the grant
awards to States for the Medicaid and CHIP programs, to ensure that the
appropriate level of Federal payments for State expenditures under the
Medicaid program and CHIP are made in accordance with the CHIP related
Balanced Budget Act legislation provisions, and to track, monitor, and
evaluate the numbers of related children being served by the Medicaid
and CHIP programs; Form Number: CMS-21 and CMS-21B (OMB 0938-
0731); Frequency: Quarterly; Affected Public: State, Local or Tribal
Gov.; Number of Respondents: 56; Total Annual Responses: 448; Total
Annual Hours: 7,840.
6. Type of Information Request: Revision of a currently approved
collection; Title of Information Collection: Quarterly Medicaid
Statement of Expenditures for the Medical Assistance Program; Use: The
State Medicaid agencies use the form CMS-64 for the Medical Assistance
Program to report their actual program benefit costs and administrative
expenses to CMS. CMS uses this information to compute the Federal
financial participation for the State's Medicaid Program costs. The
structure of the current from CMS-64 has evolved from the previous
forms used for reporting and has been revised. Classification,
identification, and referencing used in the CMS-64 forms has been in
place for several years, is readily understood and accepted by the
report users, and is supported by strong sentiments in both CMS and the
States to maintain the existing format. Therefore, our modifications
have been made to maintain the current reporting format by
incorporating all changes into the existing report structure; Form
Number: CMS-64 (OMB 0938-0067); Frequency: Quarterly; Affected
Public: State, Local or Tribal Gov.; Number of Respondents: 56; Total
Annual Responses: 224; Total Annual Hours: 16,464.
7. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare and
Medicaid Programs; Use and Reporting OASIS Data as Part of the CoPs for
HHAs and Supporting Regulations in 42 CFR 484.11 and 484.20; Form No.:
CMS-R-209 (OMB 0938-0761); Use: HHAs are required to report
data from the OASIS as a condition of participation. Specifically, the
above named regulation sections provide guidelines for HHAs for the
electronic transmission of the OASIS data as well as responsibilities
of the State agency or OASIS contractor in collecting and transmitting
this information to CMS. These requirements are necessary to achieve
broad-based, measurable improvement, in the quality of care furnished
through Federal programs, and to establish a prospective payment system
for HHAs; Frequency: Monthly; Affected Public: Business or other-for-
profit, Federal Government, State, Local or Tribal Government, Not-for-
profit institutions; Number of Respondents: 7,582; Total Annual
Responses: 93,621; Total Annual Hours: 921,271.
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 Paperwork@cms.hhs.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 Reduction Act Reports Clearance Officer designated at
the address below: CMS, Office of Strategic Operations and Regulatory
Affairs, Division of Regulations Development, Attention: Melissa
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Dated: January 13, 2005.
Dawn Willinghan,
Acting, CMS Paperwork Reduction Act Reports Clearance Officer, Office
of Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-1320 Filed 1-24-05; 8:45 am]
BILLING CODE 4120-03-M