[Federal Register: July 8, 2005 (Volume 70, Number 130)]
[Notices]
[Page 39513]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08jy05-52]
[[Page 39513]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10164, CMS-855, CMS-R-257, and CMS-10064]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
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: New collection; Title of
Information Collection: Electronic Data Interchange (EDI) Enrollment
Form and Medicare EDI Registration Form; Form No.: CMS-10164 (OMB
0938-NEW); Use: Federal law requires that CMS take
precautions to minimize the security risk to Federal information
systems. Accordingly, CMS is requiring that trading partners who wish
to conduct the Electronic Data Interchange (EDI) transactions provide
certain assurances as a condition of receiving access to the Medicare
system for the purpose of conducting EDI exchanges. Health care
providers, clearinghouses, and health plans that wish to access the
Medicare system are required to complete this form. The information
will be used to assure that those entities that access the Medicare
system are aware of applicable provisions and penalties; Frequency:
Recordkeeping and reporting--other (one-time only); Affected Public:
Business or other for-profit, not-for-profit institutions; Number of
Respondents: 1,220,000; Total Annual Responses: 1,220,000; Total Annual
Hours: 400,000.
2. Type of Information Collection Request: New collection; Title of
Information Collection: Medicare Carrier Provider/Supplier Enrollment
Application; Form No.: CMS-855 (OMB 0938-0685); Use: This
application is currently required of all health care providers/
suppliers who wish to enroll in the Medicare program. It is submitted
at the time the applicant first requests a Medicare billing number. The
application is used by Medicare contractors to collect data to assure
the applicant has the necessary professional and/or business
credentials to provide the health care services for which they intend
to bill Medicare, including information that allows the Medicare
contractor to correctly price, process and pay the applicant's claims.
It also gathers information that allows Medicare contractors to ensure
that the provider/supplier is not sanctioned from the Medicare program,
or debarred, suspended or excluded from any other Federal agency or
program; Frequency: Reporting--other (upon initial enrollment and
revalidation); Affected Public: Business or other for-profit,
individuals or households, not-for-profit institutions; Number of
Respondents: 604,000; Total Annual Responses: 604,000; Total Annual
Hours: 1,227,000.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Advantage Disenrollment Form to original Medicare; Form No.: CMS-R-257
(OMB 0938-0741); Use: Section 4001 of the Balanced Budget Act
of 1997 amended the Social Security Act to add section 1851, including
1851(c)(1) which required the establishment of a procedure and form to
make and change Medicare Advantage elections, which include
disenrollment. The disenrollment form provides beneficiaries an option
to submit a disenrollment to a neutral third party, process the
disenrollment action as a change of election and to elicit the reasons
for disenrollment in order to discern and report disenrollment rates;
Frequency: On occasion and other (one-time only); Affected Public:
Individuals or households, business or other for-profit, not-for-profit
institutions, and Federal government; Number of Respondents: 50,000;
Total Annual Responses: 50,000; Total Annual Hours: 3,300.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Minimum Data Set
(MDS) for Swing Bed Hospitals and Supporting Regulations in 42 CFR
483.20 and 413.337; Form No.: CMS-10064 (OMB 0938-0872); Use:
As required under section 1888 (e)(7) of the Omnibus Reconciliation Act
of 1987, swing bed hospitals must be reimbursed under the skilled
nursing facility prospective payment system. CMS uses the MDS data to
reimburse swing bed hospitals for SNF-level care furnished to Medicare
beneficiaries. The MDS3.0 is currently being developed with plans for
field testing to begin in 2006 with the expectation of completion in
2007. At that time, CMS will analyze the data derived from the study,
including the implementation of the new version of the MDS for swing
bed hospitals. Since we do not have the MDS3.0 version available, we
are requesting an extension for the current SB-MDS.; Frequency:
Reporting--other (days 5, 14, 30, 60, and 90 of stay); Affected Public:
Not-for-profit institutions, and State, local, and tribal governments;
Number of Respondents: 820; Total Annual Responses: 92,789; Total
Annual Hours: 51,314.
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 to the address
below: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: William N. Parham, III,
PRA Analyst, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: June 30, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 05-13413 Filed 7-7-05; 8:45 am]
BILLING CODE 4120-01-P