[Federal Register: January 28, 2005 (Volume 70, Number 18)]
[Notices]
[Page 4128]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28ja05-81]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1771, CMS-R-71 and CMS-222]
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: Attending
Physicians Statement and Documentation of Medicare Emergency and
Supporting Regulations in 42 CFR, Section 424.103; Use: Payment may be
made for certain part A inpatient hospital services and part B
outpatient provided in a nonparticipating U.S. or foreign hospital when
services are necessary to prevent the death or serious impairment of
the health of the individual. This collection is used to document the
attending physician's statement that the hospitalization was required
due to an emergency and give clinical support for the claim.; Form
Number: CMS-1771 (OMB: 0938-0023); Frequency: On Occasion;
Affected Public: Business or other for-profit; Number of Respondents:
200; Total Annual Responses: 200; Total Annual Hours: 50.
2. Type of Information Collection Request: Extension of a Currently
Approved Collection; Title of Information Collection: Quality
Improvement Organization (QIO) Assumption of Responsibilities and
Supporting Regulations in 42 CFR Sections 412.44, 412.46, 431.630,
476.71, 476.73, 476.74, 476.78; Form No.: CMS-R-71 (OMB 0938-
0445); Use: This collection describes the review functions to be
performed by the QIO. It outlines relationships among QIOs, providers,
practitioners, beneficiaries, intermediaries, and carriers. QIOs assure
that covered care provided to Medicare patients is reasonable,
medically necessary, appropriate, and of a quality that meets
professionally recognized standards of care, and that inpatient
services could not be more appropriately provided on an outpatient
basis or in a different type of facility.; Frequency: As Needed;
Affected Public: Business or other for-profit; Number of Respondents:
6,036; Total Annual Responses: 6,036; Total Annual Hours: 81,818.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Independent Rural
Health Center/Freestanding Federally Qualified Health Center Cost
Report and Supporting Regulations in 42 CFR, Section 413.20 and 413.24;
Form No.: CMS-222 (OMB0938-0107); Use: The independent rural
health clinic/freestanding federally qualified health center cost
report is the cost report to be used by the mentioned clinics/centers
to submit annual information. This information is used to achieve a
settlement of costs for health care services rendered to Medicare
beneficiaries. Frequency: Annually; Affected Public: Not-for-Profit
institutions, Business or other for-profit, and State, local or tribal
government; Number of Respondents: 3,000; Total Annual Responses:
3,000; Total Annual Hours Requested: 150,000.
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 19, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of
Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-1482 Filed 1-27-05; 8:45 am]
BILLING CODE 4120-03-P