[Federal Register: October 21, 2005 (Volume 70, Number 203)]
[Notices]
[Page 61291-61292]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21oc05-91]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10172, CMS-R-0107 and CMS-R-285]
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: Medicare Health Support Program Medical Records
Abstraction; Form Number: CMS-10172 (OMB: 0938-New); Use: The
Medicare Health Support Program (MHS) is authorized under Section 721
of the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (MMA). There are eight Medicare Health Support Organizations
(MHSOs) that have signed cooperative agreements with the Centers for
Medicare & Medicaid Services (CMS) to provide care support services to
targeted Medicare fee-for-service (FFS) beneficiaries. The purposes of
the MHS program are to improve the quality of healthcare provided to
Medicare FFS beneficiaries with congestive heart failure and/or
diabetes and to reduce the healthcare treatment cost to Medicare. MHS
performance measures provide CMS with information to monitor the
program operations and identify positive or negative program effects,
provide MHSOs with feedback, and serve as the basis for MHS performance
guarantees. To meet these requirements, CMS has developed a performance
monitoring system for MHS. This system includes measures of clinical
performance that require the collection of clinical data from the
medical records of a sample of Medicare beneficiaries. Medical record
abstraction will be performed in two phases: the first, a pilot test,
will take place after approximately six months of program operations,
and the second, the full study. CMS will obtain active informed consent
from the affected beneficiaries prior to reviewing medical records;
Frequency: Reporting--Other: Only Once; Affected Public: Individuals or
Households and Business or other for-profit; Number of Respondents:
26,643; Total Annual Responses: 26,643; Total Annual Hours: 12,416.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare--
Determining Third Party Liability (TPL) State Plan Preprint and
Supporting Regulations in 42 CFR 433.138; Form Number: CMS-R-0107
(OMB: 0938-0502); Use: Medicaid beneficiaries frequently have
third party resources which are legally obligated to pay medical claims
before Medicaid pays. Section 42 CFR 433.138 requires State Medicaid
agencies to take specific steps to identify third party resources and
determine their legal liability to pay for services under the plan. The
collection of TPL information results in significant program savings to
the extent that liable third parties can be identified and payments can
be made for services that would otherwise be paid for by the Medicaid
program. The State Medicaid agencies are the primary users of the
collected data. Whenever States identify third party resources,
pertinent information is entered into the State's Medicaid Management
Information System (MMIS). This enables the State to advise the
provider to bill the third party and to seek reimbursement in
situations where Medicaid TPL claims have been paid; Frequency:
Recordkeeping--On occasion; Affected Public: Individuals or Households
and Federal, State, Local and Tribal Government; Number of Respondents:
2,700,000; Total Annual Responses: 2,700,000; Total Annual Hours:
472,259.
3. Type of Information Collection Request: Extension of a currently
[[Page 61292]]
approved collection; Title of Information Collection: Request for
Retirement Benefit Information (BBA `97); Form Number: CMS-R-285
(OMB: 0938-0769); Use: The Request for Retirement Benefit
Information form is used to obtain retirement benefit information from
beneficiaries that purchase Medicare Part A coverage. The Social
Security Administration (SSA) will use this information to determine if
a beneficiary meets the requirements to qualify for a Medicare Part A
premium reduction.; Frequency: Reporting--On occasion; Affected Public:
State, Local or Tribal Government; Number of Respondents: 1500; Total
Annual Responses: 1500; Total Annual Hours: 375.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'l
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.
To be assured consideration, comments and recommendations for the
proposed information collections must be received at the address below,
no later than 5 p.m. on December 20, 2005. CMS, Office of Strategic
Operations and Regulatory Affairs, Division of Regulations Development,
Attention: Bonnie L Harkless, Room C4-26-05, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: October 13, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-20962 Filed 10-20-05; 8:45 am]
BILLING CODE 4120-01-P