[Federal Register: December 30, 2005 (Volume 70, Number 250)]
[Notices]
[Page 77400-77401]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr30de05-61]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10157, CMS-10172, CMS-R-0107 and CMS-R-285]
Agency Information Collection Activities: Submission for OMB
Review; 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), 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 function; (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: CMS Real-time
Eligibility Agreement and Access Request; Form Number: CMS-10157
(OMB: 0938-0960); 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 eligibility transaction on a real-time basis to access
Medicare beneficiary information provide certain assurances as a
condition of receiving access to the Medicare database for the purpose
of conducting eligibility verification. Health care providers,
clearinghouses, and health plans that wish access to the Medicare
database are required to complete this form. The information will be
used to assure that those entities that access the Medicare database
are aware of applicable provisions and penalties; Frequency:
Recordkeeping and Reporting--One time; Affected Public: Business or
other for-profit, Not-for-profit institutions; Number of Respondents:
122,000; Total Annual Responses: 122,000; Total Annual Hours: 45,000.
2. 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
[[Page 77401]]
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.
3. 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.
4. Type of Information Collection Request: Extension of a currently
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 these paperwork collections referenced above, access CMS Web site
address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 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 at (410) 786-1326.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB Desk
Officer at the address below, no later than 5 p.m. on January 30, 2006.
OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, CMS
Desk Officer, New Executive Office Building, Room 10235, Washington, DC
20503.
Dated: December 21, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-24567 Filed 12-29-05; 8:45 am]
BILLING CODE 4120-01-P