[Federal Register: March 11, 2005 (Volume 70, Number 47)]
[Notices]
[Page 12221-12222]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr11mr05-75]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10143, CMS-R-295, CMS-R-79, and CMS-R-10]
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: New collection; Title of
Information Collection: Monthly State File of Medicaid/Medicare Dual
Eligible Enrollees and Supporting Regulations in 42 CFR 423.900 through
423.910; Use: The monthly file of dual eligible enrollees will be used
to determine those duals with drug benefits for the phased-down State
contribution process required by the Medicare Modernization Act of 2003
(MMA). Section 103(a)(2) of the MMA addresses the phased-down State
contribution (PDSC) process for the Medicare program. The reporting of
the Medicare/Medicaid dual eligibles on
[[Page 12222]]
a monthly basis is necessary to implement those provisions, and to
Support Part D subsidy determinations and auto-assignment of
individuals to Part D plans. The PDSC is a partial recoupment from the
States of ongoing Medicaid drug costs for dual eligibles assumed by
Medicare under MMA, which absent the MMA would have been paid for by
the States; Form Number: CMS-10143 (OMB: 0938-NEW); Frequency:
Recordkeeping and Monthly reporting; Affected Public: State, Local or
Tribal Government; Number of Respondents: 51; Total Annual Responses:
612; Total Annual Hours: 10,710.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare CAHPS
Disenrollment Surveys and Supporting Regulations in 42 CFR 417.126,
417.470, 422.64, and 422.210; Use: This survey helps Medicare track a
variety of consumer satisfaction measures relating to Medicare
beneficiaries who leave their MA plans. The Centers for Medicare &
Medicaid Services (CMS) has a responsibility to its Medicare
beneficiaries to require that care provided by managed care
organizations under contract to CMS is of high quality. One way of
ensuring high quality care is through the development of performance
measures and standardized satisfaction surveys that enable CMS to
gather the data needed to evaluate the care provided to Medicare
beneficiaries; Form Number: CMS-R-295 (OMB: 0938-0779);
Frequency: Quarterly; Affected Public: Individuals or Households;
Number of Respondents: 44,200; Total Annual Responses: 41,697; Total
Annual hours: 17,823.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Payment
Adjustment for Sole Community Hospitals and Supporting Regulations in
42 CFR 412.92; Form No.: CMS-R-79 (OMB 0938-0477); Use: This
collection provides that if a hospital that is classified as a sole
community hospital (SCH) experiences, due to circumstances beyond its
control, a decrease of more than 5 percent in its total number of
discharges compared to the immediately preceding cost reporting period,
the hospital may apply for a payment adjustment. To qualify for this
adjustment to its payment rate an SCH must submit documentation,
including cost information as requested by CMS, to the intermediary;
Frequency: On occasion; Affected Public: Not-for-profit institutions,
Business or other for-profit, and State, Local or Tribal Government;
Number of Respondents: 40; Total Annual Responses: 40; Total Annual
Hours: 160.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Information
Collection Requirements Contained in BPD-718: Advance Directives
(Medicare and Medicaid) and Supporting Regulations in 42 CFR 417.436,
417.801, 422.128, 430.12, 431.20, 431.107, 438.6, 440.170, 483.10,
484.10, and 489.102; Form No.: CMS-R-10 (OMB 0938-0610); Use:
Steps have been taken at both the Federal and State level, to afford
greater opportunity for the individual to participate in decisions made
concerning the medical treatment to be received by an adult patient in
the event that the patient is unable to communicate to others, a
preference about medical treatment. The individual may make his
preference known through the use of an advance directive, which is a
written instruction prepared in advance, such as a living will or
durable power of attorney. This information is documented in a
prominent part of the individual's medical record. Advance directives
as described in the Patient Self-Determination Act (enacted in 1991)
have increased the individual's control over decisions concerning
medical treatment. The advance directives requirement was enacted
because Congress wanted individuals to know that they have a right to
make health care decisions and to refuse treatment even when they are
unable to communicate.; Frequency: On occasion; Affected Public:
Business or other for-profit; Number of Respondents: 33,096; Total
Annual Responses: 33,096; Total Annual Hours: 924,120.
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 addressbelow:
CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Melissa Musotto, Room
C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of
Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-4887 Filed 3-10-05; 8:45 am]
BILLING CODE 4120-03-P