[Federal Register: April 29, 2005 (Volume 70, Number 82)]
[Notices]
[Page 22315-22316]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29ap05-45]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10123 & 10124, CMS-21/21B, CMS-64, CMS-R-43,
CMS-R-209, and CMS-R-245]
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: New Collection; Title of
Information Collection: Expedited Review notices and Supporting
Regulations contained in 42 CFR 405.1200 and 405.1202; Use: These
notices are used to inform beneficiaries that their provider services
will end, and to provide beneficiaries who request an expedited
determination with detailed information of why the services should end.
This application requests approval of an information collection
associated with CMS-4004-FC, [Medicare Program: Expedited Determination
Procedures for Provider
[[Page 22316]]
Service Terminations.] The rule provides for an expedited appeal when a
Medicare beneficiary receives notice from a provider of services that
his or her Medicare covered services will be terminated. The rule
allows beneficiaries to request an expedited determination by a Quality
Improvement Organization on whether such services should continue.
Providers affected by the rule include home health agencies,
comprehensive outpatient rehabilitation facilities, and hospices; Form
Numbers: CMS-10123 & 10124 (OMB 0938-NEW); Frequency: On
occasion; Affected Public: Individuals or Households, Business or other
for-profit, and Not-for-profit institutions; Number of Respondents:
4,200,000; Total Annual Responses: 4,200,000; Total Annual Hours:
379,400.
2. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Quarterly Children's
Health Insurance Program (CHIP) Statement of Expenditures for Title
XXI; Use: States use forms CMS-21 and CMS-21B to report budget,
expenditure, and related statistical information required for
implementation of the Children's Health Insurance Program. The
information provided by these forms is used by CMS to prepare the grant
awards to States for the Medicaid and CHIP programs, to ensure that the
appropriate level of Federal payments for State expenditures under the
Medicaid program and CHIP are made in accordance with the CHIP related
Balanced Budget Act legislation provisions, and to track, monitor, and
evaluate the numbers of related children being served by the Medicaid
and CHIP programs; Form Number: CMS-21 and CMS-21B (OMB 0938-
0731); Frequency: Quarterly; Affected Public: State, local or tribal
government; Number of Respondents: 56; Total Annual Responses: 448;
Total Annual Hours: 7,840.
3. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Quarterly Medicaid
Statement of Expenditures for the Medical Assistance Program; Use: The
State Medicaid agencies use the form CMS-64 for the Medical Assistance
Program to report their actual program benefit costs and administrative
expenses to CMS. CMS uses this information to compute the Federal
financial participation for the State's Medicaid Program costs; Form
Number: CMS-64 (OMB 0938-0067); Frequency: Quarterly; Affected
Public: State, Local or Tribal Government; Number of Respondents: 56;
Total Annual Responses: 224; Total Annual Hours: 18,144.
4. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Conditions of
Participation for X-ray Suppliers and Supporting Regulations in 42 CFR
486.104, 486.106, and 486.110; Use: The information is required to
certify portable X-ray suppliers wishing to participate in the Medicare
program. The information collection is needed to determine if portable
X-ray suppliers are in compliance with published health and safety
requirements. This is standard medical practice and is necessary in
order to ensure the well-being and safety of patients and professional
treatment accountability; Form Number: CMS-R-43 (OMB 0938-
0338); Frequency: Recordkeeping; Affected Public: Business or other
for-profit, Not-for-profit institutions; Number of Respondents: 602;
Total Annual Responses: 602; Total Annual Hours: 1,505.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare and
Medicaid: Use and Reporting OASIS Data as Part of the Conditions of
Participation (CoPs) for Home Health Agencies (HHAs) and Supporting
Regulations in 42 CFR 484.11 and 484.20; Use: HHAs are required to
report data from the OASIS as a condition of participation.
Specifically, the above named regulation sections provide guidelines
for HHAs for the electronic transmission of the OASIS data as well as
responsibilities of the State agency or OASIS contractor in collecting
and transmitting this information to CMS. These requirements are
necessary to achieve broad-based, measurable improvement, in the
quality of care furnished through Federal programs, and to establish a
prospective payment system for HHAs; Form Numbers: CMS-R-209
(OMB 0938-0761); Frequency: Monthly; Affected Public: Business
or other for-profit, Not-for-profit institutions, Federal Government,
and State, Local or Tribal Government; Number of Respondents: 7,582;
Total Annual Responses: 93,621; Total Annual Hours: 921,271.
6. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare and
Medicaid Programs OASIS Collection Requirements as Part of the
Conditions of Participation for Home Health Agencies (HHAs) and
Supporting Regulations in 42 CFR 484.55, 484.205, 484.245, 484.250;
Use: Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare and
Medicaid Programs OASIS Collection Requirements as Part of the
Conditions of Participation for Home Health Agencies (HHAs) and
Supporting Regulations in 42 CFR 484.55, 484.205, 484.245, 484.250;
Use: This collection requires HHAs to use a standard core assessment
data set, the OASIS, to collect information and to evaluate adult non-
maternity patients. In addition, data from the OASIS will be used for
purposes of case-mix adjusting patients under home health PPS, and will
facilitate the production of necessary case-mix information at relevant
time intervals in the patient's home health stay. Modifications were
previously made to the OASIS forms to allow for the preservation of
masking of personally identifiable information for the non-Medicare/
non-Medicaid individuals.; Form Numbers: CMS-R-245 (OMB 0938-
0760); Frequency: Other `` Upon patient assessment; Affected Public:
Business or other for-profit, Not-for-profit institutions, Federal
Government, and State, Local or Tribal Government; Number of
Respondents: 7,582; Total Annual Responses: 10,156,569; Total Annual
Hours: 8,556,995.
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 30 days of this notice directly to
the OMB desk officer: OMB Human Resources and Housing Branch,
Attention: Christopher Martin, New Executive Office Building, Room
10235,Washington, DC 20503.
Dated: April 22, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 05-8712 Filed 4-28-05; 8:45 am]
BILLING CODE 4120-01-P