[Federal Register: December 15, 2008 (Volume 73, Number 241)]
[Notices]
[Page 76032-76034]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15de08-52]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10272, CMS-R-254, CMS-29/30, CMS-372, CMS-
10001, CMS-10009, CMS-10242 and CMS-R-52]
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: Hospital Leadership Quality Assessment Tool
(HLQAT); Use: In 2006, the Hospital Leadership Collaborative (HLC)
launched a public-private partnership to develop a CMS-endorsed self-
assessment tool, ``The Hospital Leadership and Quality Assessment
Tool'' (HLQAT) to assist hospitals in the improvement of quality
through enhanced hospital governance, executive, physician, and
clinical engagement. Hospitals leaders will take the HLQAT instrument
via Web-based technology. This function will be carried out in
conjunction with CMS and the Quality Improvement Organization (QIO) 9th
Scope of Work (SOW), to convey the importance of this effort in
relation to Medicare and other public priorities. This administration
of the HLQAT seeks responses from approximately a dozen leaders in each
hospital, including physicians (e.g., CEO, CMO), board members,
director-level, and mid-level clinical managers--these responses can
provide a multi-level representation of hospital leadership showing its
commitment to institutional change. Form Number: CMS-10272
(OMB 0938-New); Frequency: Occasionally; Affected Public:
Private Sector--Business or Other for-profits; Number of Respondents:
18,000; Total Annual Responses: 36,000; Total Annual Hours: 44,820.
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: National Medicare
& You Education Program (NMEP) Survey of Medicare Beneficiaries Use:
The Centers for Medicare and Medicaid Services is requesting a revision
of this information collection request to continue to collect
information from Medicare beneficiaries, caregivers, health care
providers, and health information providers. It is critical for this
agency to obtain feedback from the aforementioned groups so that the
agency can accurately assess the needs of the Medicare audience. Using
random digit dial and/or an administrative sample, members of the
Medicare audience will be called and asked to complete the survey via
telephone. The results of this survey will be compiled and studied so
that communication may be amended to benefit Medicare's audience. The
survey has the following objectives: To assess satisfaction with and
knowledge of the Medicare program; to gather information on health
behaviors and quality of health care; to determine the most used source
for Medicare information; and to gather information from health care
provider and health information providers. Form Number: CMS-R-254
(OMB 0938-0738); Frequency: Once; Affected Public: Individuals
and Households, Private Sector--Business or other for-profits; Number
of Respondents: 7,000; Total Annual Responses: 7,000; Total Annual
Hours: 1,750.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Request for
Certification as Rural Health Clinic (RHC) and RHC Survey Report Form
and Supporting Regulations in 42 CFR 491.1-491.11; Use: The CMS-29 is
utilized as an application to be completed by suppliers of RHC services
requesting participation in the
[[Page 76033]]
Medicare/Medicaid programs. This form initiates the process of
obtaining a decision as to whether the conditions for certification are
met as a supplier of RHC services. It also promotes data reduction or
introduction to and retrieval from the Automated Survey Process
Environment (ASPEN) and related survey and certification databases by
the CMS Regional Offices. Form Number: CMS-29/30 (OMB 0938-
0074); Frequency: Yearly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 766; Total Annual Responses: 766;
Total Annual Hours: 192.
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Annual Report on
Home and Community Based Services Waivers and Supporting Regulations in
42 CFR 440.180 and 441.300-310.; Use: States within an approved waiver
under section 1915(c) of the act are required to submit a report
annually in order for CMS to: (1) Verify that State assurances
regarding waiver cost-neutrality are met; and, (2) Determine the
waiver's impact on the type, amount, and cost of services provided
under the State Plan and health welfare of recipients. Form Number:
CMS-372 (OMB 0938-0272); Frequency: Yearly; Affected Public:
State, Local, or Tribal Governments; Number of Respondents: 49; Total
Annual Responses: 305; Total Annual Hours: 13,115.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Health Insurance
Portability and Accountability Act (HIPAA) Nondiscrimination Provisions
and Supporting Regulations in 45 CFR 146.121(h) and 121(i)(2)(i); Use:
If coverage has been denied to any individual because the sponsor of a
self-funded non-Federal governmental plan had exempt the plan from the
nondiscrimination requirements under 45 CFR 146.180 ``Treatment of Non-
Federal Governmental Plans'', and the plan sponsor subsequently chooses
to bring the plan into compliance, the plan sponsor must comply with
the requirements under 45 CFR 146.121(i)(2)(i) ``Special Transitional
Rule for Self-Funded Non-Federal Governmental Plans Exempted under 45
CFR 146.180''. To bring the plan into compliance with the requirements,
the plan must notify the individual that the plan will be coming into
compliance, afford the individual an opportunity to enroll, specify the
effective date of compliance, and inform the individual regarding any
enrollment restrictions that may apply under the terms of the plan once
the plan is in compliance. Form Number: CMS-10001 (OMB 0938-
0827); Frequency: Yearly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 18; Total Annual Responses: 18;
Total Annual Hours: 194.
6. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Health Insurance
Portability and Accountability Act (HIPAA) Nondiscrimination Provisions
and Supporting Regulations in 45 CFR 146.121 (f)(2)(v)(A); Use: Section
146.121 of the regulations requires Health plans or issuers to disclose
in all plan materials the terms of certain wellness programs including
the availability of a reasonable alternative standard. Plan
participants and their dependents need this information to understand
the rights they have under HIPAA. States and the Federal government may
need the information supplied by issuers to properly perform their
regulatory functions. Form Number: CMS-10009 (OMB 0938-0819);
Frequency: Yearly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 2,600; Total Annual Responses:
2,600; Total Annual Hours: 1,300.
7. Type of Information Collection Request: New collection; Title of
Information Collection: Emergency and Non-Emergency Ambulance
Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b);
Use: In the CY 2008 Physician Fee Schedule (PFS) final rule with
comment period, we created an additional exception to the beneficiary
signature requirements in Sec. 424.36(b) for emergency ambulance
transports (72 FR 66406). The exception allows ambulance providers and
suppliers to sign the claim on behalf of the beneficiary, at the time
of transport, provided that certain documentation requirements are met.
Following publication of the CY 2008 PFS final rule with comment
period, ambulance provider and supplier stakeholders requested that we
extend the exception in Sec. 424.36(b)(6) to non-emergency ambulance
transports, in instances where the beneficiary is physically or
mentally incapable of signing the claim form.
The current submission of this information collection request
relates to the collection of documentation pertaining to non-emergency
ambulance transports. In addition, we are updating the collection of
information that relates to the collection of documentation pertaining
to emergency ambulance transports. Form Number: CMS-10242 (OMB
0938-1049); Frequency: Occasionally; Affected Public: Private Sector--
Business or Other for-profits and Not-for-profit institutions; Number
of Respondents: 9,000; Total Annual Responses: 13,185,835; Total Annual
Hours: 1,098,819.
8. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Conditions for
Coverage of Suppliers of End Stage Renal Disease (ESRD) Services and
Supporting Regulations Contained in 42 CFR 405.2100-405.2171; Use: The
information collection requirements described herein are part of the
Medicare and Medicaid Programs; Conditions for Coverage for End-Stage
Renal Disease Facilities. The requirements fall into two categories:
Recordkeeping requirements and reporting requirements. With regard to
the recordkeeping requirements, CMS uses these conditions for coverage
to certify health care facilities that want to participate in the
Medicare or Medicaid programs. For the reporting requirements, the
information is needed to assess and ensure proper distribution and
effective utilization of ESRD treatment resources while maintaining or
improving quality of care. The recordkeeping requirements imposed by
this collection are no different than other conditions for coverage in
that they reflect comparable standards developed by industry
organizations such as the Renal Physicians Association, American
Society of Transplant Surgeons, National Kidney Foundation, and the
National Association of Patients on Hemodialysis and Transplantation.
Form Number: CMS-R-52 (OMB: 0938-0386); Frequency:
Recordkeeping and Reporting--Annually; Affected Public: Business or
other for-profit and Federal government; Number of Respondents: 5,415;
Total Annual Responses: 5,415; Total Annual Hours: 131,720.
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/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 on (410) 786-1326.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB desk
officer at
[[Page 76034]]
the address below, no later than 5 p.m. on January 14, 2009.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, New Executive Office Building, Room 10235, Washington, DC
20503, Fax Number: (202) 395-6974.
Date: December 5, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E8-29542 Filed 12-12-08; 8:45 am]
BILLING CODE 4120-01-P