[Federal Register: June 15, 2009 (Volume 74, Number 113)]
[Notices]
[Page 28249-28250]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15jn09-64]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-304/304a, CMS-10288, CMS-10289 and CMS-1450
(UB-04)]
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: Extension without change
of a currently approved collection; Title of Information Collection:
Reconciliation of State Invoice and Prior Quarter Adjustment Statement;
Use: Section 1927 of the Social Security Act requires drug
manufacturers to enter into and have in effect a rebate agreement with
CMS in order for States to receive funding for drugs dispensed to
Medicaid recipients. Drug manufacturers must complete and submit to
States the 304 form (the Reconciliation of State Invoice Form) to
explain any rebate payment adjustments for the current quarter, and
complete and submit the 304A form (the Prior Quarter Adjustment
Statement Form) to States to explain rebate payment adjustments to any
prior quarters. Both forms are used to reconcile drug rebate payments
made by manufacturers with the State invoices of rebates due. Form
Number: CMS-304/304a (OMB: 0938-0676); Frequency: Reporting--
Quarterly; Affected Public: Private Sector: Business or other for
profits; Number of Respondents: 570; Total Annual Responses: 3820;
Total Annual Hours: 141,080. (For policy questions regarding this
collection contact Cindy Bergin at 410-786-1176. For all other issues
call 410-786-1326.)
2. Type of Information Collection Request: New Collection; Title of
Information Collection: State Plan Pre-Print to Implement Required
Dental Benefits Pursuant of Children's Health Insurance Program
Reauthorizing Act (CHIPRA) 2009; Use: Section 501 of CHIPRA 2009 amends
XXI and requires that ``child health assistance provide to a targeted
low-income child shall include coverage of dental services necessary to
prevent disease and promote oral health, restore oral structures to
health and function, and treat emergency conditions.'' States that
provide coverage in a separate Children's Health Insurance Program may
choose between two methods of providing the dental services required in
Section 501. The State may define the
[[Page 28250]]
services in the dental benefit package and demonstrate that it includes
all the required services. Alternatively, the State may provide a
dental benefit package that is equivalent to one of the three benchmark
packages described in the statute. In order to implement one of these
options and comply with the statute, States must amend their State Plan
using the State Plan pre-print. Form Number: CMS-10288 (OMB :
0938--NEW); Frequency: Reporting One-time; Affected Public: State,
Local, or Tribal Governments; Number of Respondents: 51; Total Annual
Responses: 51; Total Annual Hours: 1530. (For policy questions
regarding this collection contact Nancy Goetschius at 410-786-0707. For
all other issues call 410-786-1326.)
3. Type of Information Collection Request: New Collection; Title of
Information Collection: Optional Dental-only Supplemental Coverage
State Plan Amendment Template; Use: CHIPRA 2009 provides States with an
option to provide supplemental dental-only coverage to children who
would be eligible to enroll in the State's Children's Health Insurance
Program (CHIP), except that they already have health insurance
coverage, either through a group health plan or employer sponsored
insurance. If the health insurance plan the child is enrolled in does
not provide dental benefits, the State may provide the child with the
same State-defined dental package or benchmark benefit plan provided to
children who are eligible for the entire CHIP benefit package. The
child will only be entitled to the dental services provided to other
CHIP children.
In order to choose this option, State must comply with all other
requirements of the statute regarding cost sharing, income eligibility
level, absence of a waiting list for their entire CHIP program (not
just for dental coverage), and not providing more favorable treatment
to children eligible for the supplemental dental benefit under this
option. In order to implement this option States must amend their State
Plan using the Supplemental Dental Benefits State Plan Amendment
Template. Form Number: CMS-10289 (OMB: 0938--NEW); Frequency:
Reporting One-time; Affected Public: State, local, or Tribal
Governments; Number of Respondents: 51; Total Annual Responses: 51;
Total Annual Hours: 1020. (For policy questions regarding this
collection contact Nancy Goetschius at 410-786-0707. For all other
issues call 410-786-1326.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Uniform
Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5;
Use: Section 42 CFR 424.5(a)(5) requires providers of services to
submit a claim for payment prior to any Medicare reimbursement. Charges
billed are coded by revenue codes. The bill specifies diagnoses
according to the International Classification of Diseases, Ninth
Edition (ICD-9-CM) code. Inpatient procedures are identified by ICD-9-
CM codes, and outpatient procedures are described using the CMS Common
Procedure Coding System (HCPCS). These are standard systems of
identification for all major health insurance claims payers. Submission
of information on the CMS-1450 permits Medicare intermediaries to
receive consistent data for proper payment. Form Numbers: CMS-1450 (UB-
04) (OMB: 0938-0997); Frequency: Reporting--On occasion;
Affected Public: Not-for-profit institutions, Business or other for-
profit; Number of Respondents: 53,111; Total Annual Responses:
181,909,654; Total Annual Hours: 1,567,455. (For policy questions
regarding this collection contact Matt Klischer at 410-786-7488. For
all other issues call 410-786-1326.)
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web site 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by August 14, 2009:
1. Electronically. You may submit your comments electronically to
http://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number (CMS-10078), Room C4-26-05, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: June 5, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-13944 Filed 6-12-09; 8:45 am]
BILLING CODE 4120-01-P