[Federal Register: February 13, 2009 (Volume 74, Number 29)]
[Notices]
[Page 7233-7234]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13fe09-44]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-285, CMS-10170, CMS-R-0074, CMS-R-107, CMS-
2786U, CMS-416 and CMS-10265]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
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: Request For
Retirement Benefit Information; Use: Section 1818 of the Social
Security Act provides that former State and local government employees
who are age 65 or older, that have been entitled to Premium Part A for
at least 7 years, and did not have the premium paid for by a State or a
political subdivision of a State, may have the Part A premium reduced
to zero. This collection will assist in determining whether individuals
currently paying a monthly premium for Medicare Part A coverage are
eligible to have their premium reduced to zero. Form Number: CMS-R-285
(OMB 0938-0769); Frequency: Monthly; Affected Public: State,
Local or Tribal Governments; Number of Respondents: 1,500; Total Annual
Responses: 1,500; Total Annual Hours: 375. (For policy questions
regarding this collection contact: Denise Cox at 410-786-3195. For all
other issues call 410-786-1326.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Retiree Drug
Subsidy (RDS) Payment Request and Instructions; Use: Under section
1860D-22 of the Social Security Act, plan sponsors (e.g., employers,
unions) who offer prescription drug coverage meeting specified criteria
to their qualified covered retirees are eligible to receive a 28% tax-
free subsidy for allowable drug costs. Plan sponsors must submit
required prescription drug cost data and other information in order to
receive the subsidy. Form Number: CMS-10170 (OMB 0938-0977);
Frequency: Yearly; Affected Public: Business or other for-profits, not-
for-profit institutions, not-for-profit institutions and State, Local
or Tribal Governments; Number of Respondents: 4,500; Total Annual
Responses: 4,500; Total Annual Hours: 679,500. (For policy questions
regarding this collection contact: David Mlawsky at 410-786-6851. For
all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Income and
Eligibility Verification System; Use: This collection is necessary to
verify income and eligibility requirements for Medicaid beneficiaries,
as required by Section 1137 of the Social Security Act. Form Number:
CMS-R-74 (OMB 0938-0467); Frequency: Monthly; Affected Public:
State, Local or Tribal Governments; Number of Respondents: 54; Total
Annual Responses: 54; Total Annual Hours: 124,054. (For policy
questions regarding this collection contact: Mel Schmerler at 410-786-
3414. For all other issues call 410-786-1326.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid-
Determining Third Party Liability (TPL) State Plan Preprint and
Supporting Regulations in 42 CFR 433.138; Use: The information
collected from Medicaid applicants and beneficiaries as well as from
State and local agencies is necessary to determine the legal liability
of third parties to pay for medical services in lieu of Medicaid
payment. Form Number: CMS-R-107 (OMB 0938-0502); Frequency: On
occasion; Affected Public: Individuals or households and State, Local
or Tribal Government; Number of Respondents: 2,900,000; Total Annual
Responses: 2,900,000; Total Annual Hours: 510,968. (For policy
questions regarding this collection contact Gwendolyn Talvert at 410-
786-5928. For all other issues call 410-786-1326.)
5. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Fire Safety
Survey Reports; Use: The Life Safety Code (LSC) is a compilation of
fire safety requirements for new and existing buildings and is updated
and published every 3 years by the National Fire Protection Association
(NFPA), a private, non-profit organization dedicated to reducing loss
of life due to fire. The Medicare regulations have historically
incorporated by reference these requirements along with Secretarial
waiver authority. The statutory basis for incorporating NFPA's LSC for
our providers is under the Secretary's general rulemaking authority at
Sections 1102 and 1871 of the Social Security Act. These forms are used
by the State Agencies to record data collected to determine compliance
with standards specified in 416.44(b) for ambulatory surgical centers
(ASCs), and 494.60(e) for End-Stage Renal Disease (ESRD) facilities.
The Medicare Health Insurance Program is authorized by Title XVIII of
the Social Security Act. The CMS-2786U form is being revised to include
ESRD information. Form Number: 2786U (OMB 0938-0242);
Frequency: Weekly; Affected Public: Individuals or households and
State, Local or Tribal Government; Number of Respondents: 54; Total
Annual Responses: 2,442; Total Annual Hours: 4,884. (For policy
questions regarding this collection contact JoAnn Perry at 410-786-
3336. For all other issues call 410-786-1326.)
6. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Annual Early and
Periodic Screening, Diagnostic and Treatment (EPSDT) Report; Use:
States are required to submit an annual report on the provision of
EPSDT services pursuant to section 1902(a)(43)(D) of the Social
Security Act. These reports provide CMS with data necessary to assess
the effectiveness of State EPSDT programs, to determine a State's
results in achieving its participation goal and to respond to
inquiries. This collection is being submitted as a revision based on
minor changes made to the form and instructions. CMS has added three
additional lines of data to the form (lines 12d, 12e and 12f). This
information is currently being collected; however, CMS expanded the
lines to obtain a better understanding for the utilization of dental
services. CMS believes there will be no additional burden for the
changes made to the form. The changes were necessary to
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accommodate a need for more specific dental data and to preliminary
notify States of a change in CPT codes. A clarification was also made
to line 14 of the instructions. Form Number: CMS-416 (OMB
0938-0354); Frequency: Yearly; Affected Public: State, Local or Tribal
Governments; Number of Respondents: 56; Total Annual Responses: 56;
Total Annual Hours: 1,568. (For policy questions regarding this
collection contact Cindy Ruff at 410-786-5916. For all other issues
call 410-786-1326.)
7. Type of Information Collection Request: New collection; Title of
Information Collection: Mandatory Insurer Reporting Requirements of
Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (MMSEA)
(Pub. L.110-173); Use: Section 111 of the Medicare, Medicaid and SCHIP
Extension Act of 2007 (Pub. L. 110-173) amends the Medicare Secondary
Payer (MSP) provisions of the Social Security Act (42 U.S.C. 1395y(b))
to provide for mandatory reporting by group health plan arrangements
and by liability insurance (including self-insurance), no-fault
insurance, and workers' compensation laws and plans. The law provides
that, not withstanding any other provision of law, the Secretary of
Health and Human Services may implement this provision by program
instruction or otherwise. The Secretary has elected not to implement
the provision through rulemaking and will implement by publishing
instructions on a publicly available Web site and submitting an
information collection request to OMB for review and approval of the
associated information collection requirements.
Effective January 1, 2009, as required by the MMSEA, an entity
serving as an insurer or third party administrator for a group health
plan and, in the case of a group health plan that is self-insured and
self-administered, a plan administrator or fiduciary must: (1) Secure
from the plan sponsor and plan participants such information as the
Secretary may specify to identify situations where the group health
plan is a primary plan to Medicare; and (2) report such information to
the Secretary in the form and manner (including frequency) specified by
the Secretary.
Effective July 1, 2009, as required by the MMSEA, ``applicable
plans,'' must: (1) Determine whether a claimant is entitled to Medicare
benefits; and, if so, (2) report the identity of such claimant and
provide such other information as the Secretary may require to properly
coordinate Medicare benefits with respect to such insurance
arrangements in the form and manner (including frequency) as the
Secretary may specify after the claim is resolved through a settlement,
judgment, award or other payment (regardless of whether or not there is
a determination or admission of liability). Applicable plan refers to
the following laws, plans or other arrangements, including the
fiduciary or administrator for such law, plan or arrangement: (1)
Liability insurance (including self-insurance); (2) No-fault insurance;
and (3) Workers' compensation laws or plans.
As indicated, the Secretary has elected to implement this provision
by publishing instructions at a Web site established for such purpose.
The Web site is (http://www.cms.hhs.gov/MandatoryInsRep/). CMS shall
use this Web site to publish preliminary guidance as well as the final
instructions. The Web site also advises interested parties how to
comment on the preliminary guidance. Form Number: CMS-10265
(OMB 0938-New); Frequency: Yearly; Affected Public: Business
or other for-profits, not-for-profit institutions and State, Local or
Tribal Governments; Number of Respondents: 290,404; Total Annual
Responses: 6,920,504; Total Annual Hours: 2,120,478. (For policy
questions regarding this collection contact John Albert at 410-786-
7457. 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 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 the address below, no later than 5 p.m. on March 16, 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.
Dated: February 6, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-3156 Filed 2-12-09; 8:45 am]
BILLING CODE 4120-01-P