[Federal Register Volume 75, Number 171 (Friday, September 3, 2010)]
[Notices]
[Page 54149]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-21722]
[[Page 54149]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-417, CMS-10227 and CMS-10351]
Agency Information Collection Activities: Proposed Collection;
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 and 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 of a currently
approved collection; Title of Information Collection: Hospice Request
for Certification in the Medicare Program; Use: The Hospice Request for
Certification Form is the identification and screening form used to
initiate the certification process and to determine if the provider has
sufficient personnel to participate in the Medicare program. Form
Number: CMS-417 (OMB: 0938-0313); Frequency: Annually;
Affected Public: Private Sector: Business or other for-profits; Number
of Respondents: 3,494; Total Annual Responses: 3,494; Total Annual
Hours: 594. (For policy questions regarding this collection contact
Debbie Terkay at 410-786-6835. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: PACE State Plan
Amendment Pre-print; Use: The Balanced Budget Act of 1997 created
section 1934 of the Social Security Act that established the Program
for the All-Inclusive Care for the Elderly (PACE). The legislation
established the PACE program as a Medicaid State plan option serving
the frail and elderly in the home and community. Pursuant to the notice
given in 64 FR 66271 (November 24, 1999), if a State elects to offer
PACE as an optional Medicaid benefit, it must complete a State Plan
Amendment described as Enclosures 3, 4, 5, 6 and 7. The
information collected is used by CMS to affirm that the State elects to
offer PACE an optional State plan service and the specifications of
eligibility, payment and enrollment for the program. Form Number: CMS-
10227 (OMB: 0938-1027); Frequency: Once; Affected Public:
State, Local, or Tribal Governments; Number of Respondents: 36; Total
Annual Responses: 12; Total Annual Hours: 240. (For policy questions
regarding this collection contact Angela Taube at 410-786-2638. For all
other issues call 410-786-1326.)
3. Type of Information Collection Request: New collection; Title of
Information Collection: ESRD PPS Transition Election and attestations
of Low-Volume; Use: The Medicare Improvement for Patients and Providers
Act (MIPPA) requires implementation of an End Stage Rental Disease
(ESRD) bundled prospective payment system (PPS) effective January 1,
2011. Once implemented, the ESRD PPS will replace the current basic
case-mix adjusted composite payment system and the methodologies for
the reimbursement of separately billable outpatient ESRD related items
and services. The ESRD PPS will provide a single payment to the ESRD
facilities that will cover all the resources used in providing an
outpatient dialysis treatment. Also, as required my MIPPA, ESRD
facilities are eligible to receive a low-volume adjustment when the
facility furnished less than 4000 treatments in each of the three years
pre-ceding the payment year.
In order for an ESRD facility to receive the low-volume adjustment,
CMS will require that an ESRD facility must provide an attestation to
the fiscal intermediary or the Medicare administrative contractor (FI/
MAC) that it has met the criteria to qualify as a low-volume facility.
The FI or MAC would verify the ESRD facility's attestation of their
low-volume status using the ESRD facility's final-settled cost reports.
Also, an ESRD facility may make a one-time election to be excluded from
the four-year transition to the ESRD PPS. A facility may elect to be
paid entirely based on the ESRD PPS beginning January 1, 2011. If the
ESRD facility fails to submit an election, or the ESRD facility's
election is not received by their MAC by November 1, 2010, payments to
the ESRD facility for items and services provided during the transition
will be paid under the basic case-mix adjusted composite payment
system. Form Number: CMS-10351 (OMB: 0938-New); Frequency:
Annually; Affected Public: Private Sector: Business or other for-
profits and Not-for-profit institutions; Number of Respondents: 5,808;
Total Annual Responses: 2,520; Total Annual Hours: 563.2. (For policy
questions regarding this collection contact Janet Samen at 410-786-
4533. 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 [email protected], 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 November 2, 2010:
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, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: August 26, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2010-21722 Filed 9-2-10; 8:45 am]
BILLING CODE 4120-01-P