[Federal Register Volume 76, Number 29 (Friday, February 11, 2011)]
[Notices]
[Pages 7863-7864]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-3057]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-222, CMS-1771, CMS-10008, CMS-10368, and CMS-
R-21]
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 of currently
approved collection; Title of Information Collection: Independent Rural
Health Center/Freestanding Federally Qualified Health Center Cost
Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24; Use:
Providers of service in the Medicare program are required to submit
annual information to achieve reimbursement for health care services
rendered to Medicare beneficiaries. The Form CMS-222 cost report is
needed to determine the amount of reasonable cost due to the providers
for furnishing medical services to Medicare beneficiaries; Form Number:
CMS-222 (OMB 0938-0107); Frequency: Yearly; Affected Public:
Business or other for-profit and not-for-profit institutions; Number of
Respondents: 5812; Total Annual Responses: 5812; Total Annual Hours:
290,600.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Attending
Physicians Statement and Documentation of Medicare Emergency and
Supporting Regulations in 42 CFR 424.103; Use: 42 CFR 424.103(b)
requires that before a nonparticipating hospital may be paid for
emergency services rendered to a Medicare beneficiary, a statement must
be submitted that is sufficiently comprehensive to support that an
emergency existed. Form CMS-1771 contains a series of questions
relating to the medical necessity of the emergency. The attending
physician must attest that the hospitalization was required under the
regulatory emergency definition (42 CFR 424.101) and give clinical
documentation to support the claim. Form Number: CMS-1771 (OMB
0938-0023); Frequency: Yearly; Affected Public: Private sector--
business or other for-profit and not-for-profit institutions; Number of
Respondents: 100; Total Annual Responses: 200; Total Annual Hours: 50.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Process and
Information Required to Determine Eligibility of Drugs, Biologicals,
and Radiopharmaceutical Agents for Transitional Pass-Through Status
Under the Hospital Outpatient Prospective Payment System (OPPS); Use:
Section 1833(t)(6) of the Social Security Act provides for temporary
additional payments or ``transitional pass-through payments'' for
certain drugs and biological agents. Interested parties such as
hospitals, pharmaceutical companies, and physicians can apply for
transitional pass-through payment for drugs and biologicals used with
services covered under the OPPS. CMS uses this information to determine
if the criteria for making a transitional pass-through payment are met
and if an interim Healthcare Common Procedure Coding System (HCPCS)
code for a new drug or biological is necessary. Form Number: CMS-10008
(OMB: 0938-0802); Frequency: Once; Affected Public: Private
sector--business or other for-profit; Number of Respondents: 30; Total
Annual Responses: 480; Total Annual Hours: 480.
4. Type of Information Collection Request: New collection (request
for a new OMB control number); Title of Information Collection: Dental
Action Plan Template for Medicaid and CHIP Programs; Form No.: CMS-
10368 (OMB: 0938-NEW); Use: CMS is responsible for
administering the Federal Medicaid program and the Children's Health
Insurance Program (CHIP). As part of the Federal Medicaid program, CMS
oversees the Early and Periodic Screening, Diagnostic, and Treatment
(EPSDT) benefit to assure that all requirements are met. The provision
of dental services to EPSDT-eligible individuals is required under
section 1905(r)(3) of the Social Security Act. In addition, section
1902(a)(43)(D)(iii) requires that CMS collect information on dental
services furnished to eligible individuals. Section 501(e) of CHIPRA
imposed new data reporting requirements for the CHIP program by
requiring certain dental data to be reported in 2011 on the CHIP annual
report. Dental data for CHIP is unavailable as the requirement to
report this data is new for CHIP programs. CMS intends to use the
information provided in the template to help inform us of the States
activities undertaken to achieve the national oral health goals for
Medicaid and CHIP. CMS will use the information to routinely follow-up
with States on the achievement of their goals and activities and will
share that information with other States; Frequency: Once; Affected
Public: State, Local, or Tribal Governments; Number of Respondents: 69;
Total Annual Responses: 69; Total Annual Hours: 4,485. (For policy
questions regarding this collection contact Cindy Ruff at 410-786-5916.
For all other issues call 410-786-1326.)
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Withholding
Medicare Payments to Recover Medicaid Overpayments and Supporting
Regulations in 42 CFR
[[Page 7864]]
447.31; Form No.: CMS-R-21 (OMB: 0938-0287); Use: Section 2104
of the Omnibus Reconciliation Act of 1981 (Pub. L. 97-35) provides CMS
with the authority to withhold Federal Medicare payments to recover
Medicaid overpayments that the Medicaid State Agency has been unable to
recover. When the CMS Regional Office (RO) receives an overpayment case
from a State Agency, the case file is examined to determine whether the
conditions for withholding Medicare payments have been met. If the RO
determines the case is appropriate for withholding Medicare payments,
the RO will contact the institution's intermediary or individual's
carrier to determine the amount of Medicare payments to which the
entity would otherwise be entitled. The RO will then give notice to the
intermediary/carrier to withhold the entity's Medicare payment;
Frequency: Occasionally; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 54; Total Annual Responses: 27;
Total Annual Hours: 81. (For policy questions regarding this collection
contact Rory Howe at 410-786-4878. 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 at 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 April 12, 2011:
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.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-3057 Filed 2-10-11; 8:45 am]
BILLING CODE 4120-01-P