[Federal Register Volume 76, Number 103 (Friday, May 27, 2011)]
[Notices]
[Page 30944]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-13039]
[[Page 30944]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-222, CMS-287-05, CMS-1771, and CMS-10008]
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: 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: 5,812; Total Annual Responses: 5,812; Total Annual Hours:
290,600. (For policy questions regarding this collection contact Steve
A. Raitzyk at 410-786-4599. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Chain Home Office Cost Statement and supporting Regulations in 42 CFR
413.17 and 413.20; Use: The Form CMS-287-05 is filed annually by Chain
Home Offices to report the information necessary for the determination
of Medicare reimbursement to components of chain organizations.
However, where providers are components of chain organizations,
information included in the chain home office cost statement is in
addition to that included in the provider cost report and is needed to
determine whether payments are appropriate. Form Number: CMS-287-05
(OMB 0938-0202); Frequency: Yearly; Affected Public: Business
or other for-profit and not-for-profit institutions; Number of
Respondents: 1,541; Total Annual Responses: 1,541; Total Annual Hours:
718,106. (For policy questions regarding this collection contact Nadia
Massuda at 410-786-5834. For all other issues call 410-786-1326.)
3. 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 Section 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.
(For policy questions regarding this collection contact Shauntari
Cheely at 410-786-1818. For all other issues call 410-786-1326.)
4. 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. (For policy questions
regarding this collection contact Christina Ritter Ph.D. at 410-786-
4636. For all other issues call 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 June 27, 2011.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer.
Fax Number: (202) 395-6974.
E-mail: [email protected].
Dated: May 20, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-13039 Filed 5-26-11; 8:45 am]
BILLING CODE 4120-01-P