[Federal Register Volume 76, Number 242 (Friday, December 16, 2011)]
[Notices]
[Pages 78264-78265]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32296]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-179, CMS-10221, CMS-10408, and CMS-R-245]
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 & 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: Revision of a currently
approved collection; Title of Information Collection: State Plan Under
Title XIX of the Social Security Act (Base plan pages, Attachments,
Supplements to attachments); Use: State Medicaid agencies complete the
plan pages and CMS reviews the information to determine if the State
has met all of the provisions that the State has chosen to implement.
If the requirements are met, CMS will approve the amendments to the
State's Medicaid plan giving the State the authority to implement the
flexibilities. For a State to receive Medicaid Title XIX funding, there
must be an approved Title XIX State plan; Form Number: CMS-179 (OCN
0938-0193); Frequency: Occasionally; Affected Public: State, Local, or
Tribal Governments; Number of Respondents: 56; Total Annual Responses:
1,120; Total Annual Hours: 400. (For policy questions regarding this
collection contact Candice Payne at (410) 786-4453. For all other
issues call (410) 786-1326.)
2. Type of Information Collection Request: Reinstatement without
change of a previously approved collection ; Title of Information
Collection: Worksheet for Recording Results of Medicare Site Visits of
Independent Diagnostic Testing Facilities (IDTFs); Use: The worksheet
(form) was developed, approved by the Office of Management and Budget,
and implemented to provide CMS with a standard format to collect and
verify information regarding the compliance of IDTFs with the
performance standards found in 42 CFR 410.33(g). This previously
approved form was allowed to expire in error. CMS is now seeking to
reinstate the use of this form.
The worksheet is used to collect and record information obtained on
IDTF site visits; the data collected during site visits facilitates the
verification of the accuracy and completeness of the information the
IDTF furnished on its CMS-855B enrollment application. The worksheet is
completed by CMS or its contractors. Some of the answers to the
questions/data elements on the worksheet are verbally furnished by the
IDTF during the site visit; Form Number: CMS-10221 (OCN 0938-1029);
Frequency: Occasionally; Affected Public: Private Sector (Business or
other for-profits); Number of Respondents: 2,000; Total Annual
Responses: 2,000; Total Annual Hours: 4,000. (For policy questions
regarding this collection contact Michael Collett at (410) 786-6121.
For all other issues call (410) 786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Early Retiree
Reinsurance Program Survey of Plan Sponsors; Use: Under the Patient
Protection and Affordable Care Act (42 U.S.C. 18002) and implementing
regulations at 45 CFR part 149, employment-based plans that offer
health coverage to early retirees and their spouses, surviving spouses,
and dependents are eligible to receive tax-free reimbursement for a
portion of the costs of health benefits provided to such individuals.
The statute limits how the reimbursement funds can be used, and
requires the Secretary of HHS to develop a mechanism to monitor the
appropriate use of such funds. The survey that is the subject of this
PRA package is part of that mechanism; Form Number: CMS-10408 (OMB
0938-1150); Frequency: Yearly; Affected Public: Private Sector
(Business or other for-profit and Not-for-profit institutions); Number
of Respondents: 2,076; Total Responses: 2,076; Total Hours: 22,836.
(For policy questions regarding this collection contact David Mlawsky
at (410) 786-6851. For all other issues call (410) 786-1326.)
4. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Medicare and Medicaid Programs OASIS Collection Requirements as Part of
the CoPs for HHAs and Supp. Regs. in 42 CFR 48.55, 484.205, 484.245,
484.250; Use: This data set is currently mandated for use by Home
Health Agencies (HHAs) as a condition of participation (CoP) in the
Medicare program. Since 1999, the Medicare CoPs have mandated that HHAs
use the OASIS data set when evaluating adult non-maternity patients
receiving skilled services. The OASIS is a core standard assessment
data set that agencies integrate into their own patient-specific,
comprehensive assessment to identify each patient's need for home care
that meets the patient's medical, nursing, rehabilitative, social, and
discharge planning needs; Form Number: CMS-R-245 (OCN 0938-0760);
Frequency: Occasionally; Affected Public: Private Sector (Business or
other for-profit and Not-for-profit institutions); Number of
Respondents: 11,495; Total Annual Responses: 16,476,008; Total Annual
Hours: 16,567,968. (For policy questions regarding this collection
contact Robin Dowell at (410) 786-0060. 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
[[Page 78265]]
Email 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 February 14, 2012:
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: December 9, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-32296 Filed 12-15-11; 8:45 am]
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