[Federal Register Volume 78, Number 120 (Friday, June 21, 2013)]
[Notices]
[Pages 37542-37545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-14878]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-10116, CMS-R-245, CMS-1572, CMS-250-254,
CMS-379, CMS-4040, CMS-10174, CMS-10261, and CMS-R-285]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
ACTION: Notice.
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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of information
(including each proposed
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extension or reinstatement of an existing collection of information)
and to allow 60 days for public comment on the proposed action.
Interested persons are invited to send comments regarding our burden
estimates 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.
DATES: Comments must be received by August 20, 2013.
ADDRESSES: When commenting, please reference the document identifier or
OMB control number (OCN). To be assured consideration, comments and
recommendations must be submitted in any one of the following ways:
1. Electronically. You may send 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) that are 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.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to [email protected].
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.
SUPPLEMENTARY INFORMATION: This notice sets out a summary of the use
and burden associated with the following information collections. More
detailed information can be found in each collection's supporting
statement and associated materials (see ADDRESSES).
CMS-10116 Conditions for Payment of Power Mobility Devices,
including Power Wheelchairs and Power-Operated Vehicles.
CMS-R-245 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.
CMS-1572 Home Health Agency Survey and Deficiencies Report.
CMS-250-254 Medicare Secondary Payer Information Collection and
Supporting Regulations.
CMS-379 Financial Statement of Debtor and Supporting Regulations.
CMS-4040 Request for Enrollment in Supplementary Medical Insurance.
CMS-10174 Collection of Prescription Drug Event Data from
Contracted Part D Providers for Payment.
CMS-10261 Part C Medicare Advantage Reporting Requirements and
Supporting Regulations.
CMS-R-285 Request for Retirement Benefit Information.
Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-
3520), federal agencies must obtain approval from the Office of
Management and Budget (OMB) for each collection of information they
conduct or sponsor. The term ``collection of information'' is defined
in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests
or requirements that members of the public submit reports, keep
records, or provide information to a third party. Section 3506(c)(2)(A)
of the PRA requires federal agencies to publish a 60-day notice in the
Federal Register concerning each proposed collection of information,
including each proposed extension or reinstatement of an existing
collection of information, before submitting the collection to OMB for
approval. To comply with this requirement, CMS is publishing this
notice.
Information Collections
1. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Conditions for Payment of Power Mobility Devices, including
Power Wheelchairs and Power-Operated Vehicles; Use: We are renewing our
request for approval for the collection requirements associated with
the final rule, CMS-3017-F (71 FR 17021), which published on April 5,
2006, and required a face-to-face examination of the beneficiary by the
physician or treating practitioner, a written prescription, and receipt
of pertinent parts of the medical record by the supplier within 45 days
after the face-to-face examination that the durable medical equipment
(DME) suppliers maintain in their records and make available to CMS and
its agents upon request. Form Number: CMS-10116 (OCN: 0938-0971);
Frequency: Yearly; Affected Public: Private Sector--Business or other
for-profits; Number of Respondents: 90,521; Number of Responses:
173,810; Total Annual Hours: 34,762. (For policy questions regarding
this collection contact Susan Miller at 410-786-2118.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: OASIS Collection
Requirements as Part of the CoPs for HHAs and Supporting Regulations;
Use: The OASIS 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: 12,014;
Total Annual Responses: 17,268,890; Total Annual Hours: 15,305,484.
(For policy questions regarding this collection contact Robin Dowell at
410-786-0060.)
3. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Home Health Agency Survey and Deficiencies Report; Use: In
order to participate in the Medicare Program as a Home Health Agency
(HHA) provider, the HHA must meet federal standards. This form is used
to record information and patients' health and provider compliance with
requirements and to report the information to the federal government.
Form Number: CMS-1572 (OCN: 0938-0355); Frequency: Yearly; Affected
Public: State, Local or Tribal Government; Number of Respondents:
3,830; Total Annual Responses: 3,830; Total Annual Hours: 958. (For
policy questions regarding this collection contact Patricia Sevast at
410-786-8135.)
4. Type of Information Collection Request: Reinstatement without
change
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of a previously approved collection; Title of Information Collection:
Medicare Secondary Payer Information Collection and Supporting
Regulations; Use: We are seeking to renew approval to collect
information from beneficiaries, providers, physicians, insurers, and
suppliers on health insurance coverage that is primary to Medicare.
Collecting this information allows us to identify those Medicare
beneficiaries who are in situations where Medicare is statutorily
required to be a secondary payer (MSP), thereby safeguarding the
Medicare Trust Fund. Specifically, we use the information to accurately
process and pay Medicare claims and to make necessary recoveries in
accordance with Sec. 1862(b) of the Act (42 U.S.C. 1395y(b)). If an
active MSP situation is identified and Medicare is inappropriately
billed as primary, the claim will be rejected. The hospitals, other
providers, physicians, pharmacies, and suppliers use the information
collected (and furnished to them on the denial) to properly bill the
appropriate primary payer. Completing an MSP questionnaire and making
an accurate MSP determination helps hospitals, other providers,
physicians, pharmacies, and suppliers to bill correctly the first time,
saving the Medicare Program money and affording Medicare beneficiaries
an enhanced level of customer service (which, again, is particularly
important in Part D due to the real-time adjudication of claims and the
complicated nature of its benefit administration). Insurers,
underwriters, third party administrators, and self-insured/self-
administered employers use the information to ensure compliance with
the law by refunding any identified mistaken payments to Medicare. Form
Number: CMS-250-254 (OCN: 0938-0214); Frequency: Occasionally; Affected
Public: Individuals and Households, Private Sector, State, Local or
Tribal Governments; Number of Respondents: 143,070,217; Total Annual
Responses: 143,070,217; Total Annual Hours: 1,788,057. (For policy
questions regarding this collection contact Ward Marsh at 410-786-
6473.)
5. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Financial Statement of Debtor and Supporting Regulations;
Use: The form CMS-379 is used to collect financial information which is
needed to evaluate requests from physicians and suppliers to pay
indebtedness under an extended repayment schedule, or to compromise a
debt less than the full amount. Normally, when a Medicare
Administrative Contractor (MAC) overpays a physician or supplier, the
overpayment is associated with a single claim, and the amount of the
overpayment is moderate. In these cases, the physician/supplier usually
refunds the overpaid amount in a lump sum. Alternatively, the MAC may
recoup the overpaid amount against future payments. A recoupment is the
recovery by Medicare of any outstanding Medicare debt by reducing
present or future Medicare payments and applying the amount withheld to
the indebtedness. The recoupment can be made only if the physician or
supplier accepts assignment since the MAC makes payment to the
physician or supplier only on assigned claims.
Sometimes, however, an overpayment to a physician or supplier is
exceptionally large, and it cannot be recovered in the normal fashion.
The large overpayment usually results from aberrant billing practices,
such as billing for more expensive services than were rendered. This
could be discovered during routine review of a statistically valid
sample of claims. The physician or supplier may be unable to refund a
large overpaid amount in a single payment. The MAC cannot recover the
overpayment by recoupment if the physician/supplier does not accept
assignment of future claims, or is not expected to file future claims
because of going out of business, illness or death. In these unusual
circumstances, the MAC has authority to approve or deny extended
repayment schedules up to 12 months, or may recommend to that we
approve up to 60 months. Before the MAC takes these actions, the MAC
will require full documentation of the physician's or supplier's
financial situation. Thus, the physician or supplier must complete form
CMS-379. Form Number: CMS-379 (OCN: 0938-0270); Frequency:
Occasionally; Affected Public: Private Sector--Business or other for-
profits; Number of Respondents: 500; Total Annual Responses: 500; Total
Annual Hours: 1,000. (For policy questions regarding this collection
contact Ronke Fabayo at 410-786-4460.)
6. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Request for Enrollment in Supplementary Medical Insurance;
Use: Form CMS-4040 (and CMS-4040SP) is used to establish entitlement to
and enrollment in Medicare Part B for beneficiaries who file for Part B
only. The collected information is used to determine entitlement for
individuals who meet the requirements in section 1836(2) of the Social
Security Act as well as the entitlement of the applicant or their
spouses to an annuity paid by OPM for premium deduction purposes. Form
Number: CMS-4040 (OCN: 0938-0245); Frequency: Once; Affected Public:
Individuals or households; Number of Respondents: 10,000; Total Annual
Responses: 10,000; Total Annual Hours: 2,500. (For policy questions
regarding this collection contact Lindsay Smith at 410-786-6843.)
7. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Collection of Prescription Drug Event Data from Contracted
Part D Providers for Payment; Use: The information users would include
Pharmacy Benefit Managers, third party administrators and pharmacies
and prescription drug plans, Medicare Advantage plans that offer
integrated prescription drug and health care coverage, Fallbacks and
other plans that offer coverage of outpatient prescription drugs under
the Medicare Part D benefit to Medicare beneficiaries. The data is used
primarily for payment, but is also used for claim validation as well as
for other legislated functions such as quality monitoring, program
integrity, and oversight. Form Number: CMS-10174 (OCN: 0938-0982);
Frequency: Monthly; Affected Public: Private sector (business or other
for-profits and not-for-profit institutions); Number of Respondents:
747; Total Annual Responses: 947,881,770; Total Annual Hours: 1,896.
(For policy questions regarding this collection contact Ivan Iveljic at
410-786-3312.)
8. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Part C Medicare
Advantage Reporting Requirements and Supporting Regulations; Use: There
are a number of information users of Part C reporting, including CMS
central and regional office staff that use this information to monitor
health plans and to hold them accountable for their performance,
researchers, and other government agencies such as GAO. Health plans
can use this information to measure and benchmark their performance. We
intend to make some of these data available for public reporting as
``display measures'' in 2013. Form Number: CMS-10261 (OCN: 0938-1054);
Frequency: Yearly and semi-annually; Affected Public: Private sector
(business or other for-profits); Number of Respondents: 588; Total
Annual Responses: 6,715; Total Annual Hours: 200,918. (For policy
questions
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regarding this collection contact Terry Lied at 410-786-8973.)
9. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Request for Retirement Benefit Information; Use: Section
1818(d)(5) of the Social Security Act provides that former state and
local government employees (who are age 65 or older, have been entitled
to Premium Part A for at least 7 years, and did not have the premium
paid for by a state, a political subdivision of a state, or an agency
or instrumentality of one or more states or political subdivisions) may
have the Part A premium reduced to zero. These individuals must also
have 10 years of employment with the state or local government employer
or a combination of 10 years of employment with a state or local
government employer and a non-government employer. Form CMS-R-285 is an
essential part of the process of determining whether an individual
qualifies for the premium reduction. The Social Security Administration
will use this information to help determine whether a beneficiary meets
the requirements for reduction of the Part A premium. Form Number: CMS-
R-285 (OCN: 0938-0769). Frequency: Once. Affected Public: State, Local,
or Tribal Governments; Number of Respondents: 500; Total Annual
Responses: 500; Total Annual Hours: 125. (For policy questions
regarding this collection contact Lindsay Smith at 410-786-6843.)
Dated: June 18, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2013-14878 Filed 6-20-13; 8:45 am]
BILLING CODE 4120-01-P