[Federal Register Volume 80, Number 182 (Monday, September 21, 2015)]
[Notices]
[Page 56999]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-23528]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-1771]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
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 (the PRA), federal agencies are required to publish notice
in the Federal Register concerning each proposed collection of
information (including each proposed 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 November 20, 2015.
ADDRESSES: When commenting, please reference the document identifier or
OMB control number. 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:
Contents
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-1771 Emergency and Foreign Hospital Services
Under the 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 Collection
1. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Emergency and Foreign Hospital Services; Use: Section 1866
of the Social Security Act states that any provider of services shall
be qualified to participate in the Medicare program and shall be
eligible for payments under Medicare if it files an agreement with the
Secretary to meet the conditions outlined in this section of the Act.
Section 1814(d)(1) of the Social Security Act and 42 CFR 424.100,
allows payment of Medicare benefits for a Medicare beneficiary to a
nonparticipating hospital that does not have an agreement in effect
with the Centers for Medicare and Medicaid Services. These payments can
be made if such services were emergency services and if CMS would be
required to make the payment if the hospital had an agreement in effect
and met the conditions of payment. This form is used in connection with
claims for emergency hospital services provided by hospitals that do
not have an agreement in effect under Section 1866 of the Social
Security Act. As specified in 42 CFR 424.103(b), before a non-
participating 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 and give clinical documentation to support the claim. A
photocopy of the beneficiary's hospital records may be used in lieu of
the CMS-1771 if the records contain all the information required by the
form. Form Number: CMS-1771 (OMB control number: 0938-0023); Frequency:
Annually; Affected Public: Private sector (Business or other for-
profits 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.)
Dated: September 15, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2015-23528 Filed 9-18-15; 8:45 am]
BILLING CODE 4120-01-P