[Federal Register Volume 80, Number 200 (Friday, October 16, 2015)]
[Notices]
[Pages 62534-62536]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-26390]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10003, CMS-10467, CMS-1450(UB-04), CMS-
1500(08-05)]
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 (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 December 15, 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
[[Page 62535]]
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-10003 Notice of Denial of Medical Coverage (or Payment)
CMS-10467 Evaluation of the Graduate Nurse Education Demonstration
Program
CMS-1450(UB-04) Medicare Uniform Institutional Provider Bill and
Supporting Regulations CMS-1500(08-05) Health Insurance Common Claims
Form and Supporting Regulations
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: Revision of a currently
approved collection; Title of Information Collection: Notice of Denial
of Medical Coverage (or Payment); Use: Medicare health plans, including
Medicare Advantage plans, cost plans, and Health Care Prepayment Plans,
are required to issue the CMS-10003 form when a request for either a
medical service or payment is denied in whole or in part. The notice
explains why the plan denied the service or payment and informs
Medicare enrollees of their appeal rights. The notice is also used, as
appropriate, to explain Medicaid appeal rights to full dual eligible
individuals enrolled in a Medicare health plan that is also managing
the individual's Medicaid benefits. To that end, the revised notice
contains bracketed text the plan will insert if the denial notice is
being delivered to an enrollee who is a full dual eligible. The text in
square brackets ``[ ]'' reflects the Federal protections for Medicaid
managed care enrollees. Since a State may offer additional protections,
there is also free-text space for inclusion of any State-specific
protections that exceed the Federal protections. Form Number: CMS-10003
(OMB control number: 0938-0829). Frequency: Occasionally; Affected
Public: Private sector (Business or other for-profit and Not-for-profit
institutions); Number of Respondents: 730; Total Annual Responses:
33,574,293; Total Annual Hours: 5,593,477. (For policy questions
regarding this collection contact Staci Paige at 410-786-2045. For all
other issues call 410-786-1326.)
2. Type of Information Collection Request: Revision of a currently
approved information collection; Title of Information Collection:
Evaluation of the Graduate Nurse Education Demonstration Program; Use:
The Graduate Nurse Education (GNE) Demonstration is mandated under
Section 5509 of the Affordable Care Act (ACA) under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.). According to Section 5509
of the ACA, the five selected demonstration sites receive ``payment for
the hospital's reasonable costs for the provision of qualified clinical
training to advance practice registered nurses.'' Section 5509 of the
ACA also states that an evaluation of the graduate nurse education
demonstration must be completed no later than October 17, 2017. This
evaluation includes analysis of the following: (1) Growth in the number
of advanced practice registered nurses (APRNs) with respect to a
specific base year as a result of the demonstration; (2) growth for
each of the following specialties: clinical nurse specialist, nurse
practitioner, certified nurse anesthetist, certified nurse-midwife; and
(3) costs to the Medicare program as result of the demonstration.
All information collected through the Evaluation of the GNE project
will be used to meet the requirements specified under the ACA Section
5509. We will also use the information to determine the overall
effectiveness of the GNE project. The process evaluation seeks to
understand how the demonstration is implemented overall, how that
implementation has changed over time, which aspects of the
demonstration have been successful or unsuccessful, and what plans the
sites have for the remainder of the implementation and after the
demonstration formally ends. The process evaluation will answer both
quantitative and qualitative questions. Form Number: CMS-10467 (OMB
control number: 0938-1212); Frequency: Annually; Affected Public:
State, Local, or Tribal Governments; Private sector (Business and other
for-profit and Not-for-profit institutions); Number of Respondents:
104; Total Annual Responses: 104; Total Annual Hours: 802. (For policy
questions regarding this collection contact Pauline Karikari-Martin at
410-786-1040.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Uniform
Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5;
Use: Section 42 CFR 424.5(a)(5) requires providers of services to
submit a claim for payment prior to any Medicare reimbursement. Charges
billed are coded by revenue codes. The bill specifies diagnoses
according to the International Classification of Diseases, Ninth
Edition (ICD-9-CM) code. Inpatient procedures are identified by ICD-9-
CM codes, and outpatient procedures are described using the CMS Common
Procedure Coding System (HCPCS). These are standard systems of
identification for all major health insurance claims payers. Submission
of information on the CMS-1450 permits Medicare intermediaries to
receive consistent data for proper payment. Form Numbers: CMS-1450 (UB-
04)
[[Page 62536]]
(OMB control number: 0938-0997); Frequency: On occasion; Affected
Public: Private sector (Business or other for-profit and Not-for-profit
institutions); Number of Respondents: 53,111; Total Annual Responses:
181,909,654; Total Annual Hours: 1,567,455. (For policy questions
regarding this collection contact Matt Klischer at 410-786-7488.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Health Insurance
Common Claims Form and Supporting Regulations at 42 CFR part 424,
Subpart C; Use: The Form CMS-1500 answers the needs of many health
insurers. It is the basic form prescribed by CMS for the Medicare
program for claims from physicians and suppliers. The Medicaid State
Agencies, CHAMPUS/TriCare, Blue Cross/Blue Shield Plans, the Federal
Employees Health Benefit Plan, and several private health plans also
use it; it is the de facto standard ``professional'' claim form.
Medicare carriers use the data collected on the CMS-1500 and the
CMS-1490S to determine the proper amount of reimbursement for Part B
medical and other health services (as listed in section 1861(s) of the
Social Security Act) provided by physicians and suppliers to
beneficiaries. The CMS-1500 is submitted by physicians/suppliers for
all Part B Medicare. Serving as a common claim form, the CMS-1500 can
be used by other third-party payers (commercial and nonprofit health
insurers) and other Federal programs (e.g., CHAMPUS/TriCare, Railroad
Retirement Board (RRB), and Medicaid). However, as the CMS-1500
displays data items required for other third-party payers in addition
to Medicare, the form is considered too complex for use by
beneficiaries when they file their own claims. Therefore, the CMS-1490S
(Patient's Request for Medicare Payment) was explicitly developed for
easy use by beneficiaries who file their own claims. The form can be
obtained from any Social Security office or Medicare carrier. Form
Number: CMS-1500(08/05), CMS-1490-S (OMB control number: 0938-0999)
Frequency: On occasion; Affected Public: State, Local, or Tribal
Governments, Private sector (Business or other-for-profit and Not-for-
profit institutions); Number of Respondents: 1,448,346; Total Annual
Responses: 988,005,045; Total Annual Hours: 21,418,336. (For policy
questions regarding this collection contact Shannon Seales at 410-786-
4089.)
Dated: October 13, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2015-26390 Filed 10-15-15; 8:45 am]
BILLING CODE 4120-01-P