[Federal Register Volume 83, Number 105 (Thursday, May 31, 2018)]
[Notices]
[Pages 25012-25013]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11492]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers CMS-10599]
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 the necessity and utility of the
proposed information collection for the proper performance of the
agency's functions, the accuracy of the estimated burden, ways to
enhance the quality, utility, and clarity of the information to be
collected, and the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
DATES: Comments must be received by July 30, 2018.
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' website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
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: William Parham at (410) 786-4669.
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-10599 Pre-Claim Review Demonstration for Home Health 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: Revision of a currently
approved collection; Title of Information Collection: Pre-Claim Review
Demonstration for Home Health Services; Use: Section 402(a)(1)(J) of
the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J))
authorizes the Secretary to ``develop or demonstrate improved methods
for the investigation and prosecution of fraud in the provision of care
or services under the health programs established by the Social
Security Act (the Act).'' Pursuant to this authority, the CMS seeks to
develop and implement a Medicare demonstration project, which CMS
believes will help assist in developing improved procedures for the
identification, investigation, and prosecution of Medicare fraud
occurring among Home Health Agencies (HHA) providing services to
Medicare beneficiaries.
This revised demonstration would help assist in developing improved
procedures for the identification, investigation, and prosecution of
potential Medicare fraud. The demonstration would help make sure that
payments for home health services are appropriate through either pre-
claim or postpayment review, thereby working towards the prevention and
identification of potential fraud, waste, and abuse; the protection of
Medicare Trust Funds from improper payments; and the reduction of
Medicare appeals. CMS proposes initially implementing the demonstration
in Illinois, Ohio, North Carolina, Florida, and Texas with the option
to expand to other states in the Palmetto/JM jurisdiction. Under this
demonstration, CMS proposes to offer choices for providers to
demonstrate their compliance with CMS' home health policies. Providers
in the demonstration states may participate in either 100 percent pre-
claim review or 100 percent postpayment review. These providers will
continue to be subject to a review method until the HHA reaches the
target affirmation or claim approval rate. Once a HHA reaches the
target pre-claim review affirmation or post-payment review claim
approval rate, it may choose to be relieved from claim reviews, except
for a spot check of their claims to ensure continued compliance.
Providers who do not wish to participate in either 100 percent pre-
claim or postpayment reviews have the option to furnish home health
services and submit the associated claim for payment without undergoing
such reviews; however, they will receive a 25 percent payment reduction
on all claims
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submitted for home health services and may be eligible for review by
the Recovery Audit Contractors.
The information required under this collection is required by
Medicare contractors to determine proper payment or if there is a
suspicion of fraud. Under the pre-claim review option, HHA will send
the pre-claim review request along with all required documentation to
the Medicare contractor for review prior to submitting the final claim
for payment. If a claim is submitted without a pre-claim review
decision one file, the Medicare contractor will request the information
from the HHA to determine if payment is appropriate. For the
postpayment review option, the Medicare contractor will also request
the information from the HHA provider who submitted the claim for
payment from the Medicare program to determine if payment was
appropriate. Form Number: CMS-10599 (OMB control number: 0938-1311);
Frequency: Occasionally; Affected Public: Private Sector (Business or
other for-profits and Not-for-profits); Number of Respondents: 941,287;
Total Annual Responses: 1,330,980; Total Annual Hours: 670,375. (For
questions regarding this collection contact Jennifer McMullen (410)
786-7635).
Dated: May 23, 2018.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2018-11492 Filed 5-29-18; 4:15 pm]
BILLING CODE 4120-01-P