[Federal Register Volume 78, Number 38 (Tuesday, February 26, 2013)]
[Pages 13058-13059]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-04313]



Centers for Medicare & Medicaid Services

[Document Identifier CMS-10451, CMS-1450 (UB-04), CMS-R-131 and CMS-

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.
    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), Department of Health and Human Services, 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 function; (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: New collection; Title of 
Information Collection: Evaluation and Development of Outcome Measures 
for Quality Assessment in Medicare Advantage and Special Needs Plans; 
Use: Quality improvement is a major initiative for the Centers for 
Medicare and Medicaid Services (CMS). With the passing of the Patient 
Protection and Affordable Care Act in March 2010, there is a focused 
interest in providing quality and value-based healthcare for Medicare 
beneficiaries. In addition, it is critical to develop criteria not only 
for quality improvement but also as a means for beneficiaries to 
compare healthcare plans to make the choice that is right for them.
    It is critical to the CMS mission to expand its quality improvement 
efforts from collection of structure and process measures to include 
outcome measures. However, the development of outcome measures 
appropriate for the programs serving older and/or disabled patients has 
been somewhat limited. The development and subsequent implementation of 
outcome measures as part of the overall quality improvement program for 
CMS is crucial to ensuring that beneficiaries obtain high quality 
healthcare. In addition, process of care measures are needed that focus 
on the care needs of Medicare beneficiaries, such as factors affecting 
continuity of care and transitions.
    This request is for data collection to test the use of new tools 
available to CMS to measure care pertinent to vulnerable beneficiaries 
where quality of care provided by Medicare Advantage Organizations 
(MAOs) should be closely monitored. The measures to be evaluated and 
developed upon approval of this request relate to (1) Continuity of 
information and care from hospital discharge to the outpatient setting, 
(2) continuity between mental health provider and primary care provider 
(PCP), and (3) items that may be added to the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS) survey addressing language-
centered care, cultural competence, physical activity, healthy eating, 
and caregiver strain.
    Since the publication of the 60-day notice (77 FR 65391), the 
information collection request has been revised. The order of questions 
has been changed in some locations of the instrument. In addition, we 
have revised items to collect documentation about refusal to permit 
communication between the mental health provider and the primary care 
provider. Form Number: CMS-10451 (OCN: 0938-New); Frequency: Yearly, 
occasionally; Affected Public: Individuals or Households, Private 
sector--Business or other for-profits ; Number of Respondents: 2,012; 
Total Annual Responses: 2,360; Total Annual Hours: 4,630. (For policy 
questions regarding this collection contact Susan Radke at 410-786-
4450. For all other issues call 410-786-1326.)
    2. 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) (OCN: 0938-0997); Frequency: Reporting--On occasion; Affected 
Public: Not-for-profit institutions, Business or other for-profit; 
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. For all other issues 
call 410-786-1326.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Advance 
Beneficiary Notice of Noncoverage (ABN); Use: The use of written 
notices to inform beneficiaries of their liability under specific 
conditions has been available since Title XVIII of the Social Security 
Act (the Act), section 1879, Limitation On Liability, was enacted in 
1972 (Pub. L. 92-603). Similar required notification and liability 
protections are available under other sections of the Act: section 
1834(a)(18) refund requirements for certain items when unsolicited 
telephone contacts are made, section 1834(j)(4) for the same types of 
items when there is neither a required advance coverage determination 
nor required supplier number; section 1834(a)(15) also for advance 
determinations for these items and section 1842(l) applicable to 
physicians not accepting assignment. Implementing regulations are found 
at 42 CFR 411.404(b) and (c), and 411.408(d)(2) and (f), on written 
notice requirements. These statutory requirements apply only to 
Original Medicare, not Medicare Advantage plans.
    Under section 1879 of the Act, Medicare beneficiaries may be held 
financially responsible for items or services usually covered under

[[Page 13059]]

Medicare, but denied in an individual case under specific statutory 
exclusions, if the beneficiary is informed prior to furnishing the 
issues or services that Medicare is likely to deny payment.
    When required, the ABN is delivered by Part B paid physicians, 
providers (including institutional providers like outpatient hospitals) 
practitioners (such as chiropractors), and suppliers, as well as 
hospice providers and Religious Non-medical Health Care Institutions 
paid under Part A. Other Medicare institutional providers paid under 
Part A use other approved notice for this purpose.
    The revised ABN in this information collection request incorporates 
expanded use by Home Health Agencies (HHAs). There have been no 
substantive changes to the form. There are no changes that will affect 
existing ABN users. Form Number: CMS-R-131 (OMB: 0938-0566); 
Frequency: Reporting--Occasionally; Affected Public: Private Sector--
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 1,288,837; Total Annual Responses: 52,967,771; Total 
Annual Hours: 6,177,101. (For policy questions regarding this 
collection contact Evelyn Blaemire at 410-786-1803. For all other 
issues call 410-786-1326.)
    4. Type of Information Collection Request: New collection; Title: 
Home Health Change of Care Notice (HHCCN); Use: Home health agencies 
(HHAs) are required to provide written notice to original Medicare 
beneficiaries under various circumstances involving the initiation, 
reduction, or termination of services. The notice used in these 
situations has been the Home Health Advance Beneficiary Notice (HHABN), 
    The HHABN, originally a liability notice specifically for HHA 
issuance, was first approved for use and implementation in 2000 with 
the home health prospective payment system transition. In 2006, the 
notice underwent significant modifications subsequent to the decision 
of the U.S. Court of Appeals (2nd Circuit) in Lutwin v. Thompson. HHABN 
content and formatting were revised so that it could be used to provide 
beneficiaries with change of care notification consistent with HHA 
Conditions of Participation (COPs) in addition to its liability notice 
function. Three interchangeable option boxes were introduced to the 
HHABN to support the added notification purposes. Option Box 1 
addressed liability, Option Box 2 addressed change of care for agency 
reasons, and Option Box 3 addressed change of care due to provider 
orders. HHABN Collection 0938-0781 last received PRA approval in 2009 
following minor notice changes such as accessibility reformatting for 
compliance with Section 508 of the Rehabilitation Act of 1973, as 
amended in 1998, and removal of the beneficiary's health insurance 
claim number (HICN).
    In an effort to streamline, reduce, and simplify notices issued to 
Medicare beneficiaries, HHABN Option Box 1, the liability notice 
portion, will be replaced by the existing Advanced Beneficiary Notice 
of Noncoverage (ABN) which is approved by OMB (0938-0566), for 
conveying information on beneficiary liability. Written notices to 
inform beneficiaries of their liability under specific conditions have 
been available since the ``limitation on liability'' provisions in 
section 1879 of the Social Security Act were enacted in 1972 (Pub. L. 
92-603). The ABN (CMS-R-131) is presently used by providers and 
suppliers other than HHAs to inform fee for service (FFS) Medicare 
beneficiaries of potential liability for certain items/services that 
might be billed to Medicare. The HHABN was developed specifically as 
the liability notice for HHA issuance. Since 2006, the HHABN has 
evolved to serve both liability and change of care notification 
purposes. Pursuant to a separate PRA package revising the use of the 
ABN, HHAs will now use the ABN for liability notification, and the 
HHCCN will be introduced as a separate, distinct document to give 
change of care notice in compliance with HHA conditions of 
participation. The HHCCN will replace both Option Box 2 and Option Box 
3 formats of the HHABN. The single page format of the HHCCN is designed 
to specify whether the change of care is due to agency reasons or 
provider orders. Form Number: CMS-10280 (OCN: 0938-New); Frequency: 
Occasionally; Affected Public: Private Sector--Business or other for-
profits and not-for-profit institutions; Number of Respondents: 10,914; 
Total Annual Responses: 14,126,428; Total Annual Hours: 941,385. (For 
policy questions regarding this collection contact Evelyn Blaemire at 
410-786-1803. 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 
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.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on March 28, 2013.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, Email: [email protected].

    Dated: February 20, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-04313 Filed 2-25-13; 8:45 am]