[Federal Register: September 21, 2004 (Volume 69, Number 182)]
[Notices]
[Page 56430-56432]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21se04-51]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-249, CMS-906, CMS-2088-92, CMS-R-48, CMS-
382, CMS-484 and CMS-846-849, 854, 10125, 10126]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
[[Page 56431]]
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (HCFA)), 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 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.
1. Type of Information Collection Request: Extension of currently
approved collection.
Title of Information Collection: Hospice Cost Report and Supporting
Regulations Contained in 42 CFR 413.20 and 413.24.
Use: The hospice cost report is the mechanism used to collect data
from providers for rate evaluations for the Prospective Payment System
(PPS). Once CMS obtains this information, we will update the PPS as
mandated by Congress.
Form Number: CMS-R-249 (OMB: 0938-0758).
Frequency: Annually.
Affected Public: Not-for-profit Institutions and Business or other
for-profit.
Number of Respondents: 1,720.
Total Annual Responses: 1,720.
Total Annual Hours: 302,720.
2. Type of Information Collection Request: Extension of currently
approved collection.
Title of Information Collection: Fiscal Soundness Reporting
Requirements and Supporting Regulations in 42 CFR 417.126, 422.502(f)
and 422.516(a).
Use: CMS needs this information to establish on-going fiscal
soundness of the Managed Care Organizations and Insurance Companies.
Form Number: CMS-906 (OMB: 0938-0469).
Frequency: Quarterly and Annually.
Affected Public: Business or other for-profit.
Number of Respondents: 150.
Total Annual Responses: 750.
Total Annual Hours: 150.
3. Type of Information Collection Request: Extension of currently
approved collection.
Title of Information Collection: Outpatient Rehabilitation Cost
Report and Supporting Regulations Contained in 42 CFR 413.20 and
413.24.
Use: This form is used by community mental health centers to report
their health care costs to determine the amount of reimbursement for
services furnished to Medicare beneficiaries.
Form Number: CMS-2088-92 (OMB: 0938-0037).
Frequency: Annually.
Affected Public: Business or other for-profit; Not-for profit
Institutions, State, Local or Tribal governments.
Number of Respondents: 618.
Total Annual Responses: 618.
Total Annual Hours: 61,800.
4. Type of Information Collection Request: Extension of a currently
approved collection.
Title of Information Collection: Hospital Conditions of
Participation (COP) and Supporting Regulations in 42 CFR 482.12,
482.13, 482.21, 482.22, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53,
482.56, 482.57, 482.60, 482.61, 482.62, 485.618 and 485.631.
Use: Hospitals seeking to participate in the Medicare and Medicaid
programs must meet the Conditions of Participation (COP) for Hospitals,
42 CFR Part 482. The information collection requirements contained in
this package are needed to implement the Medicare and Medicaid COP for
hospitals and critical access hospitals (CAHs).
Form Number: CMS-R-48 (OMB 0938-0328).
Frequency: Annually.
Affected Public: Business or other for-profit, Not-for-profit
institutions, Federal Government, and State, Local or Tribal Gov.
Number of Respondents: 6,085.
Total Annual Responses: 6,085.
Total Annual Hours: 5,627,513.
5. Type of Information Collection Request: Revision of currently
approved collection.
Title of Information Collection: ESRD Beneficiary Selection and
Supporting Regulations Contained in 42 CFR 414.330.
Use: ESRD facilities have each new home dialysis patient select one
of two methods to handle Medicare reimbursement. The intermediaries pay
for the beneficiaries selecting Method I and the carriers pay for the
beneficiaries selecting Method II. This system was developed to avoid
duplicate billing by both intermediaries and carriers.
Form Number: CMS-382 (OMB: 0938-0372).
Frequency: Other: one time only.
Affected Public: Individuals or Households, Business or other for-
profit, and Not-for profit Institutions.
Number of Respondents: 7,400.
Total Annual Responses: 7,400.
Total Annual Hours: 617.
6. Type of Information Collection Request: Revision of currently
approved collection.
Title of Information Collection: Oxygen.
Use: This form is used to determine if oxygen is reasonable and
necessary pursuant to Medicare Statute. Medicare claims for home oxygen
therapy must be supported by the treating physician's statement and
other information including estimate length of need ( of
months), diagnosis codes (ICD-9) etc.
Form Number: CMS-484 (OMB: 0938-0534).
Frequency: Other-as needed.
Affected Public: Business or other for-profit.
Number of Respondents: 11,000.
Total Annual Responses: 1,200,000.
Total Annual Hours: 497,000.
7. Type of Information Collection Request: Revision of currently
approved collection.
Title of Information Collection: Durable Medical Equipment Regional
Carrier, Certificate of Medical Necessity and Supporting Documentation.
Use: The information collected on these forms is needed to
correctly process claims and ensure proper claim payment. Suppliers and
physicians will complete these forms and as needed supply additional
routine supporting documentation necessary to process claims. In
addition to the other revisions in this collection, it is important to
note the introduction of two new CMS form numbers. CMS form numbers
851, 852, and 853 have been replaced with DIFs and have been issued new
CMS form numbers. CMS form number 851 is now CMS form number 10125. CMS
form numbers 852 and 853 have now combined into a single DIF with CMS
form number 10126.
Form Number: CMS-846-849, 854, 10125,10126 (OMB: 0938-
0679).
Frequency: On occasion.
Affected Public: Business or other for-profit.
Number of Respondents: 51,000.
Total Annual Responses: 5,400,000.
Total Annual Hours: 1,215,000.
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/regulations/pra/, or E-mail
your request, including your address, phone number, OMB number, and CMS
document
[[Page 56432]]
identifier, to Paperwork@cms.hhs.gov, or call the Reports Clearance
Office on (410) 786-1326.
Written comments and recommendations for the proposed information
collections must be mailed within 60 days of this notice directly to
the CMS Paperwork Clearance Officer designated at the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development and Issuances, Attention: Melissa
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Dated: September 9, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, Office of Strategic Operations and
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 04-21027 Filed 9-20-04; 8:45 am]
BILLING CODE 4120-03-P