Agency Information Collection Activities: Proposed Collection; Comment Request, 12221-12222 [05-4887]
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Federal Register / Vol. 70, No. 47 / Friday, March 11, 2005 / Notices
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: Extension of a currently
approved collection; Title of
Information Collection: Model
Application Template for State Child
Health Plan Under Title XXI of the
Social Security Act, State Children’s
Health Insurance Program, and Model
Application Template and Instructions;
Use: States are required to submit Title
XXI plans and amendments for approval
by the Secretary pursuant to Section
2102 of the Social Security Act in order
to receive funds for initiating and
expanding health insurance coverage for
uninsured children. The model
application template is used to assist
States in submitting a State Child Health
Plan and amendments to that plan;
Form Number: CMS–R–211 (OMB#:
0938–0707); Frequency: Quarterly and
annually; Affected Public: State, local or
tribal government; Number of
Respondents: 40; Total Annual
Responses: 40; Total Annual Hours:
3,200.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Restraint and
Seclusion Standards for Psychiatric
Residential Treatment Facilities; Use:
Psychiatric residential treatment
facilities are required to report deaths,
serious injuries and attempted suicides
to State Medicaid Agency and
Protection and Advocacy Organization.
They are also required to provide
residents restraint and seclusion policy
in writing, and to document resident
record of all activities involving use of
restraint and seclusion. Form Number:
CMS–R–306 (OMB#: 0938–0833);
Frequency: On occasion; Affected
Public: Business or other for-profit and
not-for-profit institutions; Number of
Respondents: 500; Total Annual
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Responses: 1,199,000; Total Annual
Hours: 713,250.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Granting and
Withdrawal of Deeming Authority to
Private Nonprofit Accreditation
Organizations and of State Exemption
Under State Laboratory Program and
Supporting Regulations in 42 CFR
493.551–493.557; Use: The information
required is necessary to determine
whether a private accreditation
organization’s or State licensure
program’s standards and accreditation/
licensure process is equal to or more
stringent than those of CLIA; Form
Number: CMS–R–185 (OMB#: 0938–
0686); Frequency: As needed; Affected
Public: Not-for-profit institutions,
business or other for-profit, and State,
local or tribal government; Number of
Respondents: 8; Total Annual
Responses: 76; Total Annual Hours:
768.
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Inpatient
Psychiatric Services for Individuals
Under Age 21 and Supporting
Regulations in 42 CFR 441.151 and
441.152; Use: Certification requirements
in Section 441.152 require that the
certification of need for inpatient
psychiatric services include
documented clinical evidence that
serves as the basis for the certification
of need for inpatient psychiatric care.
Section 1905(h)(1)(B) requires
physicians and other personnel
qualified to make determinations, with
respect to mental health conditions and
the treatment thereof, certify the need
for care which they have determined to
be necessary on an inpatient basis; Form
Number: CMS–R–238 (OMB#: 0938–
0754); Frequency: Recordkeeping;
Affected Public: State, local or tribal
government, not-for-profit institutions
and business or other for-profit; Number
of Respondents: 80,000; Total Annual
Responses: 80,000; Total Annual Hours:
1.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS Web site
address at https://www.cms.hhs.gov/
regulations/pra/, or e-mail your request,
including your address, phone number,
OMB number, and CMS document
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
PO 00000
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12221
within 30 days of this notice directly to
the OMB desk officer: OMB Human
Resources and Housing Branch,
Attention: Christopher Martin, New
Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports
Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–4886 Filed 3–10–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10143, CMS–R–
295, CMS–R–79, and CMS–R–10]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
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) 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: New collection; Title of
Information Collection: Monthly State
File of Medicaid/Medicare Dual Eligible
Enrollees and Supporting Regulations in
42 CFR 423.900 through 423.910; Use:
The monthly file of dual eligible
enrollees will be used to determine
those duals with drug benefits for the
phased-down State contribution process
required by the Medicare Modernization
Act of 2003 (MMA). Section 103(a)(2) of
the MMA addresses the phased-down
State contribution (PDSC) process for
the Medicare program. The reporting of
the Medicare/Medicaid dual eligibles on
AGENCY:
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11MRN1
12222
Federal Register / Vol. 70, No. 47 / Friday, March 11, 2005 / Notices
a monthly basis is necessary to
implement those provisions, and to
Support Part D subsidy determinations
and auto-assignment of individuals to
Part D plans. The PDSC is a partial
recoupment from the States of ongoing
Medicaid drug costs for dual eligibles
assumed by Medicare under MMA,
which absent the MMA would have
been paid for by the States; Form
Number: CMS–10143 (OMB#: 0938–
NEW); Frequency: Recordkeeping and
Monthly reporting; Affected Public:
State, Local or Tribal Government;
Number of Respondents: 51; Total
Annual Responses: 612; Total Annual
Hours: 10,710.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare
CAHPS Disenrollment Surveys and
Supporting Regulations in 42 CFR
417.126, 417.470, 422.64, and 422.210;
Use: This survey helps Medicare track a
variety of consumer satisfaction
measures relating to Medicare
beneficiaries who leave their MA plans.
The Centers for Medicare & Medicaid
Services (CMS) has a responsibility to
its Medicare beneficiaries to require that
care provided by managed care
organizations under contract to CMS is
of high quality. One way of ensuring
high quality care is through the
development of performance measures
and standardized satisfaction surveys
that enable CMS to gather the data
needed to evaluate the care provided to
Medicare beneficiaries; Form Number:
CMS–R–295 (OMB#: 0938–0779);
Frequency: Quarterly; Affected Public:
Individuals or Households; Number of
Respondents: 44,200; Total Annual
Responses: 41,697; Total Annual hours:
17,823.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Payment
Adjustment for Sole Community
Hospitals and Supporting Regulations in
42 CFR 412.92; Form No.: CMS–R–79
(OMB# 0938–0477); Use: This collection
provides that if a hospital that is
classified as a sole community hospital
(SCH) experiences, due to
circumstances beyond its control, a
decrease of more than 5 percent in its
total number of discharges compared to
the immediately preceding cost
reporting period, the hospital may apply
for a payment adjustment. To qualify for
this adjustment to its payment rate an
SCH must submit documentation,
including cost information as requested
by CMS, to the intermediary; Frequency:
On occasion; Affected Public: Not-forprofit institutions, Business or other for-
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16:40 Mar 10, 2005
Jkt 205001
profit, and State, Local or Tribal
Government; Number of Respondents:
40; Total Annual Responses: 40; Total
Annual Hours: 160.
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Information
Collection Requirements Contained in
BPD–718: Advance Directives (Medicare
and Medicaid) and Supporting
Regulations in 42 CFR 417.436, 417.801,
422.128, 430.12, 431.20, 431.107, 438.6,
440.170, 483.10, 484.10, and 489.102;
Form No.: CMS–R–10 (OMB# 0938–
0610); Use: Steps have been taken at
both the Federal and State level, to
afford greater opportunity for the
individual to participate in decisions
made concerning the medical treatment
to be received by an adult patient in the
event that the patient is unable to
communicate to others, a preference
about medical treatment. The individual
may make his preference known
through the use of an advance directive,
which is a written instruction prepared
in advance, such as a living will or
durable power of attorney. This
information is documented in a
prominent part of the individual’s
medical record. Advance directives as
described in the Patient SelfDetermination Act (enacted in 1991)
have increased the individual’s control
over decisions concerning medical
treatment. The advance directives
requirement was enacted because
Congress wanted individuals to know
that they have a right to make health
care decisions and to refuse treatment
even when they are unable to
communicate.; Frequency: On occasion;
Affected Public: Business or other forprofit; Number of Respondents: 33,096;
Total Annual Responses: 33,096; Total
Annual Hours: 924,120.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’’ Web Site
address at https://www.cms.hhs.gov/
regulations/pra/, or e-mail your request,
including your address, phone number,
OMB number, and CMS document
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 Reduction Act
Reports Clearance Officer designated at
the addressbelow:
CMS, Office of Strategic Operations
and Regulatory Affairs, Division of
Regulations Development, Attention:
Melissa Musotto, Room C4–26–05, 7500
PO 00000
Frm 00052
Fmt 4703
Sfmt 4703
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports
Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–4887 Filed 3–10–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Agency Information Collection
Activities: Proposed Collection;
Comment Request
In compliance with the requirement
for the opportunity for public comment
on proposed data collection projects
(section 3506(c)(2)(A) of Title 44, United
States Code, as amended by the
Paperwork Reduction Act of 1995, Pub.
L. 104–13), the Health Resources and
Services Administration (HRSA)
publishes periodic summaries of
proposed projects being developed for
submission to OMB under the
Paperwork Reduction Act of 1995. To
request more information on the
proposed project or to obtain a copy of
the data collection plans and draft
instruments, call the HRSA Reports
Clearance Officer at (301) 443–1129.
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the Agency,
including whether the information shall
have practical utility; (b) the accuracy of
the Agency’s estimate of the burden of
the proposed collection of information;
(c) ways to enhance the quality, utility,
and clarity of the information to be
collected; and (d) ways to minimize the
burden of the collection of information
on respondents, including through the
use of automated collection techniques
or other forms of information
technology.
Proposed Project: Evaluation of
Universal Newborn Hearing Screening
and Intervention Program—(NEW)
The purpose of the universal newborn
hearing screening and intervention
evaluation project is to describe the
efficacy, or lack thereof, of a national
program to assure that all newborn
infants are screened for hearing loss
before discharge from the newborn
nursery, and that those infants who do
not pass the initial screening procedures
have timely and appropriate follow-up,
E:\FR\FM\11MRN1.SGM
11MRN1
]]>Agencies
[Federal Register Volume 70, Number 47 (Friday, March 11, 2005)]
[Notices]
[Pages 12221-12222]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-4887]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10143, CMS-R-295, CMS-R-79, and CMS-R-10]
Agency Information Collection Activities: Proposed Collection;
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) 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: New collection; Title of
Information Collection: Monthly State File of Medicaid/Medicare Dual
Eligible Enrollees and Supporting Regulations in 42 CFR 423.900 through
423.910; Use: The monthly file of dual eligible enrollees will be used
to determine those duals with drug benefits for the phased-down State
contribution process required by the Medicare Modernization Act of 2003
(MMA). Section 103(a)(2) of the MMA addresses the phased-down State
contribution (PDSC) process for the Medicare program. The reporting of
the Medicare/Medicaid dual eligibles on
[[Page 12222]]
a monthly basis is necessary to implement those provisions, and to
Support Part D subsidy determinations and auto-assignment of
individuals to Part D plans. The PDSC is a partial recoupment from the
States of ongoing Medicaid drug costs for dual eligibles assumed by
Medicare under MMA, which absent the MMA would have been paid for by
the States; Form Number: CMS-10143 (OMB: 0938-NEW); Frequency:
Recordkeeping and Monthly reporting; Affected Public: State, Local or
Tribal Government; Number of Respondents: 51; Total Annual Responses:
612; Total Annual Hours: 10,710.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare CAHPS
Disenrollment Surveys and Supporting Regulations in 42 CFR 417.126,
417.470, 422.64, and 422.210; Use: This survey helps Medicare track a
variety of consumer satisfaction measures relating to Medicare
beneficiaries who leave their MA plans. The Centers for Medicare &
Medicaid Services (CMS) has a responsibility to its Medicare
beneficiaries to require that care provided by managed care
organizations under contract to CMS is of high quality. One way of
ensuring high quality care is through the development of performance
measures and standardized satisfaction surveys that enable CMS to
gather the data needed to evaluate the care provided to Medicare
beneficiaries; Form Number: CMS-R-295 (OMB: 0938-0779);
Frequency: Quarterly; Affected Public: Individuals or Households;
Number of Respondents: 44,200; Total Annual Responses: 41,697; Total
Annual hours: 17,823.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Payment
Adjustment for Sole Community Hospitals and Supporting Regulations in
42 CFR 412.92; Form No.: CMS-R-79 (OMB 0938-0477); Use: This
collection provides that if a hospital that is classified as a sole
community hospital (SCH) experiences, due to circumstances beyond its
control, a decrease of more than 5 percent in its total number of
discharges compared to the immediately preceding cost reporting period,
the hospital may apply for a payment adjustment. To qualify for this
adjustment to its payment rate an SCH must submit documentation,
including cost information as requested by CMS, to the intermediary;
Frequency: On occasion; Affected Public: Not-for-profit institutions,
Business or other for-profit, and State, Local or Tribal Government;
Number of Respondents: 40; Total Annual Responses: 40; Total Annual
Hours: 160.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Information
Collection Requirements Contained in BPD-718: Advance Directives
(Medicare and Medicaid) and Supporting Regulations in 42 CFR 417.436,
417.801, 422.128, 430.12, 431.20, 431.107, 438.6, 440.170, 483.10,
484.10, and 489.102; Form No.: CMS-R-10 (OMB 0938-0610); Use:
Steps have been taken at both the Federal and State level, to afford
greater opportunity for the individual to participate in decisions made
concerning the medical treatment to be received by an adult patient in
the event that the patient is unable to communicate to others, a
preference about medical treatment. The individual may make his
preference known through the use of an advance directive, which is a
written instruction prepared in advance, such as a living will or
durable power of attorney. This information is documented in a
prominent part of the individual's medical record. Advance directives
as described in the Patient Self-Determination Act (enacted in 1991)
have increased the individual's control over decisions concerning
medical treatment. The advance directives requirement was enacted
because Congress wanted individuals to know that they have a right to
make health care decisions and to refuse treatment even when they are
unable to communicate.; Frequency: On occasion; Affected Public:
Business or other for-profit; Number of Respondents: 33,096; Total
Annual Responses: 33,096; Total Annual Hours: 924,120.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS''
Web Site address at https://www.cms.hhs.gov/regulations/pra/, or e-mail
your request, including your address, phone number, OMB number, and CMS
document 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 Reduction Act Reports Clearance Officer designated at
the addressbelow:
CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Melissa Musotto, Room
C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of
Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-4887 Filed 3-10-05; 8:45 am]
BILLING CODE 4120-03-P
