Agency Information Collection Activities: Submission for OMB Review; Comment Request, 62122-62124 [05-21517]
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Federal Register / Vol. 70, No. 208 / Friday, October 28, 2005 / Notices
many of the questions raised by outdoor
users and public health officials, and
improve and strengthen evidence-based
NPS guidelines for backcountry health
and sanitation practices. To gather this
information, consent to contact after the
conclusion of the backcountry trip will
be obtained from an estimated 7,000
backcountry users 18 years of age or
older when they present to the
Yellowstone National Park’s permit
offices prior to entering the
backcountry. A questionnaire (in either
Internet-based or paper-based format)
will then be offered to an estimated
5,600 backcountry users who consent to
be contacted. Participants will be asked
about their health (before, during and
after backcountry travel), water
consumption, water preparation habits,
food consumption, food preparation
habits, sanitation practices, recreational
water use, animal exposure, and
demographics.
This study is the beginning of what
will be an ongoing effort to improve the
scientific basis of NPS
recommendations and policies related
to protecting human health in the
backcountry. This effort seeks to begin
to identify disease transmission
pathways and assess disease and injury
risks associated with specific activities,
choices, and behaviors of backcountry
visitors, such as water purification,
sanitation practices, and hygiene.
Thoroughly understanding transmission
pathways and the interactions of agent,
environment, and host will enable the
NPS to effectively and efficiently
improve visitor protection efforts.
There will be no cost to or
remuneration of respondents other than
their time. Their participation is
voluntary and there will be no penalty
for non-participation.
Estimate of Annualized Burden Table
Number of
respondents
Number
responses
per respondent
Consent to Further Contact ......................
Web-Based Questionnaire ........................
7000
5600
1
1
2/60
15/60
233
1400
Total .......................................................
....................
..................
..................
1633
Respondents
Form name
Backcountry Users of Yellowstone Park ...
Dated: October 21, 2005.
Betsey Dunaway,
Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.
[FR Doc. 05–21540 Filed 10–27–05; 8:45 am]
BILLING CODE 4163–18–P 1
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–0021, CMS–
838, CMS–10134, CMS–R–137, CMS–R–257,
CMS–29/CMS–30, CMS–10150, CMS–381,
CMS–10161, CMS–10162, and 10136]
Agency Information Collection
Activities: Submission for OMB
Review; 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), 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,
AGENCY:
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18:15 Oct 27, 2005
Jkt 208001
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: Withholding
Medicare Payments to Recover
Medicaid Overpayments and
Supporting Regulations in 42 CFR
447.31; Use: Overpayments may occur
in either the Medicare and Medicaid
program, at times resulting in a situation
where an institution or person that
provides services owes a repayment to
one program while still receiving
reimbursement from the other. Certain
Medicaid providers which are subject to
offsets for the collection of Medicaid
overpayments may terminate or
substantially reduce their participation
in Medicaid, leaving the State Medicaid
Agency unable to recover the amounts
due. These information collection
requirements give CMS the authority to
recover Medicaid overpayments by
offsetting payments due to a provider
under the program. Form Number:
CMS–R–0021 (OMB #0938–0287);
Frequency: Reporting—On occasion;
Affected Public: State, Local or Tribal
Government; Number of Respondents:
54; Total Annual Responses: 27; Total
Annual Hours: 81.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare Credit
PO 00000
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Sfmt 4703
Hrs/response
(in hours)
Total response burden hours
Balance Reporting Requirements and
Supporting Regulations in 42 CFR
405.371, 405.378, and 413.20; Form
Number: CMS–838 (OMB #0938–0600);
Use: Section 1815(a) of the Social
Security Act authorizes the Secretary to
request information from providers
which is necessary to properly
administer the Medicare program.
Quarterly credit balance reporting is
needed to monitor and control the
identification and timely collection of
improper payments. The reporting
requirements provide CMS with the
authority to impose sanctions such as
the suspension of program payments in
accordance with 42 CFR 413.20(e) and
405.371 if providers do not report credit
balances on a timely basis. Furthermore,
once a credit balance has been
identified on a CMS–838 form and
demand for payment is made, CMS has
the authority to charge interest if the
amount is not repaid within 30 days in
accordance with 42 CFR 405.378. The
collection of credit balance information
is needed to ensure that millions of
dollars in improper program payments
are collected. Approximately 48,300
health care providers will be required to
submit a quarterly credit balance report
that identifies the amount of improper
payments they received that are due to
Medicare. The intermediaries will
monitor the reports to ensure these
funds are collected; Frequency:
Quarterly; Affected Public: Not-forprofit institutions, Business or other forprofit; Number of Respondents: 48,300;
Total Annual Responses: 193,200; Total
Annual Hours: 579,600.
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Federal Register / Vol. 70, No. 208 / Friday, October 28, 2005 / Notices
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Physician Group
Practice (PGP) Standardized
Ambulatory Care Quality Measure
Collection Initiative; Use: The Benefits
Improvement & Protection Act of 2000
mandated the PGP Demonstration and
gave the Secretary discretion to use
quality measures to assess physician
performance in order to reward
physicians for improvements in the
quality and efficiency of health care.
This demonstration is intended to
strengthen the Medicare program by
offering innovative models to people on
Medicare that improve quality and
access and lower costs. As a result,
Medicare beneficiaries will directly
benefit from these innovative models.
The demonstration represents the first
pay for performance project for
physician group practices and will
enable comparisons across groups and
geography; Form Number: CMS–10134
(OMB #0938–0942); Frequency:
Annually; Affected Public: Business or
other for-profit and Not-for-profit
institutions; Number of Respondents:
10; Total Annual Responses: 10; Total
Annual Hours: 790.
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Internal
Revenue Service/Social Security
Administration/Centers for Medicare
and Medicaid Services Data Match and
Supporting Regulations in 42 CFR
411.20–491.206; Form Number: CMS–
R–137 (OMB #0938–0565); Use: The
Data Match project and information
collection activity provides a ‘‘check
and balance’’ against the Medicare
program relying solely on a single
information collection system. It gives
CMS the opportunity to pursue
collection of identified mistaken
payments (within legal constraints) and
to update incorrect status indicators to
prevent further incorrect suspensions or
mistaken payment or denial. Employers
identified through a match of IRS, SSA,
and Medicare records will be contacted
concerning group health plan coverage
of identified individuals to ensure
compliance with Medicare Secondary
Payer provisions, in accordance with
the Medicare statute found at 42 U.S.C.
1395y(b); Frequency: Reporting—
Annually; Affected Public: Business or
other for-profit, Not-for-profit
institutions, Farms, Federal
Government, State, Local or Tribal
Government; Number of Respondents:
341,065; Total Annual Responses:
341,065; Total Annual Hours: 1,986,810.
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5. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare
Advantage Disenrollment Form to
original Medicare; Form Number: CMS–
R–257 (OMB #0938–0741); Use: Section
4001 of the Balanced Budget Act of 1997
amended the Social Security Act to add
Section 1851, including 1851(c)(1)
which required the establishment of a
procedure and form to make and change
Medicare Advantage elections, which
include disenrollment. The
disenrollment form provides
beneficiaries an option to submit a
disenrollment to a neutral third party,
process the disenrollment action as a
change of election and to elicit the
reasons for disenrollment in order to
discern and report disenrollment rates;
Frequency: On occasion and Other (onetime only); Affected Public: Individuals
or Households, Business or other forprofit, Not-for-profit institutions, and
Federal Government; Number of
Respondents: 50,000; Total Annual
Responses: 50,000; Total Annual Hours:
3,300.
6. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Request for
Certification as Rural Health Clinic and
Rural Health Clinic Survey Report Form
and Supporting Regulations in 42 CFR
491.1–491.11; Form Number: CMS–29
and CMS–30 (OMB #0938–0074); Use:
The form CMS–29 is utilized as an
application to be completed by
suppliers of Rural Health Clinic (RHC)
services requesting participation in the
Medicare/Medicaid programs. This form
initiates the process of obtaining a
decision as to whether the conditions
for certification are met as a supplier of
RHC services. It also promotes data
reduction or introduction to and
retrieval from the Online Survey and
Certification and Reporting System
(OSCAR) by CMS Regional Offices (RO).
The Form CMS–30 is an instrument
used by the State survey agency to
record data collected in order to
determine RHC compliance with
individual conditions of participation
and to report it to the Federal
government. The form is primarily a
coding worksheet designed to facilitate
data reduction (keypunching) and
retrieval into OSCAR at the CMS ROs.
The form includes basic information on
compliance (i.e., met, not met and
explanatory statements) and does not
require any descriptive information
regarding the survey activity itself;
Frequency: Reporting—Annually;
Affected Public: State, Local or Tribal
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62123
Government; Number of Respondents:
698; Total Annual Responses: 698; Total
Annual Hours: 1,222.
7. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Collection of
Drug Pricing and Network Pharmacy
Data from Medicare Prescription Drug
Plans (PDPs and MA–PDs) and
Supporting Regulations in 42 CFR
423.48; Form Number: CMS–10150
(OMB #0938–0951); Use: Both stand
alone prescription drug plans (PDPs)
and Medicare Advantage Prescription
Drug (MA–PDs) plans will be required
to submit drug pricing and pharmacy
network data to CMS. These data will be
made publicly available to Medicare
beneficiaries through the new Medicare
prescription drug plan finder tool that
will be launched in the fall of 2005 on
https://www.medicare.gov. The purpose
of the data is to enable beneficiaries to
compare, learn, select and enroll in a
plan that best meets their needs;
Frequency: Reporting—Weekly;
Affected Public: Business or other forprofit; Number of Respondents: 350;
Total Annual Responses: 18,200; Total
Annual Hours: 36,400.
8. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Identification of
Extension Units of Outpatient Physical
Therapy/Outpatient Speech Pathology
(OPT/OSP) Providers and Supporting
Regulations in 42 CFR Sections
485.701–485.729; Form Number: CMS–
381 (OMB #0938–0273); Use: Medicare
provides OPT/OSP providers to be
surveyed to determine compliance with
Federal regulations. All locations where
OPT/OSP providers furnish services
must meet these requirements. The
CMS–381 is the form used to identify all
the OPT/OSP locations. Frequency:
Reporting—Annually; Affected Public:
Business or other for-profit; Number of
Respondents: 2960; Total Annual
Responses: 2960; Total Annual Hours:
740.
9. Type of Information Collection
Request: New Collection; Title of
Information Collection: New Freedom
Initiative—Web-based Reporting System
for Grantees; Form Number: CMS–10161
(OMB #0938–NEW); Use: CMS currently
awards competitive grants to States and
other eligible entities for the purpose of
designing and implementing effective
and enduring improvements in
community-based long-term services
and supporting systems. We currently
require grantees to report quarterly,
semi-annual, and or annually,
depending on the grant type. CMS
requires the information obtained
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Federal Register / Vol. 70, No. 208 / Friday, October 28, 2005 / Notices
through web-based grantee reporting for
two reasons: (1) In order to effectively
monitor the grants, and; (2) to report to
Congress and other interested
stakeholders the progress and obstacles
experienced by the grantees. The
grantees are the respondents to the webbased reporting system; Frequency:
Reporting—Quarterly, Semi-annually,
and Annually; Affected Public: State,
Local or Tribal Government and Not-forprofit institutions; Number of
Respondents: 298; Total Annual
Responses: 836; Total Annual Hours:
6,440.
10. Type of Information Collection
Request: New Collection; Title of
Information Collection: Medicare Care
Improvement Survey; Use: The purpose
of this beneficiary survey is to obtain
information about beneficiary
behavioral change, physical functioning
and satisfaction with the Chronic Care
Improvement (CCI) programs.
Legislation requires that all of the
aforementioned data elements be
collected, as they provide information
that is critical to the decision-making
process as it pertains to the expansion
of the pilot programs. The chronic care
improvement programs are to be
designed to incorporate relevant
features from private sector programs
but also be sufficiently flexible to adapt
to the unique needs of their Medicare
populations. This survey is required to
support the legislative mandate to
evaluate the Chronic Care Improvement
Programs. Beneficiary participation in
the CCI–I program will be voluntary and
will not change the scope, duration or
amount of Medicare fee-for-service
(FFS) benefits currently received by FFS
Medicare beneficiaries; Form Number:
CMS–10162 (OMB #0938–NEW);
Frequency: Reporting—On occasion;
Affected Public: Individuals or
Households; Number of Respondents:
9,449; Total Annual Responses: 9,449;
Total Annual Hours: 2,636.
11. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare Care
Management Performance (MCMP)
Demonstration—Standardized
Ambulatory Care Quality Collection
Initiative; Use: The MCMP
Demonstration was authorized by
Section 649 of the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA). This
project requires the Secretary to
establish a pay-for-performance 3-year
pilot with physicians to promote the
adoption and use of health information
technology to improve the quality of
patient care for chronically ill Medicare
patients. This demonstration represents
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the first pay for performance project
fostering the adoption of health
information technology in small
physician group practices and will
enable a test of the concept to improve
the quality and efficiency of care in Feefor-Service Medicare; Form Number:
CMS–10136 (OMB #0938–0941);
Frequency: Annually; Affected Public:
Business or other for-profit and Not-forprofit institutions; Number of
Respondents: 800; Total Annual
Responses: 800; Total Annual Hours:
19,200.
To obtain copies of the supporting
statement and any related forms for
these 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 and (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 November 28, 2005. OMB Human
Resources and Housing Branch,
Attention: CMS Desk Officer, New
Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: October 21, 2005.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 05–21517 Filed 10–27–05; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1316–N]
Medicare Program; Meeting of the
Practicing Physicians Advisory
Council, December 5, 2005
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
SUMMARY: This notice announces a
quarterly meeting of the Practicing
Physicians Advisory Council (the
Council). The Council will meet to
discuss certain proposed changes in
regulations and carrier manual
instructions related to physicians’
services, as identified by the Secretary
of Health and Human Services (the
PO 00000
Frm 00035
Fmt 4703
Sfmt 4703
Secretary). This meeting is open to the
public.
DATES: The Council meeting is
scheduled for Monday, December 5,
2005, from 8:30 a.m. until 3:30 p.m.
e.s.t.
ADDRESSES: The meeting will be held in
Room 705A 7th floor, in the Hubert H.
Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201.
MEETING REGISTRATION: Persons wishing
to attend this meeting must register by
contacting Kelly Buchanan, the
Designated Federal Official (DFO) by email at PPAC@cms.hhs.gov or by
telephone at (410) 786–6132, at least 72
hours in advance of the meeting. This
meeting will be held in a Federal
Government Building, Hubert H.
Humphrey Building, and persons
attending the meeting will be required
to show a photographic identification,
preferably a valid driver’s license, and
will be listed on an approved security
list before persons are permitted
entrance. Persons not registered in
advance will not be permitted into the
Hubert H. Humphrey Building and will
not be permitted to attend the Council
meeting.
FOR FURTHER INFORMATION CONTACT:
Kelly Buchanan, (410)786–6132, or
e-mail PPAC@cms.hhs.gov. News media
representatives must contact the CMS
Press Office, (202) 690–6145. Please
refer to the CMS Advisory Committees’
Information Line (1–877–449–5659 toll
free), (410)786–9379 local) or the
Internet at https://www.cms.hhs.gov/
faca/ppac/default.asp for additional
information and updates on committee
activities.
SUPPLEMENTARY INFORMATION: In
accordance with section 10(a) of the
Federal Advisory Committee Act, this
notice announces the quarterly meeting
of the Practicing Physicians Advisory
Council (the Council). The Secretary is
mandated by section 1868(a)(1) of the
Social Security Act (the Act) to appoint
a Practicing Physicians Advisory
Council based on nominations
submitted by medical organizations
representing physicians. The Council
meets quarterly to discuss certain
proposed changes in regulations and
carrier manual instructions related to
physicians’ services, as identified by the
Secretary. To the extent feasible and
consistent with statutory deadlines, the
Council’s consultation must occur
before Federal Register publication of
the proposed changes. The Council
submits an annual report on its
recommendations to the Secretary and
the Administrator of the Centers for
Medicare & Medicaid Services (CMS)
not later than December 31 of each year.
E:\FR\FM\28OCN1.SGM
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]]>Agencies
[Federal Register Volume 70, Number 208 (Friday, October 28, 2005)]
[Notices]
[Pages 62122-62124]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-21517]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-0021, CMS-838, CMS-10134, CMS-R-137, CMS-R-
257, CMS-29/CMS-30, CMS-10150, CMS-381, CMS-10161, CMS-10162, and
10136]
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: Extension of a currently
approved collection; Title of Information Collection: Withholding
Medicare Payments to Recover Medicaid Overpayments and Supporting
Regulations in 42 CFR 447.31; Use: Overpayments may occur in either the
Medicare and Medicaid program, at times resulting in a situation where
an institution or person that provides services owes a repayment to one
program while still receiving reimbursement from the other. Certain
Medicaid providers which are subject to offsets for the collection of
Medicaid overpayments may terminate or substantially reduce their
participation in Medicaid, leaving the State Medicaid Agency unable to
recover the amounts due. These information collection requirements give
CMS the authority to recover Medicaid overpayments by offsetting
payments due to a provider under the program. Form Number: CMS-R-0021
(OMB 0938-0287); Frequency: Reporting--On occasion; Affected
Public: State, Local or Tribal Government; Number of Respondents: 54;
Total Annual Responses: 27; Total Annual Hours: 81.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Credit
Balance Reporting Requirements and Supporting Regulations in 42 CFR
405.371, 405.378, and 413.20; Form Number: CMS-838 (OMB 0938-
0600); Use: Section 1815(a) of the Social Security Act authorizes the
Secretary to request information from providers which is necessary to
properly administer the Medicare program. Quarterly credit balance
reporting is needed to monitor and control the identification and
timely collection of improper payments. The reporting requirements
provide CMS with the authority to impose sanctions such as the
suspension of program payments in accordance with 42 CFR 413.20(e) and
405.371 if providers do not report credit balances on a timely basis.
Furthermore, once a credit balance has been identified on a CMS-838
form and demand for payment is made, CMS has the authority to charge
interest if the amount is not repaid within 30 days in accordance with
42 CFR 405.378. The collection of credit balance information is needed
to ensure that millions of dollars in improper program payments are
collected. Approximately 48,300 health care providers will be required
to submit a quarterly credit balance report that identifies the amount
of improper payments they received that are due to Medicare. The
intermediaries will monitor the reports to ensure these funds are
collected; Frequency: Quarterly; Affected Public: Not-for-profit
institutions, Business or other for-profit; Number of Respondents:
48,300; Total Annual Responses: 193,200; Total Annual Hours: 579,600.
[[Page 62123]]
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Physician Group
Practice (PGP) Standardized Ambulatory Care Quality Measure Collection
Initiative; Use: The Benefits Improvement & Protection Act of 2000
mandated the PGP Demonstration and gave the Secretary discretion to use
quality measures to assess physician performance in order to reward
physicians for improvements in the quality and efficiency of health
care. This demonstration is intended to strengthen the Medicare program
by offering innovative models to people on Medicare that improve
quality and access and lower costs. As a result, Medicare beneficiaries
will directly benefit from these innovative models. The demonstration
represents the first pay for performance project for physician group
practices and will enable comparisons across groups and geography; Form
Number: CMS-10134 (OMB 0938-0942); Frequency: Annually;
Affected Public: Business or other for-profit and Not-for-profit
institutions; Number of Respondents: 10; Total Annual Responses: 10;
Total Annual Hours: 790.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Internal Revenue
Service/Social Security Administration/Centers for Medicare and
Medicaid Services Data Match and Supporting Regulations in 42 CFR
411.20-491.206; Form Number: CMS-R-137 (OMB 0938-0565); Use:
The Data Match project and information collection activity provides a
``check and balance'' against the Medicare program relying solely on a
single information collection system. It gives CMS the opportunity to
pursue collection of identified mistaken payments (within legal
constraints) and to update incorrect status indicators to prevent
further incorrect suspensions or mistaken payment or denial. Employers
identified through a match of IRS, SSA, and Medicare records will be
contacted concerning group health plan coverage of identified
individuals to ensure compliance with Medicare Secondary Payer
provisions, in accordance with the Medicare statute found at 42 U.S.C.
1395y(b); Frequency: Reporting--Annually; Affected Public: Business or
other for-profit, Not-for-profit institutions, Farms, Federal
Government, State, Local or Tribal Government; Number of Respondents:
341,065; Total Annual Responses: 341,065; Total Annual Hours:
1,986,810.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Advantage Disenrollment Form to original Medicare; Form Number: CMS-R-
257 (OMB 0938-0741); Use: Section 4001 of the Balanced Budget
Act of 1997 amended the Social Security Act to add Section 1851,
including 1851(c)(1) which required the establishment of a procedure
and form to make and change Medicare Advantage elections, which include
disenrollment. The disenrollment form provides beneficiaries an option
to submit a disenrollment to a neutral third party, process the
disenrollment action as a change of election and to elicit the reasons
for disenrollment in order to discern and report disenrollment rates;
Frequency: On occasion and Other (one-time only); Affected Public:
Individuals or Households, Business or other for-profit, Not-for-profit
institutions, and Federal Government; Number of Respondents: 50,000;
Total Annual Responses: 50,000; Total Annual Hours: 3,300.
6. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Certification as Rural Health Clinic and Rural Health Clinic Survey
Report Form and Supporting Regulations in 42 CFR 491.1-491.11; Form
Number: CMS-29 and CMS-30 (OMB 0938-0074); Use: The form CMS-
29 is utilized as an application to be completed by suppliers of Rural
Health Clinic (RHC) services requesting participation in the Medicare/
Medicaid programs. This form initiates the process of obtaining a
decision as to whether the conditions for certification are met as a
supplier of RHC services. It also promotes data reduction or
introduction to and retrieval from the Online Survey and Certification
and Reporting System (OSCAR) by CMS Regional Offices (RO). The Form
CMS-30 is an instrument used by the State survey agency to record data
collected in order to determine RHC compliance with individual
conditions of participation and to report it to the Federal government.
The form is primarily a coding worksheet designed to facilitate data
reduction (keypunching) and retrieval into OSCAR at the CMS ROs. The
form includes basic information on compliance (i.e., met, not met and
explanatory statements) and does not require any descriptive
information regarding the survey activity itself; Frequency:
Reporting--Annually; Affected Public: State, Local or Tribal
Government; Number of Respondents: 698; Total Annual Responses: 698;
Total Annual Hours: 1,222.
7. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Collection of
Drug Pricing and Network Pharmacy Data from Medicare Prescription Drug
Plans (PDPs and MA-PDs) and Supporting Regulations in 42 CFR 423.48;
Form Number: CMS-10150 (OMB 0938-0951); Use: Both stand alone
prescription drug plans (PDPs) and Medicare Advantage Prescription Drug
(MA-PDs) plans will be required to submit drug pricing and pharmacy
network data to CMS. These data will be made publicly available to
Medicare beneficiaries through the new Medicare prescription drug plan
finder tool that will be launched in the fall of 2005 on https://
www.medicare.gov. The purpose of the data is to enable beneficiaries to
compare, learn, select and enroll in a plan that best meets their
needs; Frequency: Reporting--Weekly; Affected Public: Business or other
for-profit; Number of Respondents: 350; Total Annual Responses: 18,200;
Total Annual Hours: 36,400.
8. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Identification of
Extension Units of Outpatient Physical Therapy/Outpatient Speech
Pathology (OPT/OSP) Providers and Supporting Regulations in 42 CFR
Sections 485.701-485.729; Form Number: CMS-381 (OMB 0938-
0273); Use: Medicare provides OPT/OSP providers to be surveyed to
determine compliance with Federal regulations. All locations where OPT/
OSP providers furnish services must meet these requirements. The CMS-
381 is the form used to identify all the OPT/OSP locations. Frequency:
Reporting--Annually; Affected Public: Business or other for-profit;
Number of Respondents: 2960; Total Annual Responses: 2960; Total Annual
Hours: 740.
9. Type of Information Collection Request: New Collection; Title of
Information Collection: New Freedom Initiative--Web-based Reporting
System for Grantees; Form Number: CMS-10161 (OMB 0938-NEW);
Use: CMS currently awards competitive grants to States and other
eligible entities for the purpose of designing and implementing
effective and enduring improvements in community-based long-term
services and supporting systems. We currently require grantees to
report quarterly, semi-annual, and or annually, depending on the grant
type. CMS requires the information obtained
[[Page 62124]]
through web-based grantee reporting for two reasons: (1) In order to
effectively monitor the grants, and; (2) to report to Congress and
other interested stakeholders the progress and obstacles experienced by
the grantees. The grantees are the respondents to the web-based
reporting system; Frequency: Reporting--Quarterly, Semi-annually, and
Annually; Affected Public: State, Local or Tribal Government and Not-
for-profit institutions; Number of Respondents: 298; Total Annual
Responses: 836; Total Annual Hours: 6,440.
10. Type of Information Collection Request: New Collection; Title
of Information Collection: Medicare Care Improvement Survey; Use: The
purpose of this beneficiary survey is to obtain information about
beneficiary behavioral change, physical functioning and satisfaction
with the Chronic Care Improvement (CCI) programs. Legislation requires
that all of the aforementioned data elements be collected, as they
provide information that is critical to the decision-making process as
it pertains to the expansion of the pilot programs. The chronic care
improvement programs are to be designed to incorporate relevant
features from private sector programs but also be sufficiently flexible
to adapt to the unique needs of their Medicare populations. This survey
is required to support the legislative mandate to evaluate the Chronic
Care Improvement Programs. Beneficiary participation in the CCI-I
program will be voluntary and will not change the scope, duration or
amount of Medicare fee-for-service (FFS) benefits currently received by
FFS Medicare beneficiaries; Form Number: CMS-10162 (OMB 0938-
NEW); Frequency: Reporting--On occasion; Affected Public: Individuals
or Households; Number of Respondents: 9,449; Total Annual Responses:
9,449; Total Annual Hours: 2,636.
11. Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection:
Medicare Care Management Performance (MCMP) Demonstration--Standardized
Ambulatory Care Quality Collection Initiative; Use: The MCMP
Demonstration was authorized by Section 649 of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
This project requires the Secretary to establish a pay-for-performance
3-year pilot with physicians to promote the adoption and use of health
information technology to improve the quality of patient care for
chronically ill Medicare patients. This demonstration represents the
first pay for performance project fostering the adoption of health
information technology in small physician group practices and will
enable a test of the concept to improve the quality and efficiency of
care in Fee-for-Service Medicare; Form Number: CMS-10136 (OMB
0938-0941); Frequency: Annually; Affected Public: Business or
other for-profit and Not-for-profit institutions; Number of
Respondents: 800; Total Annual Responses: 800; Total Annual Hours:
19,200.
To obtain copies of the supporting statement and any related forms
for these 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 and (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 November 28,
2005. OMB Human Resources and Housing Branch, Attention: CMS Desk
Officer, New Executive Office Building, Room 10235, Washington, DC
20503.
Dated: October 21, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-21517 Filed 10-27-05; 8:45 am]
BILLING CODE 4120-01-P
