Agency Information Collection Activities: Proposed Collection; Comment Request, 22932-22933 [E9-11422]
Download as PDF
<![CDATA[
22932
Federal Register / Vol. 74, No. 93 / Friday, May 15, 2009 / Notices
FR 28471–72) soliciting public
comments on a proposal to introduce a
cost sharing requirement for the HPP
program. Twenty-eight comments were
received from hospitals, hospital
associations, State Health Officials, and
professional organizations. The
comments received included concerns
about finding the resources needed to
cost share, additional administrative
recordkeeping related to cost sharing,
and overall decreased participation in
the HPP. In response, HHS believes the
concerns that were raised about
awardees finding the resources needed
to cost share, additional administrative
recordkeeping, and a potential for
decreased participation in the HPP are
outweighed by the benefits a cost
sharing requirement will bring to HPP.
The cost sharing requirement will be a
concrete way of solidifying
collaboration between States and the
Federal government in assuring this
program will achieve enhanced
sustainability in healthcare system
preparedness during and after the
project period has ended.
Thus, HPP cooperative agreement
recipients will be required to contribute
non-Federal matching funds starting
with the FY 2009 funding cycle and
each year thereafter. Awardees will be
required to make available, either
directly or through donations from
public or private entities, non-Federal
contributions in an amount equal to five
percent of the award amount in FY 2009
and ten percent of the award amount in
FY 2010 and each successive year for
the duration of the program. NonFederal contributions will be provided
directly or through donations from
public or private entities and may be in
cash or in kind, fairly evaluated,
including plant, equipment or services.
Amounts provided by the Federal
government, or services assisted or
subsidized to any significant extent by
the Federal government, may not be
included in determining the amount of
such non-Federal contributions.
The cost sharing requirement will
apply to the entire award amount
received by the awardee from the U.S.
Department of Health and Human
Services through the HPP.
The cost sharing requirement will be
enforced as a term and condition of the
HPP award.
Dated: May 8, 2009.
William C. Vanderwagen,
Assistant Secretary for Preparedness and
Response, U.S. Department of Health and
Human Services.
[FR Doc. E9–11307 Filed 5–14–09; 8:45 am]
BILLING CODE 4150–37–P
VerDate Nov<24>2008
16:43 May 14, 2009
Jkt 217001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–276, CMS–43,
CMS–1763, CMS–R–194, CMS–R–232, and
CMS–R–296]
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: Extension of a currently
approved collection; Title of
Information Collection: Prepaid Health
Plan Cost Report; Use: Health
Maintenance Organizations and
Competitive Medical Plans (HMO/
CMPs) contracting with the Secretary
under Section 1876 of the Social
Security Act are required to submit a
budget and enrollment forecast, four
quarterly reports and a final certified
cost report. Health Care Prepayment
Plans (HCPPs) contracting with the
Secretary under Section 1833 of the
Social Security Act are required to
submit a budget and enrollment
forecast, mid-year report, and final cost
report. An HMO/CMP is a health care
delivery system that furnishes directly
or arranges for the delivery of the full
spectrum of health services to an
enrolled population. A HCPP is a health
care delivery system that furnishes
directly or arranges for the delivery of
certain physician and diagnostics
services up to the full spectrum of nonprovider Part B health services to an
enrolled population. These reports will
be used to establish the reasonable cost
of delivering covered services furnished
PO 00000
Frm 00052
Fmt 4703
Sfmt 4703
to Medicare enrollees by an HMO/CMP
or HCPP.; Form Numbers: CMS–276
(OMB #: 0938–0165); Frequency:
Recordkeeping, Reporting—Quarterly
and Annually; Affected Public: Business
or other for-profit; Number of
Respondents: 35; Total Annual
Responses: 128; Total Annual Hours:
5,285. (For policy questions regarding
this collection contact Temeshia
Johnson at 410–786–8692. For all other
issues call 410–786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Application for
Hospital Insurance Benefits for
Individuals with End Stage Renal
Disease: Use: Effective July 1, 1973,
individuals with End Stage Renal
Disease (ESRD) became entitled to
Medicare. Because this entitlement has
a different set of requirements, the
existing applications for Medicare were
not sufficient to capture the information
needed to determine Medicare
entitlement under the ESRD provisions
of the law. The Application for Hospital
Insurance Benefits for Individuals with
End Stage Renal Disease, was designed
to capture all the information needed to
make a Medicare entitlement
determination; Form Numbers: CMS–43
(OMB #: 0938–0800; Frequency:
Reporting—Once; Affected Public:
Individuals or households; Number of
Respondents: 60,000; Total Annual
Responses: 60,000; Total Annual Hours:
25989. (For policy questions regarding
this collection contact Naomi Rappaport
at 410–786–2175. For all other issues
call 410–786–1326.)
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Request for
Termination of Premium Hospital and/
or Supplementary Medical Insurance:
Use: The Social Security Act (the Act)
allows a Medicare enrollee to
voluntarily terminate Supplementary
Medical Insurance (Part B) and/or the
premium Hospital Insurance
(premium—Part A) coverage by filing a
written request with CMS or the Social
Security Administration (SSA). The Act
also stipulates when coverage will end
based upon the date the request was
filed. Because Medicare is recognized as
a valuable protection against the high
cost of medical and hospital bills, when
an individual wishes to voluntarily
terminate Part B and/or premium Part
A, CMS and SSA requests the reason
that an individual wishes to terminate
coverage to ensure that the individual
understands the ramifications of the
decision. The Request for Termination
of Premium Hospital and/or
E:\FR\FM\15MYN1.SGM
15MYN1
Federal Register / Vol. 74, No. 93 / Friday, May 15, 2009 / Notices
Supplementary Medical Insurance,
provides a standardized form to satisfy
the requirements of law as well as
allowing both agencies to protect the
individual from an inappropriate
decision; Form Numbers: CMS–1763
(OMB #: 0938–0025; Frequency:
Reporting—Once; Affected Public:
Individuals or households; Number of
Respondents: 14,000; Total Annual
Responses: 14,000; Total Annual Hours:
5,831. (For policy questions regarding
this collection contact Naomi Rappaport
at 410–786–2175. For all other issues
call 410–786–1326.)
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare
Disproportionate Share Adjustment
Procedures and Criteria and Supporting
Regulations in 42 CFR 412.106: Use:
Section 1886(d)(5)(F) of the Social
Security Act established the Medicare
disproportionate share adjustment
(DSH) for hospitals, which provides
additional payment to hospitals that
serve a disproportionate share of the
indigent patient population. This
payment is an add-on to the set amount
per case CMS pays to hospitals under
the Medicare Inpatient Prospective
Payment System (IPPS).
Under current regulations at 42 CFR
412.106, in order to meet the qualifying
criteria for this additional DSH
payment, a hospital must prove that a
disproportionate percentage of its
patients are low income using
Supplemental Security Income (SSI)
and Medicaid as proxies for this
determination. This percentage includes
two computations: (1) the ‘‘Medicare
fraction’’ or the ‘‘SSI ratio’’ which is the
percent of patient days for beneficiaries
who are eligible for Medicare Part A and
SSI and (2) the ‘‘Medicaid fraction’’
which is the percent of patient days for
patients who are eligible for Medicaid
but not Medicare. Once a hospital
qualifies for this DSH payment, CMS
also determines a hospital’s payment
adjustment; Form Numbers: CMS–R–
194 (OMB #: 0938–0691; Frequency:
Reporting—Occasionally; Affected
Public: Business or other for-profit and
Not-for-profit institutions; Number of
Respondents: 800; Total Annual
Responses: 800; Total Annual Hours:
400. (For policy questions regarding this
collection contact JoAnn Cerne at 410–
786–4530. For all other issues call 410–
786–1326.)
5. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare
Integrity Program Organizational
Conflict of Interest Disclosure Certificate
VerDate Nov<24>2008
16:43 May 14, 2009
Jkt 217001
and Supporting Regulations at 42 CFR
421.300–421.316; Use: Section
1893(d)(1) of the Social Security Act
requires CMS to establish a process for
identifying, evaluating, and resolving
conflicts of interest. CMS proposed a
process in Section 421.310 to mandate
submission of pertinent information
regarding conflicts of interest. The
entities providing the information will
be organizations that have been
awarded, or seek award of, a Medicare
Integrity Program contract. CMS needs
this information to assess whether
contractors who perform, or who seek to
perform, Medicare Integrity Program
functions, such as medical review, fraud
review or cost audits, have
organizational conflicts of interest and
whether any conflicts have been
resolved. Form Number: CMS–R–232
(OMB #: 0938–0723); Frequency:
Reporting—On occasion; Affected
Public: Business or other for-profit;
Number of Respondents: 11; Total
Annual Responses: 44; Total Annual
Hours: 2,200. (For policy questions
regarding this collection contact Joe
Strazzire at 410–786–2775. For all other
issues call 410–786–1326.)
6. Type of Information Collection
Request: Revision of a currently
approved Collection; Title of
Information Collection: Home Health
Advance Beneficiary Notice (HHABN);
Use: Home health agencies (HHAs) are
required to provide written notice to
Medicare beneficiaries under various
circumstances involving the initiation,
reduction, or termination of services.
The vehicle used in these situations is
the Home Health Advance Beneficiary
Notice (HHABN). The notice is designed
to ensure that beneficiaries receive
complete and useful information
regarding potential financial liability or
any changes made to their plan of care
(POC) to enable them to make informed
consumer decisions. The notice must
provide clear and accurate information
about the specified services and, when
applicable, the cost of services when
Medicare denial of payment is expected
by the HHA. Form Number: CMS–R–296
(OMB #: 0938–0781); Frequency:
Reporting—Hourly, Daily, Weekly,
Monthly, Yearly, Quarterly, Semiannually, Biennially, Once and
Occasionally; Affected Public: Business
or other for-profits and Not-for-profit
institutions; Number of Respondents:
9024; Total Annual Responses:
12,349,787; Total Annual Hours:
1,028,737. (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
PO 00000
Frm 00053
Fmt 4703
Sfmt 4703
22933
proposed paperwork collections
referenced above, access CMS’ Web Site
at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or email 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.
In commenting on the proposed
information collections please reference
the document identifier or OMB control
number. To be assured consideration,
comments and recommendations must
be submitted in one of the following
ways by July 14, 2009:
1. Electronically. You may submit
your comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) 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 (CMS–10283), Room
C4–26–05, 7500 Security Boulevard,
Baltimore, Maryland 21244–1850.
Dated: May 7, 2009.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E9–11422 Filed 5–14–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10237 and
10214, and CMS–10171]
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
E:\FR\FM\15MYN1.SGM
15MYN1
]]>Agencies
[Federal Register Volume 74, Number 93 (Friday, May 15, 2009)]
[Notices]
[Pages 22932-22933]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-11422]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-276, CMS-43, CMS-1763, CMS-R-194, CMS-R-232,
and CMS-R-296]
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: Extension of a currently
approved collection; Title of Information Collection: Prepaid Health
Plan Cost Report; Use: Health Maintenance Organizations and Competitive
Medical Plans (HMO/CMPs) contracting with the Secretary under Section
1876 of the Social Security Act are required to submit a budget and
enrollment forecast, four quarterly reports and a final certified cost
report. Health Care Prepayment Plans (HCPPs) contracting with the
Secretary under Section 1833 of the Social Security Act are required to
submit a budget and enrollment forecast, mid-year report, and final
cost report. An HMO/CMP is a health care delivery system that furnishes
directly or arranges for the delivery of the full spectrum of health
services to an enrolled population. A HCPP is a health care delivery
system that furnishes directly or arranges for the delivery of certain
physician and diagnostics services up to the full spectrum of non-
provider Part B health services to an enrolled population. These
reports will be used to establish the reasonable cost of delivering
covered services furnished to Medicare enrollees by an HMO/CMP or
HCPP.; Form Numbers: CMS-276 (OMB : 0938-0165); Frequency:
Recordkeeping, Reporting--Quarterly and Annually; Affected Public:
Business or other for-profit; Number of Respondents: 35; Total Annual
Responses: 128; Total Annual Hours: 5,285. (For policy questions
regarding this collection contact Temeshia Johnson at 410-786-8692. For
all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Application for
Hospital Insurance Benefits for Individuals with End Stage Renal
Disease: Use: Effective July 1, 1973, individuals with End Stage Renal
Disease (ESRD) became entitled to Medicare. Because this entitlement
has a different set of requirements, the existing applications for
Medicare were not sufficient to capture the information needed to
determine Medicare entitlement under the ESRD provisions of the law.
The Application for Hospital Insurance Benefits for Individuals with
End Stage Renal Disease, was designed to capture all the information
needed to make a Medicare entitlement determination; Form Numbers: CMS-
43 (OMB : 0938-0800; Frequency: Reporting--Once; Affected
Public: Individuals or households; Number of Respondents: 60,000; Total
Annual Responses: 60,000; Total Annual Hours: 25989. (For policy
questions regarding this collection contact Naomi Rappaport at 410-786-
2175. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Termination of Premium Hospital and/or Supplementary Medical Insurance:
Use: The Social Security Act (the Act) allows a Medicare enrollee to
voluntarily terminate Supplementary Medical Insurance (Part B) and/or
the premium Hospital Insurance (premium--Part A) coverage by filing a
written request with CMS or the Social Security Administration (SSA).
The Act also stipulates when coverage will end based upon the date the
request was filed. Because Medicare is recognized as a valuable
protection against the high cost of medical and hospital bills, when an
individual wishes to voluntarily terminate Part B and/or premium Part
A, CMS and SSA requests the reason that an individual wishes to
terminate coverage to ensure that the individual understands the
ramifications of the decision. The Request for Termination of Premium
Hospital and/or
[[Page 22933]]
Supplementary Medical Insurance, provides a standardized form to
satisfy the requirements of law as well as allowing both agencies to
protect the individual from an inappropriate decision; Form Numbers:
CMS-1763 (OMB : 0938-0025; Frequency: Reporting--Once;
Affected Public: Individuals or households; Number of Respondents:
14,000; Total Annual Responses: 14,000; Total Annual Hours: 5,831. (For
policy questions regarding this collection contact Naomi Rappaport at
410-786-2175. For all other issues call 410-786-1326.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Disproportionate Share Adjustment Procedures and Criteria and
Supporting Regulations in 42 CFR 412.106: Use: Section 1886(d)(5)(F) of
the Social Security Act established the Medicare disproportionate share
adjustment (DSH) for hospitals, which provides additional payment to
hospitals that serve a disproportionate share of the indigent patient
population. This payment is an add-on to the set amount per case CMS
pays to hospitals under the Medicare Inpatient Prospective Payment
System (IPPS).
Under current regulations at 42 CFR 412.106, in order to meet the
qualifying criteria for this additional DSH payment, a hospital must
prove that a disproportionate percentage of its patients are low income
using Supplemental Security Income (SSI) and Medicaid as proxies for
this determination. This percentage includes two computations: (1) the
``Medicare fraction'' or the ``SSI ratio'' which is the percent of
patient days for beneficiaries who are eligible for Medicare Part A and
SSI and (2) the ``Medicaid fraction'' which is the percent of patient
days for patients who are eligible for Medicaid but not Medicare. Once
a hospital qualifies for this DSH payment, CMS also determines a
hospital's payment adjustment; Form Numbers: CMS-R-194 (OMB :
0938-0691; Frequency: Reporting--Occasionally; Affected Public:
Business or other for-profit and Not-for-profit institutions; Number of
Respondents: 800; Total Annual Responses: 800; Total Annual Hours: 400.
(For policy questions regarding this collection contact JoAnn Cerne at
410-786-4530. For all other issues call 410-786-1326.)
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Integrity Program Organizational Conflict of Interest Disclosure
Certificate and Supporting Regulations at 42 CFR 421.300-421.316; Use:
Section 1893(d)(1) of the Social Security Act requires CMS to establish
a process for identifying, evaluating, and resolving conflicts of
interest. CMS proposed a process in Section 421.310 to mandate
submission of pertinent information regarding conflicts of interest.
The entities providing the information will be organizations that have
been awarded, or seek award of, a Medicare Integrity Program contract.
CMS needs this information to assess whether contractors who perform,
or who seek to perform, Medicare Integrity Program functions, such as
medical review, fraud review or cost audits, have organizational
conflicts of interest and whether any conflicts have been resolved.
Form Number: CMS-R-232 (OMB : 0938-0723); Frequency:
Reporting--On occasion; Affected Public: Business or other for-profit;
Number of Respondents: 11; Total Annual Responses: 44; Total Annual
Hours: 2,200. (For policy questions regarding this collection contact
Joe Strazzire at 410-786-2775. For all other issues call 410-786-1326.)
6. Type of Information Collection Request: Revision of a currently
approved Collection; Title of Information Collection: Home Health
Advance Beneficiary Notice (HHABN); Use: Home health agencies (HHAs)
are required to provide written notice to Medicare beneficiaries under
various circumstances involving the initiation, reduction, or
termination of services. The vehicle used in these situations is the
Home Health Advance Beneficiary Notice (HHABN). The notice is designed
to ensure that beneficiaries receive complete and useful information
regarding potential financial liability or any changes made to their
plan of care (POC) to enable them to make informed consumer decisions.
The notice must provide clear and accurate information about the
specified services and, when applicable, the cost of services when
Medicare denial of payment is expected by the HHA. Form Number: CMS-R-
296 (OMB : 0938-0781); Frequency: Reporting--Hourly, Daily,
Weekly, Monthly, Yearly, Quarterly, Semi-annually, Biennially, Once and
Occasionally; Affected Public: Business or other for-profits and Not-
for-profit institutions; Number of Respondents: 9024; Total Annual
Responses: 12,349,787; Total Annual Hours: 1,028,737. (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 at https://www.cms.hhs.gov/PaperworkReductionActof1995, 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by July 14, 2009:
1. Electronically. You may submit your comments electronically to
https://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) 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 (CMS-10283), Room C4-26-05, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: May 7, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-11422 Filed 5-14-09; 8:45 am]
BILLING CODE 4120-01-P
