Agency Information Collection Activities: Submission for OMB Review; Comment Request, 38207-38208 [E9-18379]
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Federal Register / Vol. 74, No. 146 / Friday, July 31, 2009 / Notices
38207
9 Staff will enter data on flexible funds expenditures into a Web-based application or will recode existing data on flexible funds expenditures to
match the Flex Funds Data Dictionary format. Each community will use flexible funds expenditures on average for approximately one-quarter of
the estimated 356 children/youth enrolled, suggesting a total of 89 children/youth will receive services from flexible funds per community. Thus,
there will be data entered for 89 × 30 = 2,670 children/youth using the Flex Funds Data Dictionary.
10 Assumes that three expenditures, on average, will be spent on each child/youth receiving flexible fund benefits.
11 Staff will collect paper-based forms from agencies and enter them into a Web-based application or will extract data from agencies’ existing
data systems. Staff will recode data to match the Services and Costs Data Dictionary format. Service and costs records will be compiled for all
356 × 30 = 10,680 children/youth enrolled.
12 Assumes that each child/youth will have 100 service episodes, on average, during his/her time in a system of care.
13 This survey will be administered in 5 communities funded in 2006, 25 communities funded in 2005, 2 communities funded in 2000, and 20
communities funded in 1999. For each community, one respondent will be a caregiver and three respondents will be administrators/providers.
Written comments and
recommendations concerning the
proposed information collection should
be sent by August 31, 2009 to: SAMHSA
Desk Officer, Human Resources and
Housing Branch, Office of Management
and Budget, New Executive Office
Building, Room 10235, Washington, DC
20503; due to potential delays in OMB’s
receipt and processing of mail sent
through the U.S. Postal Service,
respondents are encouraged to submit
comments by fax to: 202–395–6974.
Dated: July 27, 2009.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. E9–18315 Filed 7–30–09; 8:45 am]
BILLING CODE 4162–20–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–43, CMS–1763,
CMS–R–194 and CMS–R–296]
PWALKER on DSK8KYBLC1PROD with NOTICES
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.
VerDate Nov<24>2008
16:38 Jul 30, 2009
Jkt 217001
1. 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.)
2. 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 (premiumPart 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
Supplementary Medical Insurance,
PO 00000
Frm 00043
Fmt 4703
Sfmt 4703
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.)
3. 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:
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31JYN1
PWALKER on DSK8KYBLC1PROD with NOTICES
38208
Federal Register / Vol. 74, No. 146 / Friday, July 31, 2009 / Notices
400. (For policy questions regarding this
collection contact JoAnn Cerne at 410–
786–4530. For all other issues call 410–
786–1326.)
4. 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
proposed paperwork collections
referenced above, access CMS Web Site
address 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.
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 August 31, 2009.
OMB, Office of Information and
Regulatory Affairs, Attention: CMS
Desk Officer, Fax Number: (202) 395–
6974, e-mail:
OIRA_submission@omb.eop.gov.
VerDate Nov<24>2008
16:38 Jul 30, 2009
Jkt 217001
Dated: July 23, 2009.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E9–18379 Filed 7–30–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10191]
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: Revision of a currently
approved collection; Title of
Information Collection: Medicare Parts
C and D Universal Audit Guide; Use:
Under the Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 and implementing regulations at
42 CFR Parts 422 and 423 Medicare Part
D plan sponsors and Medicare
Advantage organizations are required to
comply with all Medicare Parts C and D
program requirements. 42 CFR 422.502
describes CMS’ regulatory authority to
evaluate, through inspection or other
means, Medicare Advantage Part C
organizations. These records include
books, contracts, medical records,
patient care documentation and other
records that pertain to any aspect of
services performed, reconciliation of
benefit liabilities, and determination of
amounts payable. 42 CFR 423.503 states
that CMS must oversee a Part D plan
PO 00000
Frm 00044
Fmt 4703
Sfmt 4703
sponsor’s continued compliance with
the requirements for a Part D plan
sponsor. § 423.514 states that the Part D
plan sponsor must have an effective
procedure to develop, compile,
evaluate, and report to CMS, to its
enrollees, and to the general public, at
the times and in the manner that CMS
requires, statistics regarding areas such
as cost of operations, patterns of
utilization availability, accessibility,
and acceptability of services.
The explosive growth of these
sponsoring organizations has forced
CMS to update its current auditing
strategy to ensure we continue to obtain
meaningful audit results. As a result,
CMS’ audit strategy will reflect a move
away from routine audits to more
targeted, data-driven and risk-based
audits. CMS will also focus on high-risk
areas that have the greatest potential for
beneficiary harm. The goal of the audits
will be the earliest possible detection
and correction of issues and
improvement in quality and
performance of Part D sponsors and
Medicare Advantage organizations.
To accomplish these goals, we have
combined all Part C and Part D audit
elements into one universal guide
which will also promote consistency,
effectiveness and reduce financial and
time burdens for both CMS and
Medicare-contracting entities. Please
refer to the crosswalk document for a
list of changes. Form Number: CMS–
10191 (OMB#: 0938–1000); Frequency:
Reporting—Yearly; Affected Public:
Business or other for-profits and Notfor-profit institutions; Number of
Respondents: 195; Total Annual
Responses: 195; Total Annual Hours:
24,180. (For policy questions regarding
this collection contact Laura Dash at
410–786–8623. 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 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 September 29, 2009:
1. Electronically. You may submit
your comments electronically to https://
www.regulations.gov. Follow the
E:\FR\FM\31JYN1.SGM
31JYN1
]]>Agencies
[Federal Register Volume 74, Number 146 (Friday, July 31, 2009)]
[Notices]
[Pages 38207-38208]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-18379]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-43, CMS-1763, CMS-R-194 and CMS-R-296]
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: 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.)
2. 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 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.)
3. 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:
[[Page 38208]]
400. (For policy questions regarding this collection contact JoAnn
Cerne at 410-786-4530. For all other issues call 410-786-1326.)
4. 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 address 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.
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 August 31, 2009.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-6974, e-mail: OIRA_submission@omb.eop.gov.
Dated: July 23, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-18379 Filed 7-30-09; 8:45 am]
BILLING CODE 4120-01-P
