Agency Information Collection Activities: Submission for OMB Review; Comment Request, 15435-15436 [2010-7033]
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Federal Register / Vol. 75, No. 59 / Monday, March 29, 2010 / Notices
extraordinarily high costs. To qualify for
outlier payments, a case must have costs
above a predetermined threshold
amount (a dollar amount by which the
estimated cost of a case must exceed the
Medicare payment). Hospital-specific
cost-to-charge ratios are applied to the
covered charges for a case to determine
the estimated cost of the case. In
general, additional outlier payments for
eligible cases are made based on a
marginal cost factor of 80 percent, i.e. a
fixed percentage of the costs. Therefore,
if the estimated cost of the case exceeds
the Medicare payment for that discharge
plus the outlier threshold, generally
Medicare will pay the hospital 80
percent of the excess amount. The
outlier threshold is updated annually at
the beginning of the Federal Fiscal Year.
Form Number: CMS–10179 (OMB #:
0938–1020); Frequency: Occasionally;
Affected Public: Private Sector and
Business or other for-profits, Not-forprofit institutions; Number of
Respondents: 18; Total Annual
Responses: 18 Total Annual Hours: 144.
(For policy questions regarding this
collection contact Michael Treitel at
410–786–4552. For all other issues call
410–786–1326.)
5. Type of Information Collection
Request: Extension without change of a
currently approved collection; Title of
Information Collection: Subpart
D—Private Contracts and Supporting
Regulations contained in 42 CFR
405.410, 405.430, 405.435, 405.440,
405.445, and 405.455. Use: Section 4507
of Balancing Budget Act (BBA) 1997
amended section 1802 of the Social
Security Act to permit certain
physicians and practitioners to opt-out
of Medicare and to provide through
private contracts services that would
otherwise be covered by Medicare.
Under such contracts the mandatory
claims submission and limiting charge
rules of section 1848(g) of the Act would
not apply. Subpart D and the
Supporting Regulations contained in 42
CFR 405.410, 405.430, 405.435, 405.440,
405.445, and 405.455, counters the
effect of certain provisions of Medicare
law that, absent section 4507 of BBA
1997, preclude physicians and
practitioners from contracting privately
with Medicare beneficiaries to pay
without regard to Medicare limits. Form
Number: CMS–R–234 (OMB#: 0938–
0730); Frequency: Biennially; Affected
Public: Private Sector and Business or
other for-profits; Number of
Respondents: 26,820; Total Annual
Responses: 26,820; Total Annual Hours:
7,197. (For policy questions regarding
this collection contact Fred Grabau at
VerDate Nov<24>2008
09:18 Apr 05, 2010
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410–786–0206. For all other issues call
410–786–1326.)
6. Type of Information Collection
Request: Extension without change of a
currently approved collection; Title of
Information Collection: Skilled Nursing
Facility and Skilled Nursing Facility
Health Care Complex Cost Report. Use:
Providers of services participating in the
Medicare program are required under
sections 1815(a), 1833(e) and
1861(v)(1)(A) of the Social Security Act
(42 USC 1395g) to submit annual
information to achieve settlement of
costs for health care services rendered to
Medicare beneficiaries. Form Number:
CMS–2540 (OMB#: 0938–0463);
Frequency: Yearly; Affected Public:
Private Sector; Number of Respondents:
15,071; Total Annual Responses:
15,071; Total Annual Hours: 2,953,916
(For policy questions regarding this
collection contact Edwin Gill Sr. at 410–
786–4525. 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 May 28, 2010:
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, Room C4–26–05, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: March 19, 2010.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2010–7027 Filed 3–26–10; 8:45 am]
BILLING CODE 4120–01–P
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15435
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10292, CMS–
718–721 and CMS–685]
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,
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: State Medicaid
HIT Plan and Templates for
Implementation of Section 4201 of
ARRA; Form Number: CMS–10292
(OMB#: 0938–NEW); Use: This
information is being requested in order
that States can submit documentation to
CMS for review and approval in order
that States can implement the Medicaid
program and draw down Federal
financial participation. The American
Reinvestment and Recovery Act of 2009
(ARRA) provides States with the
flexibility to request funds to develop a
health information technology vision
and road to get to the ultimate goal of
meaningful use of certified electronic
health records technology. We will be
sending State Medicaid Directors letters
and templates for the State Medicaid Hit
Plan (SMHP), the Planning Advance
Planning Document (PAPD) and the
Implementation Advance Planning
Document (IAPD) to States in an effort
to request these changes if they so
choose to make the process as simple as
possible. Frequency: Yearly, once and/
or occasionally; Affected Public: State,
Tribal and Local governments; Number
AGENCY:
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cprice-sewell on DSK89S0YB1PROD with NOTICES
15436
Federal Register / Vol. 75, No. 59 / Monday, March 29, 2010 / Notices
of Respondents: 56; Total Annual
Responses: 56; Total Annual Hours:
280. (For policy questions regarding this
collection contact Donna Schmidt at
410–786–5532. For all other issues call
410–786–1326.)
2. Type of Information Collection
Request: Reinstatement with change of a
previously approved collection; Title of
Information Collection: Business
Proposal Forms for Quality
Improvement Organizations (QIOs); Use:
The submission of proposal information
by current quality improvement
associations (QIOs) and other bidders,
on the appropriate forms, will satisfy
CMS’s need for meaningful, consistent,
and verifiable data with which to
evaluate contract proposals. The data
collected on the forms associated with
this information collection request is
used by CMS to negotiate QIO contracts.
The revised business proposal forms
will be useful in a number of important
ways. The Government will be able to
compare the costs reported by the QIOs
on the cost reports to the proposed costs
noted on the business proposal forms.
Subsequent contract and modification
negotiations will be based on historic
cost data. The business proposal forms
will be one element of the historical cost
data from which we can analyze future
proposed costs. In addition, the
business proposal format will
standardize the cost proposing and
pricing process among all QIOs. With
well-defined cost centers and line items,
proposals can be compared among QIOs
for reasonableness and appropriateness.
Form Number: CMS–718–721 (OMB#:
0938–0579); Frequency: Reporting—
Triennially; Affected Public: Business or
other for-profits and Not-for-profit
institutions; Number of Respondents:
21; Total Annual Responses: 21; Total
Annual Hours: 1,785. (For policy
questions regarding this collection
contact Clarissa Whatley at 410–786–
7154. For all other issues call 410–786–
1326.)
3. Type of Information Collection
Request: Reinstatement without change
of a previously approved collection;
Title of Information Collection: End
Stage Renal Disease (ESRD) Network
Semi-Annual Cost Report Forms and
Supporting Regulations in 42 CFR
405.2110 and 42 CFR 405.2112; Use:
Section 1881(c) of the Social Security
Act establishes End Stage Renal Disease
(ESRD) Network contracts. The
regulations found at 42 CFR 405.2110
and 405.2112 designated 18 ESRD
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Networks which are funded by
renewable contracts. These contracts are
on 3-year cycles. To better administer
the program, CMS is requiring
contractors to submit semi-annual cost
reports. The purpose of the cost reports
is to enable the ESRD Networks to
report costs in a standardized manner.
This will allow CMS to review, compare
and project ESRD Network costs during
the life of the contract. Form Number:
CMS–685 (OMB#: 0938–0657);
Frequency: Reporting—Semi-annually;
Affected Public: Not-for-profit
institutions; Number of Respondents:
18; Total Annual Responses: 36; Total
Annual Hours: 108. (For policy
questions regarding this collection
contact Victoria Morgan at 410–786–
7232. 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 April 28, 2010: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–6974, E-mail:
OIRA_submission@omb.eop.gov.
Dated: March 19, 2010.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2010–7033 Filed 3–26–10; 8:45 am]
BILLING CODE 4120–01–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 opportunity for public comment on
proposed data collection projects
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(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 the Office of Management
and Budget (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, e-mail
paperwork@hrsa.gov or call the HRSA
Reports Clearance Officer at (301) 443–
1129.
Comments are invited on: (a) The
proposed collection of information for
the proper performance of the functions
of the agency; (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: Federally Qualified
Health Centers (FQHC) Application
Forms: (OMB No. 0915–0285 Revisions)
HRSA’s Bureau of Primary Health
Care Federally Qualified Health Centers
(FQHCs) are a major component of
America’s health care safety net, the
Nation’s ‘‘system’’ of providing health
care to low-income and other vulnerable
populations. Health Centers care for
people regardless of their ability to pay
and whether or not they have health
insurance. They provide primary and
preventive health care, as well as
services such as transportation and
translation. Many Health Centers also
offer dental, mental health and
substance abuse care.
FQHC’s are administered by the
Health Resources and Services
Administration’s (HRSA) Bureau of
Primary Health Care (BPHC). HRSA uses
the following application forms to
administer and manage the FQHCs.
These application forms are used by
new and existing FQHCs to apply for
grant and non-grant opportunities,
renew their grant or non-grant
opportunities or change their scope of
project.
Estimates of annualized reporting
burden are as follows:
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]]>Agencies
[Federal Register Volume 75, Number 59 (Monday, March 29, 2010)]
[Notices]
[Pages 15435-15436]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-7033]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10292, CMS-718-721 and CMS-685]
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: New Collection; Title of
Information Collection: State Medicaid HIT Plan and Templates for
Implementation of Section 4201 of ARRA; Form Number: CMS-10292
(OMB: 0938-NEW); Use: This information is being requested in
order that States can submit documentation to CMS for review and
approval in order that States can implement the Medicaid program and
draw down Federal financial participation. The American Reinvestment
and Recovery Act of 2009 (ARRA) provides States with the flexibility to
request funds to develop a health information technology vision and
road to get to the ultimate goal of meaningful use of certified
electronic health records technology. We will be sending State Medicaid
Directors letters and templates for the State Medicaid Hit Plan (SMHP),
the Planning Advance Planning Document (PAPD) and the Implementation
Advance Planning Document (IAPD) to States in an effort to request
these changes if they so choose to make the process as simple as
possible. Frequency: Yearly, once and/or occasionally; Affected Public:
State, Tribal and Local governments; Number
[[Page 15436]]
of Respondents: 56; Total Annual Responses: 56; Total Annual Hours:
280. (For policy questions regarding this collection contact Donna
Schmidt at 410-786-5532. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Business Proposal Forms for Quality Improvement
Organizations (QIOs); Use: The submission of proposal information by
current quality improvement associations (QIOs) and other bidders, on
the appropriate forms, will satisfy CMS's need for meaningful,
consistent, and verifiable data with which to evaluate contract
proposals. The data collected on the forms associated with this
information collection request is used by CMS to negotiate QIO
contracts. The revised business proposal forms will be useful in a
number of important ways. The Government will be able to compare the
costs reported by the QIOs on the cost reports to the proposed costs
noted on the business proposal forms. Subsequent contract and
modification negotiations will be based on historic cost data. The
business proposal forms will be one element of the historical cost data
from which we can analyze future proposed costs. In addition, the
business proposal format will standardize the cost proposing and
pricing process among all QIOs. With well-defined cost centers and line
items, proposals can be compared among QIOs for reasonableness and
appropriateness. Form Number: CMS-718-721 (OMB: 0938-0579);
Frequency: Reporting--Triennially; Affected Public: Business or other
for-profits and Not-for-profit institutions; Number of Respondents: 21;
Total Annual Responses: 21; Total Annual Hours: 1,785. (For policy
questions regarding this collection contact Clarissa Whatley at 410-
786-7154. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: End Stage Renal Disease (ESRD) Network Semi-Annual Cost
Report Forms and Supporting Regulations in 42 CFR 405.2110 and 42 CFR
405.2112; Use: Section 1881(c) of the Social Security Act establishes
End Stage Renal Disease (ESRD) Network contracts. The regulations found
at 42 CFR 405.2110 and 405.2112 designated 18 ESRD Networks which are
funded by renewable contracts. These contracts are on 3-year cycles. To
better administer the program, CMS is requiring contractors to submit
semi-annual cost reports. The purpose of the cost reports is to enable
the ESRD Networks to report costs in a standardized manner. This will
allow CMS to review, compare and project ESRD Network costs during the
life of the contract. Form Number: CMS-685 (OMB: 0938-0657);
Frequency: Reporting--Semi-annually; Affected Public: Not-for-profit
institutions; Number of Respondents: 18; Total Annual Responses: 36;
Total Annual Hours: 108. (For policy questions regarding this
collection contact Victoria Morgan at 410-786-7232. 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 April 28, 2010:
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-6974, E-mail: OIRA_submission@omb.eop.gov.
Dated: March 19, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2010-7033 Filed 3-26-10; 8:45 am]
BILLING CODE 4120-01-P
