Agency Information Collection Activities: Proposed Collection; Comment Request, 48145-48148 [2019-19711]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 84, Number 177 (Thursday, September 12, 2019)]
[Notices]
[Pages 48145-48148]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-19711]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1500/1490S, CMS-10221, CMS-10237, CMS-R-5, 
CMS-10224 and CMS-287-19]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (the PRA), federal agencies are required to publish notice 
in the Federal Register concerning each proposed collection of 
information (including each proposed extension or reinstatement of an 
existing collection of information) and to allow 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates or any other aspect of this 
collection of information, including the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.

DATES: Comments must be received by November 12, 2019.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send 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) that are 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.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].

[[Page 48146]]

    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION:

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-1500/1490S Health Insurance Common Claims Form
CMS-10221 Independent Diagnostic Testing Facilities (IDTFs) Site 
Investigation Form Revisions
CMS-10237 Applications for Part C Medicare Advantage, 1876 Cost Plans, 
and Employer Group Waiver Plans to Provide Part C Benefits
CMS-R-5 Physician Certifications/Recertification's in Skilled Nursing 
Facilities Manual Instructions
CMS-10224 Healthcare Common Procedure Coding System (HCPCS)--Level II 
Code Modification Request Process
CMS-287-19 Home Office Cost Statement

    Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain 
approval from the Office of Management and Budget (OMB) for each 
collection of information they conduct or sponsor. The term 
``collection of information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 
1320.3(c) and includes agency requests or requirements that members of 
the public submit reports, keep records, or provide information to a 
third party. Section 3506(c)(2)(A) of the PRA requires federal agencies 
to publish a 60-day notice in the Federal Register concerning each 
proposed collection of information, including each proposed extension 
or reinstatement of an existing collection of information, before 
submitting the collection to OMB for approval. To comply with this 
requirement, CMS is publishing this notice.

Information Collection

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Common Claims Form and Supporting Regulations at 42 CFR part 424, 
subpart C (CMS-1500 and CMS-1490S); Use: The CMS-1500 and the CMS-1490S 
forms are used to deliver information to CMS in order for CMS to 
reimburse for provided services. Medicare Administrative Contractors 
use the data collected on the CMS-1500 and the CMS-1490S to determine 
the proper amount of reimbursement for Part B medical and other health 
services (as listed in section 1861(s) of the Social Security Act) 
provided by physicians and suppliers to beneficiaries. The CMS-1500 is 
submitted by physicians/suppliers for all Part B Medicare. Serving as a 
common claim form, the CMS-1500 can be used by other third-party payers 
(commercial and nonprofit health insurers) and other Federal programs 
(e.g., TRICARE, RRB, and Medicaid). The CMS-1490S (Patient's Request 
for Medical Payment) was explicitly developed for easy use by 
beneficiaries who file their own claims. Form Number: CMS-1500/1490S 
(OMB control number: 0938-1197); Frequency: Yearly; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 2,029,505; 
Total Annual Responses: 1,033,839,906; Total Annual Hours: 18,847,500. 
(For policy questions regarding this collection contact Charlene Parks 
at 410-786-8684.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Independent 
Diagnostic Testing Facilities (IDTFs) Site Investigation Form 
Revisions; Use: The data collection is used by Medicare contractors 
and/or their subcontractors on site visits to verify compliance with 
required IDTF performance standards. If a subcontractor is used, the 
subcontractor collects the information from the IDTF through an 
interview and forwards it to the Medicare contractor for evaluation. 
The collection and verification of this information defends and 
protects our beneficiaries from illegitimate IDTFs. These procedures 
also protect the Medicare Trust Fund against fraud. The data collected 
also ensures that the applicant has the necessary credentials to 
provide the health care services for which they intend to bill 
Medicare. Form Number: CMS-10221 (OMB control number: 0938-1029); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profit and Not-for-profit institutions); Number of 
Respondents: 727; Total Annual Responses: 727; Total Annual Hours: 
1,454. (For policy questions regarding this collection contact Kimberly 
McPhillips at 410-786-5374.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Applications for 
Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver 
Plans to Provide Part C Benefits; Use: This information collection 
includes the process for organizations wishing to provide healthcare 
services under MA plans. These organizations must complete an 
application annually (if required), file a bid, and receive final 
approval from CMS. The MA application process has two options for 
applicants that include (1) request for new MA product or (2) request 
for expanding the service area of an existing product. CMS utilizes the 
application process as the means to review, assess and determine if 
applicants are compliant with the current requirements for 
participation in the MA program and to make a decision related to 
contract award. This collection process is the only mechanism for 
organizations to complete the required MA application process. The 
application process is open to all health plans that want to 
participate in the MA program. The application is distinct and separate 
from the bid process, and CMS issues a determination on the application 
prior to bid submissions, or before the first Monday in June.
    Collection of this information is mandated by the Code of Federal 
Regulations, MMA, and CMS regulations at 42 CFR 422, subpart K, in 
``Application Procedures and Contracts for Medicare Advantage 
Organizations.'' In addition, the Medicare Improvement for Patients and 
Providers Act of 2008 (MIPPA) further amended titles XVII and XIX of 
the Social Security Act. Form Number: CMS-10237 (OMB control number: 
0938-0935); Frequency: Occasionally; Affected Public: Private Sector 
(Business or other for-profit and Not-for-profit institutions); Number 
of Respondents: 435; Total Annual Responses: 435; Total Annual Hours: 
6,754. (For policy questions regarding this collection contact Keith 
Penn-Jones at 410-786-3104.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Physician 
Certifications/Recertifications in Skilled Nursing Facilities Manual 
Instructions; Use: Section 1814(a) of the Social Security Act (the Act) 
requires specific certifications in order for Medicare payments to be 
made for certain services. Before the enactment of the Omnibus Budget 
Reconciliation Act of 1989 (OBRA1989, Pub. L. 101-239), section 
1814(a)(2) of the Act required that, in the case of post-hospital 
extended care services, a physician certify that the services are or 
were required to be given because the individual needs or needed, on a 
daily basis, skilled nursing care (provided directly by or requiring 
the supervision

[[Page 48147]]

of skilled nursing personnel) or other skilled rehabilitation services 
that, as a practical matter, can only be provided in a SNF on an 
inpatient basis. The physician certification requirements were included 
in the law to ensure that patients require a level of care that is 
covered by the Medicare program and because the physician is a key 
figure in determining the utilization of health services. In addition, 
it set forth qualification requirements that a nurse practitioner or 
clinical nurse specialist must meet in order to sign certification or 
recertification statements (these requirements were later revised in 
the Balanced Budget Act of 1997). Effective with items and services 
furnished on or after January 1, 2011, section 3108 of the Affordable 
Care Act added physician assistants to the existing authority for nurse 
practitioners and clinical nurse specialists. Regulations implementing 
this provision were promulgated in the calendar year (CY) 2011 Medicare 
Physician Fee Schedule (MPFS) final rule with comment period (75 FR 
73387, 73602, 73626-27, November 29, 2010). The requirements at 42 CFR 
424.20(a) and (b) concern the initial certification of a beneficiary's 
need for a SNF level of care, which must be made upon admission or as 
soon thereafter as is reasonable and practicable. The requirements at 
42 CFR 424.20(c) and (d) concern recertification of a beneficiary's 
need for continued SNF level of care, and also require an estimate of 
the time the individual will need to remain in the SNF, plans for home 
treatment, and, if appropriate, whether continued services are needed 
for a condition that occurred after admission to the SNF and while 
still receiving treatment for the condition for which he or she had 
received inpatient hospital services. These sections require 
recertification at specific intervals (the initial recertification must 
occur no later than the 14th day of SNF care, with subsequent 
recertification at least every 30 days thereafter) that posthospital 
SNF care is or was required because the individual needs or needed 
skilled care on a daily basis. The following CMS internet-Only Manuals 
provide more detailed instructions regarding the required certification 
and recertification of covered post-hospital extended care services for 
a Medicare beneficiary: Chapter 4, sections 40ff and 80 in the Medicare 
General Information, Eligibility, and Entitlement Manual (CMS Pub. 100-
01), chapter 8, sections 40ff. in the Medicare Benefit Policy Manual 
(CMS Pub. 100-02), and chapter 6, section 6.3 in the Medicare Program 
Integrity Manual (CMS Pub. 100-08). Form Number: CMS-R-5 (OMB control 
number: 0938-0454); Frequency: Occasionally; Affected Public: Private 
Sector (Not-for-profit institutions); Number of Respondents: 2,746,550; 
Total Annual Responses: 2,746,550; Total Annual Hours: 615,149. (For 
policy questions regarding this collection contact Kia Sidbury at 410-
786-7816.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Healthcare Common 
Procedure Coding System (HCPCS)--Level II Code Modification Request 
Process; Use: In October 2003, the Secretary of Health and Human 
Services (HHS) delegated authority under the Health Insurance 
Portability and Accountability Act (HIPAA) legislation to Centers for 
Medicare and Medicaid Services (CMS) to maintain and distribute HCPCS 
Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes 
uniform national definitions of services, codes to represent services, 
and payment modifiers to the codes. The HCPCS code set has been 
maintained and distributed via modifications of codes, modifiers and 
descriptions, as a direct result of data received from applicants. 
Thus, information collected in the application is significant to 
codeset maintenance. The HCPCS code set maintenance is an ongoing 
process, as changes are implemented and updated annually; therefore, 
the process requires continual collection of information from 
applicants on an annual basis. As new technology evolves and new 
devices, drugs and supplies are introduced to the market, applicants 
submit applications to CMS requesting modifications to the HCPCS Level 
II codeset. Applications have been received prior to HIPAA 
implementation and must continue to be collected to ensure quality 
decision-making. The HIPAA of 1996 required CMS to adopt standards for 
coding systems that are used for reporting health care transactions. 
The regulation that CMS published on August 17, 2000 (45 CFR 162.10002) 
to implement the HIPAA requirement for standardized coding systems 
established the HCPCS Level II codes as the standardized coding system 
for describing and identifying health care equipment and supplies in 
health care transactions. HCPCS Level II was selected as the 
standardized coding system because of its wide acceptance among both 
public and private insurers. Public and private insurers were required 
to be in compliance with the August 2000 regulation by October 1, 2002. 
Modifications to the HCPCS are initiated via application form submitted 
by any interested stakeholder. These applications have been received on 
an on-going basis with an annual deadline for each cycle. The purpose 
of the data provided is to educate the decision-making body about 
products and services for which a modification is requested so that an 
informed decision can be reached in response to the recommended coding. 
Form Number: CMS-10224 (OMB control number: 0938-1042); Frequency: 
Annually; Affected Public: Private Sector (Business or other for-profit 
and Not-for-profit institutions); Number of Respondents: 100; Total 
Annual Responses: 100; Total Annual Hours: 1,100. (For policy questions 
regarding this collection contact Kimberlee Combs Miller at 410-786-
6707.)
    6. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Home Office Cost 
Statement; Use: Home offices of chain organizations vary greatly in 
size, number of locations, staff, mode of operations, and services 
furnished to the facilities in the chain. The home office of a chain is 
not in itself certified by Medicare. The relationship of the home 
office is that of a related organization to participating providers 
(See 42 CFR 413.17). When a provider claims costs on its cost report 
that are allocated from a home office, the Home Office Cost Statement 
constitutes the documentary support required of the provider to be 
reimbursed for home office costs in the provider's cost report. Each 
contractor servicing a provider in a chain must be furnished with a 
detailed Home Office Cost Statement as a basis for reimbursing the 
provider for cost allocations from a home office or chain organization. 
Home offices usually furnish central management and administrative 
services, e.g., centralized accounting, purchasing, personnel services, 
management direction and control, and other services. To the extent 
that the home office furnishes services related to patient care to a 
provider, the reasonable costs of such services are included in the 
provider's cost report and are reimbursable as part of the provider's 
costs. If the home office of the chain provides no services related to 
patient care, the costs of the home office may not be recognized in 
determining the allowable costs of the providers in the chain. Under 
the authority of sections 1815(a) and 1833(e) of the Social Security 
Act (42 U.S.C. 1395g), CMS requires that providers of services 
participating in the

[[Page 48148]]

Medicare program submit information to determine costs for health care 
services rendered to Medicare beneficiaries. CMS requires that 
providers follow reasonable cost principles under 1861(v)(1)(A) of the 
Act when completing the Medicare cost report. Under the regulations at 
42 CFR 413.20 and 413.24, CMS defines adequate cost data and requires 
cost reports from providers on an annual basis. Providers receiving 
Medicare reimbursement must provide adequate cost data based on 
financial and statistical records, which can be verified by qualified 
auditors. The Form CMS-287-19 home office cost statement is needed to 
determine a provider's reasonable cost incurred in furnishing medical 
services to Medicare beneficiaries and reimbursement due to or from a 
provider. Form Number: CMS-287-19 (OMB control number: 0938-0202); 
Frequency: Annually; Affected Public: Private Sector (Business or other 
for-profit and Not-for-profit institutions); Number of Respondents: 
1,507; Total Annual Responses: 1,507; Total Annual Hours: 702,262. (For 
policy questions regarding this collection contact Yaakov Feinstein at 
410-786-3137.)

    Dated: September 6, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-19711 Filed 9-11-19; 8:45 am]
BILLING CODE 4120-01-P