Agency Information Collection Activities: Submission for OMB Review; Comment Request, 10443-10444 [2020-03537]
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Federal Register / Vol. 85, No. 36 / Monday, February 24, 2020 / Notices
for-profit, not-for-profit institutions);
Number of Respondents: 240; Total
Annual Responses: 240; Total Annual
Hours: 120. For policy questions
regarding this collection contact
Christopher Lofts at 410–786–4076.
3. Type of Information Collection
Request: Extension without change of a
currently approved collection; Title of
Information Collection: Durable Medical
Equipment Medicare Administrative
Contractor Certificate of Medical
Necessity and Supporting
Documentation Requirements; Use: The
certificates of medical necessity (CMNs)
collect information required to help
determine the medical necessity of
certain items. CMS requires CMNs
where there may be a vulnerability to
the Medicare program. Each initial
claim for these items must have an
associated CMN for the beneficiary.
Suppliers (those who bill for the items)
complete the administrative information
(e.g., patient’s name and address, items
ordered, etc.) on each CMN. The 1994
Amendments to the Social Security Act
require that the supplier also provide a
narrative description of the items
ordered and all related accessories, their
charge for each of these items, and the
Medicare fee schedule allowance (where
applicable). The supplier then sends the
CMN to the treating physician or other
clinicians (e.g., physician assistant,
LPN, etc.) who completes questions
pertaining to the beneficiary’s medical
condition and signs the CMN. The
physician or other clinician returns the
CMN to the supplier who has the option
to maintain a copy and then submits the
CMN electronically to CMS, along with
a claim for reimbursement. Form
Numbers: CMS–484, 846, 847, 848, 849,
10125, 10126 (OMB control number:
0938–0679); Frequency: Occasionally;
Affected Public: Individuals or
Households; Number of Respondents:
1,335,658; Total Annual Responses:
1,335,658; Total Annual Hours: 267,132.
For policy questions regarding this
collection contact Melissa Singer at
410–786–0365.
lotter on DSKBCFDHB2PROD with NOTICES
Dated: February 19, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2020–03633 Filed 2–21–20; 8:45 am]
BILLING CODE 4120–01–P
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18:30 Feb 21, 2020
Jkt 250001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–199, CMS–
10180 and CMS–1771]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
10443
1. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
2. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
AGENCY: Centers for Medicare &
must obtain approval from the Office of
Medicaid Services, HHS
Management and Budget (OMB) for each
ACTION: Notice.
collection of information they conduct
or sponsor. The term ‘‘collection of
SUMMARY: The Centers for Medicare &
Medicaid Services (CMS) is announcing information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
an opportunity for the public to
includes agency requests or
comment on CMS’ intention to collect
requirements that members of the public
information from the public. Under the
submit reports, keep records, or provide
Paperwork Reduction Act of 1995
information to a third party. Section
(PRA), federal agencies are required to
3506(c)(2)(A) of the PRA (44 U.S.C.
publish notice in the Federal Register
3506(c)(2)(A)) requires federal agencies
concerning each proposed collection of
to publish a 30-day notice in the
information, including each proposed
extension or reinstatement of an existing Federal Register concerning each
proposed collection of information,
collection of information, and to allow
including each proposed extension or
a second opportunity for public
reinstatement of an existing collection
comment on the notice. Interested
of information, before submitting the
persons are invited to send comments
collection to OMB for approval. To
regarding the burden estimate or any
comply with this requirement, CMS is
other aspect of this collection of
information, including the necessity and publishing this notice that summarizes
the following proposed collection(s) of
utility of the proposed information
collection for the proper performance of information for public comment:
the agency’s functions, the accuracy of
1. Type of Information Collection
the estimated burden, ways to enhance
Request: Reinstatement without change
the quality, utility, and clarity of the
of a currently approved collection; Title
information to be collected, and the use of Information Collection: Medicaid
of automated collection techniques or
Report on Payables and Receivables;
other forms of information technology to Use: Section 1903(b)(d)(1) of the Social
minimize the information collection
Security Act requires the Secretary to
burden.
estimate the amount each State should
DATES: Comments on the collection(s) of be paid at the beginning of each quarter.
This amount is to be based on a report
information must be received by the
filed by the State. Section
OMB desk officer by March 25, 2020.
1903(b)(d)(2)(A) of the Social Security
ADDRESSES: When commenting on the
Act authorizes the Secretary to pay the
proposed information collections,
please reference the document identifier amount estimated, reduced or increased
to the extent of any overpayment or
or OMB control number. To be assured
underpayment for any prior quarter.
consideration, comments and
Section 3515 of CFO Act requires
recommendations must be received by
government agencies to produce
the OMB desk officer via one of the
following transmissions: OMB, Office of auditable financial statements in
accordance with Office of Management
Information and Regulatory Affairs,
and Budget guidelines on Form and
Attention: CMS Desk Officer, Fax
Content. The Government Management
Number: (202) 395–5806 OR Email:
and Reform Act of 1994 requires that all
OIRA_submission@omb.eop.gov.
offices, bureaus and associated activities
To obtain copies of a supporting
of the 24 CFO Act agencies must be
statement and any related forms for the
covered in an agency. Form Number:
proposed collection(s) summarized in
CMS–R–199 (OMB control number:
this notice, you may make your request
0938–0697); Frequency: Yearly; Affected
using one of following:
Public: State, Local, or Tribal
1. Access CMS’ website address at
website address at https://www.cms.gov/ Governments; Number of Respondents:
56; Total Annual Responses: 56; Total
Regulations-and-Guidance/Legislation/
Annual Hours: 504. (For policy
PaperworkReductionActof1995/PRAquestions regarding this collection
Listing.html.
PO 00000
Frm 00046
Fmt 4703
Sfmt 4703
SUPPLEMENTARY INFORMATION:
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lotter on DSKBCFDHB2PROD with NOTICES
10444
Federal Register / Vol. 85, No. 36 / Monday, February 24, 2020 / Notices
contact Beverly Boher at (410) 786–
7806.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Children’s
Health Insurance Program (CHIP) Report
on Payables and Receivables; Use:
Section 2105 of the Social Security Act
(Title XXI) requires the Secretary to
estimate the amount each State should
be paid at the beginning of each quarter.
This amount is based on a report filed
by the State. Section 2105 of the Social
Security Act authorizes the Secretary to
pay the amount estimated, reduced or
increased to the extent of any
overpayment or underpayment for any
prior quarter. Section 3515 of the CFO
Act requires government agencies to
produce auditable financial statements
in accordance with Office of
Management and Budget guidelines on
Form and Content. The Government
Management and Reform Act of 1994
requires that all offices, bureaus and
associated activities of the 24 CFO Act
agencies must be covered in an agencywide, audited financial statement.
Collection of CHIP data and the
calculation of the CHIP Incurred But
Not Reported (IBNR) estimate are
pertinent to CMS’ financial audit. The
CHIP Report on Payables and
Receivables will provide the
information needed to calculate the
CHIP IBNR. Failure to collect this
information could result in noncompliance with the law. Form Number:
CMS–10180 (OMB control number:
0938–0988); Frequency: Yearly; Affected
Public: State, Local, or Tribal
Governments; Number of Respondents:
56; Total Annual Responses: 56; Total
Annual Hours: 504. (For policy
questions regarding this collection
contact Beverly Boher at (410) 786–
7806.)
3. Type of Information Collection
Request: Reinstatement without change
of a currently approved collection; Title
of Information Collection: Emergency
and Foreign Hospital Services and
Supporting Regulation in 42 CFR
Section 424.103; Use: Section 1866 of
the Social Security Act states that any
provider of services shall be qualified to
participate in the Medicare program and
shall be eligible for payments under
Medicare if it files an agreement with
the Secretary to meet the conditions
outlined in this section of the Act.
Section 1814 (d)(1) of the Social
Security Act and 42 CFR 424.100,
allows payment of Medicare benefits for
a Medicare beneficiary to a
nonparticipating hospital that does not
have an agreement in effect with the
Centers for Medicare and Medicaid
VerDate Sep<11>2014
18:30 Feb 21, 2020
Jkt 250001
Services. These payments can be made
if such services were emergency
services and if CMS would be required
to make the payment if the hospital had
an agreement in effect and met the
conditions of payment. This form is
used in connection with claims for
emergency hospital services provided
by hospitals that do not have an
agreement in effect under Section 1866
of the Social Security Act. 42 CFR
424.103 (b) requires that before a nonparticipating hospital may be paid for
emergency services rendered to a
Medicare beneficiary, a statement must
be submitted that is sufficiently
comprehensive to support that an
emergency existed. Form CMS- 1771
contains a series of questions relating to
the medical necessity of the emergency.
The attending physician must attest that
the hospitalization was required under
the regulatory emergency definition (42
CFR 424.101 attached) and give clinical
documentation to support the claim. A
photocopy of the beneficiary’s hospital
records may be used in lieu of the CMS–
1771 if the records contain all the
information required by the form. Form
Number: CMS–1771 (OMB control
number: 0938–0023); Frequency: Yearly;
Affected Public: Private Sector; Business
or other for-profits, Not-for-profit
Institutions; Number of Respondents:
100; Total Annual Responses: 200; Total
Annual Hours: 50. (For policy questions
regarding this collection contact
Shauntari Cheely at (410) 786–1818.)
Dated: February 18, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2020–03537 Filed 2–21–20; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–267 and
CMS–10396]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
ACTION: Notice.
AGENCY:
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
SUMMARY:
PO 00000
Frm 00047
Fmt 4703
Sfmt 4703
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.
Comments must be received by
April 24, 2020.
DATES:
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 lll, 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
website address at https://www.cms.gov/
Regulations-and-Guidance/Legislation/
PaperworkReductionActof1995/PRAListing.html.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
William N. Parham at (410) 786–4669.
SUPPLEMENTARY INFORMATION:
E:\FR\FM\24FEN1.SGM
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]]>Agencies
[Federal Register Volume 85, Number 36 (Monday, February 24, 2020)]
[Notices]
[Pages 10443-10444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-03537]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-199, CMS-10180 and CMS-1771]
Agency Information Collection Activities: Submission for OMB
Review; 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 (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 a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate 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 on the collection(s) of information must be received by
the OMB desk officer by March 25, 2020.
ADDRESSES: When commenting on the proposed information collections,
please reference the document identifier or OMB control number. To be
assured consideration, comments and recommendations must be received by
the OMB desk officer via one of the following transmissions: OMB,
Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-5806 OR Email:
OIRA_[email protected].
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 website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
1. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to [email protected].
2. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(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 (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-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 that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Reinstatement without
change of a currently approved collection; Title of Information
Collection: Medicaid Report on Payables and Receivables; Use: Section
1903(b)(d)(1) of the Social Security Act requires the Secretary to
estimate the amount each State should be paid at the beginning of each
quarter. This amount is to be based on a report filed by the State.
Section 1903(b)(d)(2)(A) of the Social Security Act authorizes the
Secretary to pay the amount estimated, reduced or increased to the
extent of any overpayment or underpayment for any prior quarter.
Section 3515 of CFO Act requires government agencies to produce
auditable financial statements in accordance with Office of Management
and Budget guidelines on Form and Content. The Government Management
and Reform Act of 1994 requires that all offices, bureaus and
associated activities of the 24 CFO Act agencies must be covered in an
agency. Form Number: CMS-R-199 (OMB control number: 0938-0697);
Frequency: Yearly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 56; Total Annual Responses: 56;
Total Annual Hours: 504. (For policy questions regarding this
collection
[[Page 10444]]
contact Beverly Boher at (410) 786-7806.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Children's Health
Insurance Program (CHIP) Report on Payables and Receivables; Use:
Section 2105 of the Social Security Act (Title XXI) requires the
Secretary to estimate the amount each State should be paid at the
beginning of each quarter. This amount is based on a report filed by
the State. Section 2105 of the Social Security Act authorizes the
Secretary to pay the amount estimated, reduced or increased to the
extent of any overpayment or underpayment for any prior quarter.
Section 3515 of the CFO Act requires government agencies to produce
auditable financial statements in accordance with Office of Management
and Budget guidelines on Form and Content. The Government Management
and Reform Act of 1994 requires that all offices, bureaus and
associated activities of the 24 CFO Act agencies must be covered in an
agency-wide, audited financial statement. Collection of CHIP data and
the calculation of the CHIP Incurred But Not Reported (IBNR) estimate
are pertinent to CMS' financial audit. The CHIP Report on Payables and
Receivables will provide the information needed to calculate the CHIP
IBNR. Failure to collect this information could result in non-
compliance with the law. Form Number: CMS-10180 (OMB control number:
0938-0988); Frequency: Yearly; Affected Public: State, Local, or Tribal
Governments; Number of Respondents: 56; Total Annual Responses: 56;
Total Annual Hours: 504. (For policy questions regarding this
collection contact Beverly Boher at (410) 786-7806.)
3. Type of Information Collection Request: Reinstatement without
change of a currently approved collection; Title of Information
Collection: Emergency and Foreign Hospital Services and Supporting
Regulation in 42 CFR Section 424.103; Use: Section 1866 of the Social
Security Act states that any provider of services shall be qualified to
participate in the Medicare program and shall be eligible for payments
under Medicare if it files an agreement with the Secretary to meet the
conditions outlined in this section of the Act. Section 1814 (d)(1) of
the Social Security Act and 42 CFR 424.100, allows payment of Medicare
benefits for a Medicare beneficiary to a nonparticipating hospital that
does not have an agreement in effect with the Centers for Medicare and
Medicaid Services. These payments can be made if such services were
emergency services and if CMS would be required to make the payment if
the hospital had an agreement in effect and met the conditions of
payment. This form is used in connection with claims for emergency
hospital services provided by hospitals that do not have an agreement
in effect under Section 1866 of the Social Security Act. 42 CFR 424.103
(b) requires that before a non-participating hospital may be paid for
emergency services rendered to a Medicare beneficiary, a statement must
be submitted that is sufficiently comprehensive to support that an
emergency existed. Form CMS- 1771 contains a series of questions
relating to the medical necessity of the emergency. The attending
physician must attest that the hospitalization was required under the
regulatory emergency definition (42 CFR 424.101 attached) and give
clinical documentation to support the claim. A photocopy of the
beneficiary's hospital records may be used in lieu of the CMS-1771 if
the records contain all the information required by the form. Form
Number: CMS-1771 (OMB control number: 0938-0023); Frequency: Yearly;
Affected Public: Private Sector; Business or other for-profits, Not-
for-profit Institutions; Number of Respondents: 100; Total Annual
Responses: 200; Total Annual Hours: 50. (For policy questions regarding
this collection contact Shauntari Cheely at (410) 786-1818.)
Dated: February 18, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2020-03537 Filed 2-21-20; 8:45 am]
BILLING CODE 4120-01-P
