```

[Federal Register Volume 78, Number 91 (Friday, May 10, 2013)]
[Notices]
[Pages 27400-27402]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-11035]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-R-70, CMS-R-72, CMS-R-247, CMS-10287, CMS-R-
43, CMS-855(POH), CMS-2552-10, and CMS-10062]

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: Reinstatement with a 
change of a previously approved collection; Title of Information 
Collection: Information Collection Requirements in HSQ-110, 
Acquisition, Protection and Disclosure of Peer review Organization 
Information and Supporting Regulations in 42 CFR, Sections 480.104, 
480.105, 480.116, and 480.134; Use: The Peer Review Improvement Act of 
1982 authorizes quality improvement organizations

[[Page 27401]]

(QIOs), formally known as peer review organizations (PROs), to acquire 
information necessary to fulfill their duties and functions and places 
limits on disclosure of the information. The QIOs are required to 
provide notices to the affected parties when disclosing information 
about them. These requirements serve to protect the rights of the 
affected parties. The information provided in these notices is used by 
the patients, practitioners and providers to: obtain access to the data 
maintained and collected on them by the QIOs; add additional data or 
make changes to existing QIO data; and reflect in the QIO's record the 
reasons for the QIO's disagreeing with an individual's or provider's 
request for amendment.: Form Number: CMS-R-70 (OCN: 0938-0426); 
Frequency: Reporting--On occasion; Affected Public: Business or other 
for-profits; Number of Respondents: 400; Total Annual Responses: 
21,200; Total Annual Hours: 42,400. (For policy questions regarding 
this collection contact Coles Mercier at 410-786-2112. For all other 
issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Information Collection Requirements in 42 CFR 478.18, 
478.34, 478.36, 478.42, QIO Reconsiderations and Appeals; Use: In the 
event that a beneficiary, provider, physician, or other practitioner 
does not agree with the initial determination of a Quality Improvement 
Organization (QIO) or a QIO subcontractor, it is within that party's 
rights to request reconsideration. The information collection 
requirements at 42 CFR 478.18, 478.34, 478.36, and 478.42, contain 
procedures for QIOs to use in reconsideration of initial 
determinations. The information requirements contained in these 
regulations are imposed on QIOs to provide information to parties 
requesting the reconsideration. These parties will use the information 
as guidelines for appeal rights in instances where issues are actively 
being disputed. Form Number: CMS-R-72 (OCN: 0938-0443); Frequency: 
Reporting--On occasion; Affected Public: Individuals or Households and 
Business or other for-profit institutions; Number of Respondents: 
2,590; Total Annual Responses: 5,228; Total Annual Hours: 2,822. (For 
policy questions regarding this collection contact Coles Mercier at 
410-786-2112. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Reinstatement with a 
change of a previously approved collection; Title of Information 
Collection: Expanded Coverage for Diabetes Outpatient Self-Management 
Training Services and Supporting Regulations Contained in 42 CFR 
410.141, 410.142, 410.143, 410.144, 410.145, 410.146, 414.63; Use: 
According to the National Health and Nutrition Examination Survey 
(NHANES), as many as 18.7 percent of Americans over age 65 are at risk 
for developing diabetes. The goals in the management of diabetes are to 
achieve normal metabolic control and reduce the risk of micro- and 
macro-vascular complications. Numerous epidemiologic and interventional 
studies point to the necessity of maintaining good glycemic control to 
reduce the risk of the complications of diabetes. Despite this 
knowledge, diabetes remains the leading cause of blindness, lower 
extremity amputations and kidney disease requiring dialysis. Diabetes 
and its complications are primary or secondary factors in an estimated 
9 percent of hospitalizations (Aubert, RE, et al., Diabetes-related 
hospitalizations and hospital utilization. In: Diabetes in America. 2nd 
ed. National Institutes of Health, National Institute of Diabetes and 
Digestive and Kidney Disease, NIH, Pub. No 95-1468-1995: 553-570). 
Overall, beneficiaries with diabetes are hospitalized 1.5 times more 
often than beneficiaries without diabetes. HCFA-3002-F ``Expanded 
Coverage for Outpatient Diabetes Self-Management Training and Diabetes 
Outcome Measurements'', provided for uniform coverage of diabetes 
outpatient self-management training services. These services include 
educational and training services furnished to a beneficiary with 
diabetes by an entity approved to furnish the services. The physician 
or qualified non-physician practitioner treating the beneficiary's 
diabetes would certify that these services are needed as part of a 
comprehensive plan of care. This rule established the quality standards 
that an entity would be required to meet in order to participate in 
furnishing diabetes outpatient self-management training services. It 
set forth payment amounts that have been established in consultation 
with appropriate diabetes organizations. It implements section 4105 of 
the Balanced Budget Act of 1997. Form Number: CMS-R-247 (OCN: 0938-
0818); Frequency: Recordkeeping and Reporting--Occasionally; Affected 
Public: Business or other for-profit institutions; Number of 
Respondents: 5327; Total Annual Responses: 63,924; Total Annual Hours: 
197,542. (For policy questions regarding this collection contact 
Kristin Shifflett at 410-786-4133. 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 Quality 
of Care Complaint Form; Use: In accordance with Section 1154(a)(14) of 
the Social Security Act, Quality Improvement Organizations (QIOs) are 
required to conduct appropriate reviews of all written complaints 
submitted by beneficiaries concerning the quality of care received. The 
Medicare Quality of Care Complaint Form will be used by Medicare 
beneficiaries to submit quality of care complaints. This form will 
establish a standard form for all beneficiaries to utilize and ensure 
pertinent information is obtained by QIOs to effectively process these 
complaints. Form Number: CMS-10287 (OCN: 0938-1102); Frequency: 
Reporting--Occasionally; Affected Public: Individuals or Households; 
Number of Respondents: 3,500; Total Annual Responses: 3,500; Total 
Annual Hours: 583. (For policy questions regarding this collection 
contact Coles Mercier at 410-786-2112. For all other issues call 410-
786-1326.)
    5. Type of Information Collection Request: Reinstatement with 
change of a currently approved collection; Title of Information 
Collection: Conditions of Participation for Portable X-ray Suppliers 
and Supporting Regulations in 42 CFR Sections 486.104, 486.106, 
486.110; Use: The requirements contained in this information collection 
request are classified as conditions of participation or conditions for 
coverage. These conditions are based on a provision specified in law 
relating to diagnostic X-ray tests ``furnished in a place of residence 
used as the patient's home,'' and are designed to ensure that each 
supplier has a properly trained staff to provide the appropriate type 
and level of care, as well as, a safe physical environment for 
patients. CMS uses these conditions to certify suppliers of portable X-
ray services wishing to participate in the Medicare program. This is 
standard medical practice and is necessary in order to help to ensure 
the well-being, safety and quality professional medical treatment 
accountability for each patient. Form Number: CMS-R-43 (OCN: 0938-
0338); Frequency: Yearly; Affected Public: Business or other for-profit 
and Not-for-profit institutions; Number of Respondents: 578; Total 
Annual Responses: 578; Total Annual Hours: 948. (For policy questions 
regarding this collections contact Alesia Hovatter at 410-786-6861. For 
all other issues call 410-786-1326.)

[[Page 27402]]

    6. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Annual 
Report of Physician-Owned Hospital Ownership and/or Investment 
Interest; Use: Section 6001 of the Affordable Care Act (ACA) requires 
Medicare hospitals to report whether they have any physician owners 
including immediately family members of the physician.
    Currently the CMS 855A captures basic ownership/managerial 
information on providers. The CMS 855A was revised in July 2011 and a 
specific attachment designed to capture physician-owned hospital 
ownership and investment interest data was added to the form. The 
attachment is being removed from the CMS 855A application because the 
annual reporting requirement for physician-owned hospitals is not 
required for Medicare enrollment processing. This physician-owned 
hospital data collection is mandated to be reported on an annual basis. 
Additionally, the ACA prohibits the expansion of current physician-
owned hospitals and banned the establishment of new ones making the CMS 
855A the improper method to collect this required annual report.
    CMS is requesting the physician-owned hospital ownership 
information, investment information or both, previously collected in 
Attachment 1 of the CMS 855A enrollment application to become a stand-
alone form with a unique OMB number for the following reasons:
     The physician-owned data collection has a small targeted 
audience of approximately 140 physician-owned hospitals nationwide.
     The physician-owned data collection is required annually, 
as noted above.
     The data required under section 6001 is more specific than 
the data currently collected on the CMS-855A provider enrollment 
application.
     The data is not required for Medicare provider enrollment 
purposes.
    Form Number: CMS-855 (POH)(OCN: 0938-New); Frequency: Reporting--
Yearly; Affected Public: Private Sector--Business or other for-profits 
and not-for-profit institutions; Number of Respondents: 140; Total 
Annual Responses: 140; Total Annual Hours: 140. (For policy questions 
regarding this collection contact Kim McPhillips at 410-786-5374. For 
all other issues call 410-786-1326.)
    7. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Hospital and 
Health Care Complexes and Supporting Regulations in 42 CFR 413.20 and 
413.24; Use: Medicare Part A institutional providers must provide 
adequate cost data to receive Medicare reimbursement (42 CFR 
413.24(a)). Providers must submit the cost data to their Medicare 
Fiscal Intermediary (FI)/Medicare Administrative Contractor (MAC) 
through the Medicare cost report (MCR). We are submitting a revision of 
the Hospital and Hospital Health Care Complex Cost Report, Form CMS-
2552-10. Form CMS 2552-10 is used by hospitals participating in the 
Medicare program to report the health care costs to determine the 
amount of reimbursable costs for services rendered to Medicare 
beneficiaries. The revisions were caused by legislative requirements in 
the Patient Protection and Affordable Care Act of 2010 and the 
Temporary Payroll Tax Cut Continuation Act of 2011. Form Number: CMS-
2552-10 (OCN: 0938-0050); Frequency: Reporting--Yearly; Affected 
Public: Private Sector--Business or other for-profits and not-for-
profit institutions; Number of Respondents: 6,171; Total Annual 
Responses: 6,171; Total Annual Hours: 4,153,083. (For policy questions 
regarding this collection contact Nadia Massuda at 410-786-5834. For 
all other issues call 410-786-1326.)
    8. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection. Title of Information 
Collection: Collection of Diagnostic Data from Medicare Advantage 
Organizations for Risk Adjusted Payments. Use: CMS will use the data to 
make risk adjusted payment under Parts C. MA and MA-PD plans will use 
the data to develop their Parts C bids. As required by law, CMS also 
annually publishes the risk adjustment factors for plans and other 
interested entities in the Advance Notice of Methodological Changes for 
MA Payment Rates (every February) and the Announcement of Medicare 
Advantage Payment Rates (every April). Lastly, CMS issues monthly 
reports to each individual plan that contains the CMS-HCC and RxHCC 
models' output and the risk scores and reimbursements for each 
beneficiary that is enrolled in their plan. Form Number: CMS-10062 (OMB 
0938-0838). Frequency: Quarterly. Affected Public: Private Sector 
(business or other for-profit and not-for-profit institutions). Number 
of Respondents: 766. Total Annual Responses: 830,000. Total Annual 
Hours: 40,650. (For policy questions regarding this collection contact 
Michael Massimini at 410-786-1566. 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 http://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 9, 2013:
    1. Electronically. You may submit your comments electronically to 
http://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: May 6, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-11035 Filed 5-9-13; 8:45 am]
BILLING CODE 4120-01-P
```