```

[Federal Register Volume 69, Number 219 (Monday, November 15, 2004)]
[Notices]
[Pages 65602-65603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-25250]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-185, CMS 10131, CMS-10054 and CMS-R-50]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare and Medicaid Services.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid 
Services (CMS) (formerly known as the Health Care Financing 
Administration (HCFA)), 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 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: Extension of a currently 
approved collection; Title of Information Collection: Granting and 
Withdrawal of Deeming Authority to Private Nonprofit Accreditation 
Organizations and of State Exemption Under State Laboratory Programs 
and Supporting Regulations in 42 CFR 493.551-493.557; Use: The 
information required is necessary to determine whether a private 
accreditation organization's or State licensure program's standards and 
accreditation/licensure process is equal to or more stringent than 
those of CLIA. Form Number: CMS-R-185 (OMB: 0938-0686); 
Frequency: Initial application and as needed; Affected Public: Not-for-
profit institutions, Business or other for-profit and State, Local, or 
Tribal Government; Number of Respondents: 8; Total Annual Responses: 
76; Total Annual Hours: 768.
    2. Type of Information Collection Request: New Collection; Title of 
Information Collection: Evaluation of Medicare Disease Management 
Demonstrations; Form No.: CMS-10131 (OMB 0938-NEW); Use: CMS 
contracted with Mathematic Policy Research, Inc. (MPR) for the 
evaluation of disease management programs. The purpose of the patient 
survey is to assess the impact of disease management and prescription 
drug benefits on patient health, functioning status, care satisfaction, 
health behaviors and knowledge of condition. Data from the physician 
survey will be used to assess physician satisfaction with disease 
management services, physician perceptions of the impact of disease 
management on patient outcomes, education and service use, and the 
impact of disease management programs on physician practices and office 
workload.; Frequency: On Occasion; Affected Public: Individuals or 
households, Business or other for-profit; Number of Respondents: 5000; 
Total Annual Responses: 2500; Total Annual Hours: 1625.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Recognition of 
Payment for New Technology Services for Ambulatory Payment 
Classifications (APCs) under the Outpatient Prospective Payment System 
and Supporting Regulations in 42 CFR, 413.65 and 419.42; Form No.: CMS-
10054 (OMB 0938-0860); Use: Information is necessary to 
determine services eligible for payment in new technology ambulatory 
payment classifications (APCs) in the outpatient prospective payment 
system; Frequency: On Occasion; Affected Public: Business or other for-
profit; Number of Respondents: 15; Total Annual Responses: 15; Total 
Annual Hours: 180.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medical Records 
Review under PPS and Supporting Regulations in 42 CFR, Sections 412.40-
412.52; Form No.: CMS-R-50 (OMB 0938-0359); Use: The Quality 
Improvement Organizations (QIOs) are authorized to conduct medical 
review activities under the Prospective Payment System (PPS) . In order 
to conduct these review activites, the agency depends upon hospitals to 
make available specific records regarding care provided to Medicare 
beneficiaries. The Clinical Data Abstraction Centers (CDACs) obtain 
copies of medical records from which they abstract data to analyze 
patterns of care and outcomes for heart failure/myocardial infarction, 
pneumonia, diabetes and surgical infection.; Frequency: Other: when 
records are reviewed; Affected Public:

[[Page 65603]]

Business or other for-profit, Not-for-profit institutions, Federal 
Government, and State, Local or Tribal Govt.; Number of Respondents: 
6,100; Total Annual Responses: 397,500; Total Annual Hours: 11,925.
    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/regulations/pra/, or e-mail 
your request, including your address, phone number, OMB number, and CMS 
document identifier, to [email protected], or call the Reports 
Clearance Office on (410) 786-1326.
    Written comments and recommendations for the proposed information 
collections must be mailed within 60 days of this notice directly to 
the CMS Paperwork Clearance Officer designated at the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development and Issuances, Attention: Melissa 
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850.

    Dated: November 5, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 04-25250 Filed 11-12-04; 8:45 am]
BILLING CODE 4120-03-P
```