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[Federal Register Volume 78, Number 180 (Tuesday, September 17, 2013)]
[Notices]
[Pages 57162-57163]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-22515]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers CMS-1728-94, CMS-1763, CMS-R-267 and CMS-250-254]

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

ACTION: Notice.

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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 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.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by October 17, 2013:

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) 395-6974 OR, Email: OIRA_submission@omb.eop.gov .
    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' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    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.

FOR FURTHER INFORMATION CONTACT:  Reports Clearance Office at (410) 
786-1326.

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: Extension without change 
of a currently approved collection; Title of Information Collection: 
Home Health Agency Cost Report; Use: In accordance with sections 
1815(a), 1833(e) and 1861(v)(1)(A) of the Social Security Act, 
providers of service in the Medicare program are required to submit 
annual information to achieve reimbursement for health care services 
rendered to Medicare beneficiaries. In addition, 42 CFR 413.20(b) 
requires that cost reports are required from providers on an annual 
basis. Such cost reports are required to be filed with the provider's 
Medicare contractor. The Medicare contractor uses the cost report not 
only to make settlement with the provider for the fiscal period covered 
by the cost report, but also in deciding whether to audit the records 
of the provider. Section 413.24(a) requires providers receiving payment 
on the basis of reimbursable cost provide adequate cost data based on 
their financial and statistical records that must be capable of 
verification by qualified auditors. Besides determining program 
reimbursement, the data submitted on the cost reports supports the 
management of federal programs. The data is extracted from the cost 
report and used for making projections of Medicare Trust Fund 
requirements and for analysis to rebase home health agency prospective 
payment system. The data is also available to Congress, researchers, 
universities, and other interested parties. While the collection of 
data is a secondary function of the cost report, its primary function 
is to reimburse providers for services rendered to program 
beneficiaries. Form Number: CMS-1728-94 (OCN: 0938-0022); Frequency: 
Yearly; Affected Public: Business or other for-profits and Not-for-
profit institutions; Number of Respondents: 11,563; Total Annual 
Responses: 11,563; Total Annual Hours: 2,613,238. (For policy questions 
regarding this collection contact Angela Havrilla at 410-786-4516.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection;

[[Page 57163]]

Title of Information Collection: Request for Termination of Premium 
Hospital and Supplementary Medical Insurance; Use: The CMS-1763 
provides us and the Social Security Administration (SSA) with the 
enrollee's request for termination of Part B, Part A or both Part B and 
A premium coverage. The form is completed by an SSA claims or field 
representative using information provided by the Medicare enrollee 
during an interview. The purpose of the form is to provide to the 
enrollee with a standardized format to request termination of Part B, 
Part A premium coverage or both, explain why the enrollee wishes to 
terminate such coverage, and to acknowledge that the ramifications of 
the decision are understood. Form Number: CMS-1763 (OCN: 0938-0025); 
Frequency: Once; Affected Public: Individuals or households; Number of 
Respondents: 14,000; Total Annual Responses: 14,000; Total Annual 
Hours: 5,833. (For policy questions regarding this collection contact 
Lindsay Smith at 410-786-6843.)
    3. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Medicare Advantage Program Requirements; Use: Medicare Advantage (MA) 
organizations and potential MA organizations (applicants) use the 
information to comply with the application requirements and the MA 
contract requirements. We will use this information to: approve 
contract applications, monitor compliance with contract requirements, 
make proper payment to MA organizations, determine compliance with the 
new prescription drug benefit requirements, and to ensure that correct 
information is disclosed to Medicare beneficiaries (both potential 
enrollees and enrollees). Form Number: CMS-R-267 (OCN: 0938-0753); 
Frequency: Yearly; Affected Public: Individuals or households and 
Business or other for-profits; Number of Respondents: 18,043,776; Total 
Annual Responses: 21,935,728; Total Annual Hours: 8,529,541. (For 
policy questions regarding this collection contact Dana Burley at 410-
786-4547.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Medicare Secondary Payer Information Collection and 
Supporting Regulations; Use: We are seeking to renew approval to 
collect information from beneficiaries, providers, physicians, 
insurers, and suppliers on health insurance coverage that is primary to 
Medicare. Collecting this information allows us to identify those 
Medicare beneficiaries who are in situations where Medicare is 
statutorily required to be a secondary payer (MSP), thereby 
safeguarding the Medicare Trust Fund. Specifically, we use the 
information to accurately process and pay Medicare claims and to make 
necessary recoveries in accordance with Sec.  1862(b) of the Act (42 
U.S.C.1395y(b)). If an active MSP situation is identified and Medicare 
is inappropriately billed as primary, the claim will be rejected. The 
hospitals, other providers, physicians, pharmacies, and suppliers use 
the information collected (and furnished to them on the denial) to 
properly bill the appropriate primary payer. Completing an MSP 
questionnaire and making an accurate MSP determination helps hospitals, 
other providers, physicians, pharmacies, and suppliers to bill 
correctly the first time, saving the Medicare Program money and 
affording Medicare beneficiaries an enhanced level of customer service 
(which, again, is particularly important in Part D due to the real-time 
adjudication of claims and the complicated nature of its benefit 
administration). Insurers, underwriters, third party administrators, 
and self-insured/self-administered employers use the information to 
ensure compliance with the law by refunding any identified mistaken 
payments to Medicare. Form Number: CMS-250-254 (OCN: 0938-0214); 
Frequency: Occasionally; Affected Public: Individuals and Households, 
Private Sector, State, Local or Tribal Governments; Number of 
Respondents: 143,070,217; Total Annual Responses: 143,070,217; Total 
Annual Hours: 1,788,057. (For policy questions regarding this 
collection contact Ward Marsh at 410-786-6473.)

    Dated: September 11, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-22515 Filed 9-16-13; 8:45 am]
BILLING CODE 4120-01-P
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