```

[Federal Register: September 3, 2010 (Volume 75, Number 171)]
[Notices]               
[Page 54149]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr03se10-63]                         

[[Page 54149]]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-417, CMS-10227 and CMS-10351]

 
Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & 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) 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: Hospice Request 
for Certification in the Medicare Program; Use: The Hospice Request for 
Certification Form is the identification and screening form used to 
initiate the certification process and to determine if the provider has 
sufficient personnel to participate in the Medicare program. Form 
Number: CMS-417 (OMB: 0938-0313); Frequency: Annually; 
Affected Public: Private Sector: Business or other for-profits; Number 
of Respondents: 3,494; Total Annual Responses: 3,494; Total Annual 
Hours: 594. (For policy questions regarding this collection contact 
Debbie Terkay at 410-786-6835. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: PACE State Plan 
Amendment Pre-print; Use: The Balanced Budget Act of 1997 created 
section 1934 of the Social Security Act that established the Program 
for the All-Inclusive Care for the Elderly (PACE). The legislation 
established the PACE program as a Medicaid State plan option serving 
the frail and elderly in the home and community. Pursuant to the notice 
given in 64 FR 66271 (November 24, 1999), if a State elects to offer 
PACE as an optional Medicaid benefit, it must complete a State Plan 
Amendment described as Enclosures 3, 4, 5, 6 and 7. The 
information collected is used by CMS to affirm that the State elects to 
offer PACE an optional State plan service and the specifications of 
eligibility, payment and enrollment for the program. Form Number: CMS-
10227 (OMB: 0938-1027); Frequency: Once; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 36; Total 
Annual Responses: 12; Total Annual Hours: 240. (For policy questions 
regarding this collection contact Angela Taube at 410-786-2638. For all 
other issues call 410-786-1326.)
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: ESRD PPS Transition Election and attestations 
of Low-Volume; Use: The Medicare Improvement for Patients and Providers 
Act (MIPPA) requires implementation of an End Stage Rental Disease 
(ESRD) bundled prospective payment system (PPS) effective January 1, 
2011. Once implemented, the ESRD PPS will replace the current basic 
case-mix adjusted composite payment system and the methodologies for 
the reimbursement of separately billable outpatient ESRD related items 
and services. The ESRD PPS will provide a single payment to the ESRD 
facilities that will cover all the resources used in providing an 
outpatient dialysis treatment. Also, as required my MIPPA, ESRD 
facilities are eligible to receive a low-volume adjustment when the 
facility furnished less than 4000 treatments in each of the three years 
pre-ceding the payment year.
    In order for an ESRD facility to receive the low-volume adjustment, 
CMS will require that an ESRD facility must provide an attestation to 
the fiscal intermediary or the Medicare administrative contractor (FI/
MAC) that it has met the criteria to qualify as a low-volume facility. 
The FI or MAC would verify the ESRD facility's attestation of their 
low-volume status using the ESRD facility's final-settled cost reports. 
Also, an ESRD facility may make a one-time election to be excluded from 
the four-year transition to the ESRD PPS. A facility may elect to be 
paid entirely based on the ESRD PPS beginning January 1, 2011. If the 
ESRD facility fails to submit an election, or the ESRD facility's 
election is not received by their MAC by November 1, 2010, payments to 
the ESRD facility for items and services provided during the transition 
will be paid under the basic case-mix adjusted composite payment 
system. Form Number: CMS-10351 (OMB: 0938-New); Frequency: 
Annually; Affected Public: Private Sector: Business or other for-
profits and Not-for-profit institutions; Number of Respondents: 5,808; 
Total Annual Responses: 2,520; Total Annual Hours: 563.2. (For policy 
questions regarding this collection contact Janet Samen at 410-786-
4533. 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 at http://www.cms.hhs.gov/PaperworkReductionActof1995, or E-
mail 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 November 2, 2010:
    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: August 26, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-21722 Filed 9-2-10; 8:45 am]
BILLING CODE 4120-01-P
```