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[Federal Register Volume 78, Number 20 (Wednesday, January 30, 2013)]
[Notices]
[Pages 6331-6332]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-01849]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-276 and CMS-339]

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 
change of a previously approved collection; Title: Prepaid Health Plan 
Cost Report; Use: Health Maintenance Organizations and Competitive 
Medical Plans (HMO/CMPs) contracting with the Secretary under Section 
1876 of the Social Security Act are required to submit a budget and 
enrollment forecast, semi-annual interim report, interim final cost 
report, and a final certified cost report in accordance with 42 CFR 
417.572-417.576. Health Care Prepayment Plans

[[Page 6332]]

(HCPPs) contracting with the Secretary under Section 1833 of the Social 
Security Act are required to submit a budget and enrollment forecast, 
semi-annual interim report, and final cost report in accordance with 42 
CFR 417.808 and 42 CFR 417.810. CMS is requesting approval for the 
reinstatement with change of Form CMS-276 (OCN: 0938-0165). This Cost 
Report outlines the provisions for implementing Section 1876(h) and 
Section 1833(a)(1)(A) of the Social Security Act. The purposes of the 
revisions were to implement some changes in response to the Affordable 
Care Act, clarify certain instructions, and update outdated issues 
within the Cost Report. Form Number: CMS-276 (OMB 0938-0165); 
Frequency: Annually; Affected Public: Private Sector--Business or other 
for-profits and not-for-profit institutions; Number of Respondents: 29; 
Total Annual Responses: 106; Total Annual Hours: 1,384. (For policy 
questions regarding this collection contact Temeshia Johnson at 410-
786-8692. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Medicare Provider Cost Report Reimbursement Questionnaire; 
Use: The purpose of Form CMS-339 is to assist the provider in preparing 
an acceptable cost report and to minimize subsequent contact between 
the provider and its Medicare Administrative Contractor (MAC). Form 
CMS-339 provides the basic data necessary to support the information in 
the cost report. Exhibit 1of Form CMS-339 contains a series of 
reimbursement-oriented questions which serve to update information on 
the operations of the provider. It is arranged topically regarding 
financial activities such as independent audits, provider organization 
and operation, etc. The MAC is responsible for the settlement of the 
Medicare cost report and must determine the reasonableness and the 
accuracy of the reimbursement claimed. This process includes performing 
both a desk review of the cost report and an analysis leading to a 
decision to settle the cost report with or without further audit. Form 
CMS-339 provides essential information to enable the MAC to make the 
audit or no audit decision, scope of the audit if one is necessary, and 
to update the provider documentation (i.e., documentation to support 
the financial profile of the provider). If the information is not 
collected, the MAC will have to go onsite to each provider to get this 
information. Consequently, it is far less burdensome and extremely cost 
effective to capture this information through the Form CMS-339.
    Exhibit 2 of Form CMS-339 is a listing of bad debts pertaining to 
uncollectible Medicare deductible and coinsurance amounts. Preparation 
of the listing is a convenient way for providers to supply the MAC with 
information needed to determine the allow ability of the bad debts for 
reimbursement. Some items required to determine allow ability that are 
included on this exhibit are patient's name, dates of service, date 
first bill sent to beneficiary, and date the collection effort ceased. 
Supplying the MAC with this information may be all that is required for 
the MAC to determine whether or not the bad debt is allowable. This too 
may eliminate a visit to the provider to gather this needed data. Form 
Number: CMS-339 (OCN: 0938-0301); Frequency: Yearly; Affected Public: 
Private Sector--Business or other for-profits and not-for-profit 
institutions; Number of Respondents: 17,939; Total Annual Responses: 
17,939; Total Annual Hours: 53,817. (For policy questions regarding 
this collection contact Christine Dobrzycki at 410-786-3389. 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 April 1, 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: January 24, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-01849 Filed 1-29-13; 8:45 am]
BILLING CODE 4120-01-P
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