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[Federal Register Volume 76, Number 242 (Friday, December 16, 2011)]
[Notices]
[Pages 78264-78265]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-32296]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-179, CMS-10221, CMS-10408, and CMS-R-245]

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 & 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: Revision of a currently 
approved collection; Title of Information Collection: State Plan Under 
Title XIX of the Social Security Act (Base plan pages, Attachments, 
Supplements to attachments); Use: State Medicaid agencies complete the 
plan pages and CMS reviews the information to determine if the State 
has met all of the provisions that the State has chosen to implement. 
If the requirements are met, CMS will approve the amendments to the 
State's Medicaid plan giving the State the authority to implement the 
flexibilities. For a State to receive Medicaid Title XIX funding, there 
must be an approved Title XIX State plan; Form Number: CMS-179 (OCN 
0938-0193); Frequency: Occasionally; Affected Public: State, Local, or 
Tribal Governments; Number of Respondents: 56; Total Annual Responses: 
1,120; Total Annual Hours: 400. (For policy questions regarding this 
collection contact Candice Payne at (410) 786-4453. 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: Worksheet for Recording Results of Medicare Site Visits of 
Independent Diagnostic Testing Facilities (IDTFs); Use: The worksheet 
(form) was developed, approved by the Office of Management and Budget, 
and implemented to provide CMS with a standard format to collect and 
verify information regarding the compliance of IDTFs with the 
performance standards found in 42 CFR 410.33(g). This previously 
approved form was allowed to expire in error. CMS is now seeking to 
reinstate the use of this form.
    The worksheet is used to collect and record information obtained on 
IDTF site visits; the data collected during site visits facilitates the 
verification of the accuracy and completeness of the information the 
IDTF furnished on its CMS-855B enrollment application. The worksheet is 
completed by CMS or its contractors. Some of the answers to the 
questions/data elements on the worksheet are verbally furnished by the 
IDTF during the site visit; Form Number: CMS-10221 (OCN 0938-1029); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profits); Number of Respondents: 2,000; Total Annual 
Responses: 2,000; Total Annual Hours: 4,000. (For policy questions 
regarding this collection contact Michael Collett at (410) 786-6121. 
For all other issues call (410) 786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Early Retiree 
Reinsurance Program Survey of Plan Sponsors; Use: Under the Patient 
Protection and Affordable Care Act (42 U.S.C. 18002) and implementing 
regulations at 45 CFR part 149, employment-based plans that offer 
health coverage to early retirees and their spouses, surviving spouses, 
and dependents are eligible to receive tax-free reimbursement for a 
portion of the costs of health benefits provided to such individuals. 
The statute limits how the reimbursement funds can be used, and 
requires the Secretary of HHS to develop a mechanism to monitor the 
appropriate use of such funds. The survey that is the subject of this 
PRA package is part of that mechanism; Form Number: CMS-10408 (OMB 
0938-1150); Frequency: Yearly; Affected Public: Private Sector 
(Business or other for-profit and Not-for-profit institutions); Number 
of Respondents: 2,076; Total Responses: 2,076; Total Hours: 22,836. 
(For policy questions regarding this collection contact David Mlawsky 
at (410) 786-6851. For all other issues call (410) 786-1326.)
    4. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Medicare and Medicaid Programs OASIS Collection Requirements as Part of 
the CoPs for HHAs and Supp. Regs. in 42 CFR 48.55, 484.205, 484.245, 
484.250; Use: This data set is currently mandated for use by Home 
Health Agencies (HHAs) as a condition of participation (CoP) in the 
Medicare program. Since 1999, the Medicare CoPs have mandated that HHAs 
use the OASIS data set when evaluating adult non-maternity patients 
receiving skilled services. The OASIS is a core standard assessment 
data set that agencies integrate into their own patient-specific, 
comprehensive assessment to identify each patient's need for home care 
that meets the patient's medical, nursing, rehabilitative, social, and 
discharge planning needs; Form Number: CMS-R-245 (OCN 0938-0760); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profit and Not-for-profit institutions); Number of 
Respondents: 11,495; Total Annual Responses: 16,476,008; Total Annual 
Hours: 16,567,968. (For policy questions regarding this collection 
contact Robin Dowell at (410) 786-0060. 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

[[Page 78265]]

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 February 14, 2012:
    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: December 9, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-32296 Filed 12-15-11; 8:45 am]
BILLING CODE 4120-01-P
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