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[Federal Register Volume 76, Number 103 (Friday, May 27, 2011)]
[Notices]
[Page 30944]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-13039]

[[Page 30944]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-222, CMS-287-05, CMS-1771, and CMS-10008]

Agency Information Collection Activities: Submission for OMB 
Review; 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), 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 function; (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 currently 
approved collection; Title of Information Collection: Independent Rural 
Health Center/Freestanding Federally Qualified Health Center Cost 
Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24; Use: 
Providers of service in the Medicare program are required to submit 
annual information to achieve reimbursement for health care services 
rendered to Medicare beneficiaries. The Form CMS-222 cost report is 
needed to determine the amount of reasonable cost due to the providers 
for furnishing medical services to Medicare beneficiaries; Form Number: 
CMS-222 (OMB 0938-0107); Frequency: Yearly; Affected Public: 
Business or other for-profit and not-for-profit institutions; Number of 
Respondents: 5,812; Total Annual Responses: 5,812; Total Annual Hours: 
290,600. (For policy questions regarding this collection contact Steve 
A. Raitzyk at 410-786-4599. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Chain Home Office Cost Statement and supporting Regulations in 42 CFR 
413.17 and 413.20; Use: The Form CMS-287-05 is filed annually by Chain 
Home Offices to report the information necessary for the determination 
of Medicare reimbursement to components of chain organizations. 
However, where providers are components of chain organizations, 
information included in the chain home office cost statement is in 
addition to that included in the provider cost report and is needed to 
determine whether payments are appropriate. Form Number: CMS-287-05 
(OMB 0938-0202); Frequency: Yearly; Affected Public: Business 
or other for-profit and not-for-profit institutions; Number of 
Respondents: 1,541; Total Annual Responses: 1,541; Total Annual Hours: 
718,106. (For policy questions regarding this collection contact Nadia 
Massuda at 410-786-5834. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Attending 
Physicians Statement and Documentation of Medicare Emergency and 
Supporting Regulations in 42 CFR Section 424.103; Use: 42 CFR 424.103 
(b) requires that before a nonparticipating hospital may be paid for 
emergency services rendered to a Medicare beneficiary, a statement must 
be submitted that is sufficiently comprehensive to support that an 
emergency existed. Form CMS-1771 contains a series of questions 
relating to the medical necessity of the emergency. The attending 
physician must attest that the hospitalization was required under the 
regulatory emergency definition (42 CFR 424.101) and give clinical 
documentation to support the claim. Form Number: CMS-1771 (OMB 
0938-0023); Frequency: Yearly; Affected Public: Private sector--
Business or other for-profit and not-for-profit institutions; Number of 
Respondents: 100; Total Annual Responses: 200; Total Annual Hours: 50. 
(For policy questions regarding this collection contact Shauntari 
Cheely at 410-786-1818. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Process and 
Information Required To Determine Eligibility of Drugs, Biologicals, 
and Radiopharmaceutical Agents for Transitional Pass-Through Status 
Under the Hospital Outpatient Prospective Payment System (OPPS); Use: 
Section 1833(t)(6) of the Social Security Act provides for temporary 
additional payments or ``transitional pass-through payments'' for 
certain drugs and biological agents. Interested parties such as 
hospitals, pharmaceutical companies, and physicians can apply for 
transitional pass-through payment for drugs and biologicals used with 
services covered under the OPPS. CMS uses this information to determine 
if the criteria for making a transitional pass-through payment are met 
and if an interim Healthcare Common Procedure Coding System (HCPCS) 
code for a new drug or biological is necessary. Form Number: CMS-10008 
(OMB: 0938-0802); Frequency: Once; Affected Public: Private 
sector--Business or other for-profit; Number of Respondents: 30; Total 
Annual Responses: 480; Total Annual Hours: 480. (For policy questions 
regarding this collection contact Christina Ritter Ph.D. at 410-786-
4636. For all other issues call 410-786-1326.)
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on June 27, 2011. 
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer.
    Fax Number: (202) 395-6974.
    E-mail: OIRA_submission@omb.eop.gov.

    Dated: May 20, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2011-13039 Filed 5-26-11; 8:45 am]
BILLING CODE 4120-01-P
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