[Federal Register Volume 86, Number 22 (Thursday, February 4, 2021)]
[Notices]
[Pages 8200-8202]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-02358]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-71, CMS-370 and CMS-377, CMS-1572, and CMS-
R-65]


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

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

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 the necessity and utility of the 
proposed information collection for the proper performance of

[[Page 8201]]

the agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and 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 March 8, 2021.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
    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 the following:
    1. Access CMS' website address at website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

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 of a currently 
approved collection; Title of Information Collection: Quality 
Improvement Organization (QIO) Assumption of Responsibilities and 
Supporting Regulations; Use: The Peer Review Improvement Act of 1982 
amended Title XI of the Social Security Act to create the Utilization 
and Quality Control Peer Review Organization (PRO) program which 
replaces the Professional Standards Review Organization (PSRO) program 
and streamlines peer review activities. The term PRO has been renamed 
Quality Improvement Organization (QIO). This information collection 
describes the review functions to be performed by the QIO. It outlines 
relationships among QIOs, providers, practitioners, beneficiaries, 
intermediaries, and carriers. Form Number: CMS-R-71 (OMB control 
number: 0938-0445); Frequency: Yearly; Affected Public: Business or 
other for-profit and Not-for-profit institutions; Number of 
Respondents: 6,939; Total Annual Responses: 972,478; Total Annual 
Hours: 1,034,655. (For policy questions regarding this collection 
contact Kimberly Harris at 401-837-1118.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Titles of Information Collection: ASC Forms for 
Medicare Program Certification; Use: The form CMS-370 titled ``Health 
Insurance Benefits Agreement'' is used for the purpose of establishing 
an ASC's eligibility for payment under Title XVIII of the Social 
Security Act (the ``Act''). This agreement, upon acceptance by the 
Secretary of Health & Human Services, shall be binding on the ASC and 
the Secretary. The agreement may be terminated by either party in 
accordance with regulations. In the event of termination of this 
agreement, payment will not be available for the ASC's services 
furnished to Medicare beneficiaries on or after the effective date of 
termination.
    The CMS-377 form is used by ASCs to initiate both the initial and 
renewal survey by the State Survey Agency, which provides the 
certification required for an ASC to participate in the Medicare 
program. An ASC must complete the CMS-377 form and send it to the 
appropriate State Survey Agency prior to their scheduled accreditation 
renewal date. The CMS-377 form provides the State Survey Agency with 
information about the ASC facility's characteristics, such as, 
determining the size and the composition of the survey team on the 
basis of the number of ORs/procedure rooms and the types of surgical 
procedures performed in the ASC. Form Numbers: CMS-370 and CMS-377 (OMB 
control number: 0938-0266); Frequency: Occasionally; Affected Public: 
Private Sector--Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 1,567; Total Annual Responses: 
1,567; Total Annual Hours: 1,012. (For policy questions regarding this 
collection contact Caroline Gallaher at 410-786-8705.)
    3. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Home Health Agency Survey and Deficiencies Report; Use: In 
order to participate in the Medicare Program as a Home Health Agency 
(HHA) provider, the HHA must meet federal standards. This form is used 
to record information and patients' health and provider compliance with 
requirements and to report the information to the federal government. 
Form Number: CMS-1572 (OMB control number: 0938-0355); Frequency: 
Yearly; Affected Public: State, Local or Tribal Government; Number of 
Respondents: 3,833; Total Annual Responses: 3,833; Total Annual Hours: 
1,917. (For policy questions regarding this collection contact Tara 
Lemons at 410-786-3030.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Final Peer Review 
Organizations Sanction Regulations; Use: The Peer Review Improvement 
Act of 1982 amended Title XI of the Social Security Act (the Act), 
creating the Utilization and Quality Control Peer Review Organization 
Program. Section 1156 of the Act imposes obligations on health care 
practitioners and others who furnish or order services or items under 
Medicare. This section also provides for sanction actions, if the 
Secretary determines that the obligations as stated by this section are 
not met. Quality Improvement Organizations (QIOs) are responsible for 
identifying violations. The QIOs may allow practitioners or other 
entities, opportunities to submit relevant information before 
determining that a violation has occurred. The information collection 
requirements contained in this information collection request are used 
by the QIOs to collect the information necessary to make their 
decision. Form Number: CMS-R-65 (OMB control number: 0938-0444); 
Frequency: Occasionally; Affected Public: Private sector--Business or 
other for-profit and Not-for-profit institutions; Number of 
Respondents: 18; Total Annual Responses: 18; Total Annual Hours: 4,716. 
(For policy questions regarding this collection contact Kimberly Harris 
at 401-837-1118.)


[[Page 8202]]


    Dated: February 1, 2021.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2021-02358 Filed 2-3-21; 8:45 am]
BILLING CODE 4120-01-P