20404 Federal Register / Vol. 77, No. 65 / Wednesday, April 4, 2012 / Notices 

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 June 4, 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: March 28, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–8009 Filed 4–3–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–437A and CMS– 

437B] 

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: Revision of a currently 

approved collection. Title of 

Information Collection: State Agency 

Sheets for Verifying Exclusions from the 

Inpatient Prospective Payment System 

and Supporting Regulations in 42 CFR 

Parts 412.20–412.29. Use: For first time 

verification requests for exclusion from 

the Inpatient Prospective Payment 

System (IPPS), a hospital/unit must 

notify the Regional Office (RO) servicing 

the State in which it is located that it 

believes it meets the criteria for 

exclusion from the IPPS. Currently, all 

new inpatient rehabilitation facilities 

(IRFs) must provide written certification 

that the inpatient population it intends 

to serve will meet the requirements of 

the IPPS exclusion criteria for IRFs. 

They must also complete the Form 

CMS–437A if they are a rehabilitation 

unit or complete Form CMS–437B if 

they are a rehabilitation hospital. This 

information is submitted to the State 

Agency (SA) no later than 5 months 

before the date the hospital/unit would 

become subject to IRF–PPS. 

CMS proposes to continue to use the 

Criteria Worksheets (Forms CMS–437A 

and CMS–437B) for verifying first-time 

exclusions from the IPPS, for complaint 

surveys, for its annual 5 percent 

validation sample, and for facility selfattestation. These forms are related to 

the survey and certification and 

Medicare approval of the IPPS-excluded 

rehabilitation units and rehabilitation 

hospitals. 

For rehabilitation hospitals and 

rehabilitation units already excluded 

from the IPPS, annual onsite reverification surveys by the SA are not 

required. These hospitals and units will 

be provided with a copy of the 

appropriate CMS–437 Worksheet at 

least 120 days prior to the beginning of 

its cost reporting period, so that the 

hospital/unit official may complete and 

sign an attestation statement and 

complete and return the appropriate 

CMS–437A or CMS–437B at least 120 

days prior to the beginning of its cost 

reporting period. Fiscal Intermediaries 

(FIs) will continue to verify, on an 

annual basis, compliance with the 60 

percent rule (42 CFR 412.29(b)(2)) for 

rehabilitation hospitals and 

rehabilitation units through a sample of 

medical records and the SA will verify 

the medical director requirement. 

The SA will maintain the documents 

unless instructed otherwise by the RO. 

The SA will notify the RO at least 60 

days prior to the end of the 

rehabilitation hospital’s/unit’s cost 

reporting period of the IRF’s compliance 

or non-compliance with the payment 

requirements. The information collected 

on these forms, along with other 

information submitted by the IRF is 

necessary for determining exclusion 

from the IPPS. Hospitals and units that 

have already been excluded need not 

reapply for exclusion. These facilities 

will automatically be reevaluated yearly 

to determine whether they continue to 

meet the exclusion criteria. 

In this PRA package, both forms have 

been revised. Form Number: CMS–437A 

and CMS–437B (OCN 0938–0986). 

Frequency: Yearly. Affected Public: 

Private Sector (Business or other forprofits). Number of Respondents: 1,164. 

Total Annual Responses: 1,164. Total 

Annual Hours: 291. (For policy 

questions regarding this collection 

contact Georgia Johnson at 410–786– 

6859. 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 June 4, 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 CMS–437A and CMS– 

437B (OCN 0938–0986), Room C4–26– 

05, 7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: March 28, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–8013 Filed 4–3–12; 8:45 am] 

BILLING CODE 4120–01–P 


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