44366 Federal Register / Vol. 74, No. 166 / Friday, August 28, 2009 / Notices 

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. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, e-mail your request, 

including your address, phone number, 

OMB number, and OS document 

identifier, to 

Sherette.funncoleman@hhs.gov, or call 

the Reports Clearance Office on (202) 

690–5683. Send written comments and 

recommendations for the proposed 

information collections within 30 days 

of this notice directly to the OS OMB 

Desk Officer; faxed to OMB at 202–395– 

5806. 

Proposed Project: Adolescent Family 

Life Care and Prevention End of Year 

Report Templates (Revision) OMB No. 

0990–0299, Office of Adolescent 

Pregnancy Programs (OAPP). 

Abstract: OAPP is proposing to revise 

the current OMB approved Adolescent 

Family Life Care and Prevention End of 

Year Report Templates. The current 

OMB approval is applicable through 

May 31, 2009. All AFL grantees are 

required by their Notice of Grant 

Awards to submit an end of year report 

once per year. The current End of Year 

Report templates provide a degree of 

standardization across the AFL grantees, 

allowing for more complete data 

collection by OAPP for program 

assessment. 

OAPP is also proposing to consolidate 

0990–0300—AFL Prevention Project 

End of Year Report Template ICR and 

0990–0299—AFL Care and Prevention 

End of Year Report Templates ICR. After 

the approval by OMB on 0990–0299 

ICR, OAPP will eliminate 0990–0300. 

This action will reduce the redundancy 

across ICRs and lessen the number of 

burden hours reported by including 

both templates under one ICR (0990– 

0299). 

The original title will be changed to 

Adolescent Family Life End of the Year 

Report Template. 

ESTIMATED ANNUALIZED BURDEN TABLE

Type of respondent Form name Number of 

respondents 

Number of 

responses/ 

respondent 

Average 

burden/ 

response 

(hours) 

Total 

burden 

(hours) 

Care demonstration 

projects.

Adolescent Family Life Care and Prevention Template.31 1 65 2,015 

Prevention demonstration 

projects.

Adolescent Family Life Care and Prevention Template.35 1 65 2,275 

Seleda Perryman, 

Office of the Secretary, Paperwork Reduction 

Act Reports Clearance Officer. 

[FR Doc. E9–20795 Filed 8–27–09; 8:45 am] 

BILLING CODE 4150–30–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–1515/1572, 

CMS–301, CMS–317, CMS–319, CMS–1957 

and CMS–10296] 

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: Extension without change of a 

currently approved collection; Title of 

Information Collection: Home Health 

Agency Survey and Deficiencies Report, 

Home Health Functional Assessment 

Instrument and Supporting Regulations 

in 42 CFR 488.26 and 442.30. Use: In 

order to participate in the Medicare 

Program as a Home Home Agency 

(HHA) provider, the HHA must meet 

Federal Standards. These forms are used 

to record information and patients’ 

health and provider compliance with 

requirements and to report the 

information to the Federal Government. 

Form Number: CMS–1515/1572 (OMB#: 

0938–0355); Frequency: Reporting— 

Yearly; Affected Public: Health Care 

Services; Number of Respondents: 

10,078; Total Annual Responses: 5,614; 

Total Annual Hours: 9,821. (For policy 

questions regarding this collection 

contact Patricia Sevast at 410–786–8135. 

For all other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Certification of 

Medicaid Eligibility Quality Control 

Payment Error Rates and Supporting 

Regulations Contained in 42 CFR 

431.816. Use: Under the MEQC 

program, States can operate the 

traditional MEQC sample-and-review 

program or States can elect to study 

targeted areas of eligibility or program 

administration that are error-prone or 

that will help to prevent or reduce 

erroneous or misspent funds. These 

alternative MEQC programs are called 

MEQC pilots. Some States operate 

alternative MEQC programs as part of 

their research and demonstration 

waivers under Section 1115 of the 

Social Security Act. The majority of 

States operate some form of alternative 

MEQC program. However, since the 

number of States that conduct 

traditional MEQC programs and 

alternative MEQC programs can 

fluctuate at any time, we have assessed 

the burden and costs associated with 

submitting the Payment Error Rate form 

as if all States were reporting this 

information. 

State agencies are required to submit 

the Payment Error Rate form to their 

respective CMS Regional Offices. 

Regional Office staff will review these 

forms for completeness and will forward 

these forms to the Central Office for 

compilation of error rate charts for 


hsrobinson on DSK69SOYB1PROD with NOTICES
Federal Register / Vol. 74, No. 166 / Friday, August 28, 2009 / Notices 44367 

projected quarterly withholdings and/or 

fiscal disallowances. The collection of 

information is also necessary to 

implement provisions from the 

Children’s Health Insurance Program 

Reauthorization Act of 2009 (CHIPRA) 

(Pub. L. 111–3) with regard to the 

Medicaid Eligibility Quality Control 

(MEQC) and Payment Error Rate 

Measurement (PERM) programs. Form 

Number: CMS–301 (OMB#: 0938–0246); 

Frequency: Reporting and 

Recordkeeping—Yearly; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

51; Total Annual Responses: 102; Total 

Annual Hours: 16,446. (For policy 

questions regarding this collection 

contact Jessica Woodard at 410–786– 

9249. For all other issues call 410–786– 

1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: State Medicaid 

Eligibility Quality Control Sampling 

Plan and Supporting Regulations in 42 

CFR 431.800–431.865; Use: The 

Medicaid Eligibility Quality Control 

(MEQC) System is operated by the State 

Title XIX agency to monitor and 

improve the administration of its 

Medicaid system. The MEQC system is 

based on monthly State reviews of 

Medicaid cases by States performing the 

traditional sampling process identified 

through statistically reliable statewide 

samples of cases selected from the 

eligibility files. These reviews are 

conducted to determine whether or not 

the sampled cases meet applicable State 

Title XIX eligibility requirements. The 

reviews are also used to assess 

beneficiary liability, if any, and to 

determine the amounts paid to provide 

Medicaid services for these cases.; Form 

Number: CMS–317 (OMB#: 0938–0146); 

Frequency: Recordkeeping and 

Reporting—Semi-annually; Affected 

Public: State, Local or Tribal 

governments; Number of Respondents: 

10; Total Annual Responses: 20; Total 

Annual Hours: 480. (For policy 

questions regarding this collection 

contact Jessica Woodard at 410–786– 

9249. For all other issues call 410–786– 

1326.) 

4. Type of Information Collection 

Request: Revision of the currently 

approved collection; Title of 

Information Collection: State Medicaid 

Eligibility Quality Control (MEQC) 

Sample Selection Lists and Supporting 

Regulations in 42 CFR 431.800–431.865; 

Use: State Medicaid Eligibility Quality 

Control (MEQC) is operated by the State 

Title XIX agency to monitor and 

improve the administration of its 

Medicaid system. The MEQC system is 

based on State reviews of Medicaid 

beneficiaries identified through 

statistically reliable statewide samples 

of cases selected from the eligibility 

files. These reviews are conducted to 

determine whether or not the sampled 

cases meet applicable State Title XIX 

eligibility requirements by States 

performing the traditional sample 

process. The reviews are also used to 

assess beneficiary liability, if any, and to 

determine the amounts paid to provide 

Medicaid services for these cases. At the 

beginning of each month, State agencies 

still performing the traditional sample 

are required to submit sample selection 

lists which identify all of the cases 

selected for review in the States’ 

samples. The sample selection lists 

contain identifying information on 

Medicaid beneficiaries such as: State 

agency review number; beneficiary’s 

name and address; the name of the 

county where beneficiary resides; 

Medicaid case number, etc. The 

submittal of the sample selection lists is 

necessary for regional office (RO) 

validation of State reviews. Without 

these lists, the integrity of the sampling 

results would be suspect and the ROs 

would have no data on the adequacy of 

the States’ monthly sample draw or 

review completion status.; Form 

Number: CMS–319 (OMB#: 0938–0147); 

Frequency: Reporting—Monthly; 

Affected Public: State, Local or Tribal 

governments; Number of Respondents: 

10; Total Annual Responses: 120; Total 

Annual Hours: 960. (For policy 

questions regarding this collection 

contact Jessica Woodard at 410–786– 

9249. For all other issues call 410–786– 

1326.) 

5. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: SSO 

Report of State Buy-in Problem and 

Supporting Regulations in 42 CFR 

407.40; Use: Under the State Buy-In 

program, States enroll certain groups of 

needy people under the Part B 

Supplementary Medical Insurance (SMI) 

Program and pay their premiums. The 

purpose of the ‘‘buy-in’’ is to allow the 

States to provide SMI protection to 

certain groups of needy individuals as 

part of its total assistance plan. 

Generally, States ‘‘buy-in’’ for 

individuals who are categorically needy 

under Medicaid and meet the eligibility 

requirements for Medicare Part B. States 

can also include in their buy-in 

agreement those eligible for medical 

assistance only. The CMS–1957 is used 

in the resolution of beneficiary 

complaints regarding State buy-in. This 

form facilitates the coordination of 

efforts between the SSO, State Medicaid 

Agencies, and CMS in the resolution of 

a beneficiary’s State buy-in problem. 

Form Number: CMS–1957 (OMB#: 

0938–0035); Frequency: Reporting—On 

occasion; Affected Public: Federal 

government, Individuals or Households, 

and State, Local, and Tribal 

governments; Number of Respondents: 

5,600; Total Annual Responses: 5,600; 

Total Annual Hours: 1,816. (For policy 

questions regarding this collection 

contact Lucia Diaz-Robinson at 410– 

786–0598. For all other issues call 410– 

786–1326.) 

6. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Electronic 

Health Records (EHR) Testing; Use: The 

Centers for Medicare and Medicaid 

Services (CMS) has indicated through 

statements in proposed and final 

rulemaking for the Reporting Hospital 

Quality Data for Annual Payment 

Update (RHQDAPU) program that it is 

actively seeking to pursue quality 

measurement based on alternative 

sources of data that do not require 

manual chart abstraction or that utilize 

data already being reported by many 

hospitals for other programs, as doing so 

would potentially reduce the burden 

associated with the collection and 

reporting of measures for the program. 

Over the years, we have encouraged 

hospitals to take steps toward the 

adoption of electronic health records 

(EHRs) that would allow for reporting of 

clinical quality data from the EHRs 

directly to a CMS data repository 

beginning with the FY 2006 Inpatient 

Prospective Payment System (IPPS) 

Rule (70 FR 47420 through 47421). We 

have also encouraged hospitals that are 

implementing, upgrading, or developing 

EHR systems to ensure that the 

technology obtained, upgraded, or 

developed conforms to standards 

adopted by the Department of Health 

and Human Services (HHS). 

In the IPPS 2010 proposed rule (74 FR 

24182), we described our intent to begin 

a voluntary testing program for the 

submission to CMS of standardized data 

elements needed to calculate inpatient 

hospital quality measures on the topics 

of Stroke, Venous thromboembolism, 

and Emergency department throughput. 

These measures have not been adopted 

for the Reporting Hospital Quality for 

Annual Payment Update (RHQDAPU) 

program, and participation in this 

voluntary EHR-testing program will not 

substitute for submission of data 

elements required under the RHQDAPU 

program in a time, form and manner 

specified by the Secretary. Similarly, 

non-participation in this voluntary 

program will not incur any penalties. 


hsrobinson on DSK69SOYB1PROD with NOTICES
44368 Federal Register / Vol. 74, No. 166 / Friday, August 28, 2009 / Notices 

The results of this voluntary testing 

process will enable CMS to assess the 

feasibility of collecting data elements 

via electronic health records as a future 

alternative to submission of manually 

abstracted chart data elements by 

hospitals, thereby potentially reducing 

the administrative burden associated 

with submission of quality measures for 

the RHQDAPU program. Form Number: 

CMS–10296 (OMB#: 0938–New); 

Frequency: Reporting—Once; Affected 

Public: Private Sector—Business or 

other for-profits and Not-for-profit 

institutions; Number of Respondents: 

55; Total Annual Responses: 55; Total 

Annual Hours: 28,655. (For policy 

questions regarding this collection 

contact Shaheen Halim at 410–786– 

0641. 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 

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 October 27, 2009: 

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: August 21, 2009. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E9–20845 Filed 8–27–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10080, CMS–R– 

70, CMS–R–38 and CMS–846–849, 854, 

10125, 10126, 10269] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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), 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: Revision of a currently 

approved collection; Title of 

Information Collection: Publication 

Usage Survey; Use: The Publication 

Usage survey was developed to gather 

information from people who request or 

access Medicare publications, to ensure 

comprehension, usability, and use of the 

publications. CMS is seeking 

understanding about whether 

publications have been effective in 

informing members of the Medicare 

audience regarding policy and benefits. 

Included in the survey are questions 

regarding the satisfaction of publication 

users with specific publications and 

whether the information they received 

informed them about the Medicare 

program. Information gathered in this 

survey will be used only for purposes of 

targeting and improving 

communications with Medicare 

beneficiaries, caregivers, partners, and 

community organizations. Form 

Number: CMS–10080 (OMB#: 0938– 

0892); Frequency: Reporting—On 

occasion; Affected Public: Individuals or 

Households; Number of Respondents: 

3,800; Total Annual Responses: 3,800; 

Total Annual Hours: 950. (For policy 

questions regarding this collection 

contact Renee Clarke at 410–786–0006. 

For all other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Information 

Collection Requirements in HSQ–110, 

Acquisition, Protection and Disclosure 

of Peer review Organization Information 

and Supporting Regulations in 42 CFR, 

Sections 480.104, 480.105, 480.116, and 

480.134; Use: The Peer Review 

Improvement Act of 1982 authorizes 

quality improvement organizations 

(QIOs), formally known as peer review 

organizations (PROs), to acquire 

information necessary to fulfill their 

duties and functions and places limits 

on disclosure of the information. The 

QIOs are required to provide notices to 

the affected parties when disclosing 

information about them. These 

requirements serve to protect the rights 

of the affected parties. The information 

provided in these notices is used by the 

patients, practitioners and providers to: 

obtain access to the data maintained and 

collected on them by the QIOs; add 

additional data or make changes to 

existing QIO data; and reflect in the 

QIO’s record the reasons for the QIO’s 

disagreeing with an individual’s or 

provider’s request for amendment.: 

Form Number: CMS–R–70 (OMB#: 

0938–0426); Frequency: Reporting—On 

occasion; Affected Public: Business or 

other for-profits; Number of 

Respondents: 362; Total Annual 

Responses: 3729; Total Annual Hours: 

60,919. (For policy questions regarding 

this collection contact Tom Kessler at 

410–786–1991. For all other issues call 

410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Conditions of 

Certification for Rural Health Clinics 

and Supporting Regulations in 42 CFR 

491.9, 491.10, 491.11; Use: The Rural 

Health Clinic (RHC) conditions of 

certification are based on criteria 

prescribed in law and are designed to 

ensure that each facility has a properly 

trained staff to provide appropriate care 

and to assure a safe physical 

environment for patients. The Centers 

for Medicare and Medicaid Services 

(CMS) uses these conditions of 

participation to certify RHCs wishing to 

participate in the Medicare program. 

These requirements are similar in intent 

to standards developed by industry 

organizations such as the Joint 

Commission on Accreditation of 

Hospitals, and the National League of 

Nursing/American Public Association 


hsrobinson on DSK69SOYB1PROD with NOTICES