Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Notices 52079 

Dated: August 25, 2006. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 06–7290 Filed 8–31–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–R–143, CMS–R–

247, CMS–10199, and CMS–10184] 

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 a currently 

approved collection. 

Title of Information Collection: 

Medicare Physician Fee Schedule 

Geographic Practice Expense Index 

(GPCI). 

Use: This information collection is a 

survey of State insurance 

commissioners and malpractice insurers 

to acquire premium data for use in 

computing the malpractice component 

of the geographic practice cost index, a 

component of the geographic cost index 

as set forth in the Omnibus 

Reconciliation Act of 1989. The data 

collected in this information collection 

request will be used by CMS staff and 

outside contractors to update the 

Medicare physician fee schedule 

geographic practice expense index 

(MGPCI), the malpractice relative value 

units (MRVUs), and to supplement the 

updating of the malpractice component 

of the Medicare Economic Index (MEI). 

The MGPCI is one of the components of 

the GPCI, the others being physician 

work (net income), employee wages, 

office rents, medical equipment and 

supplies, and miscellaneous expenses. 

The MRVUs are one of the three 

components of the fee schedule, the 

others being physician work RVUs and 

practice expense RVUs. The GPCIs and 

fee schedule RVUs also used by other 

Federal agencies such as the Veteran’s 

Administration and the Department of 

Labor. Form Number: CMS–R–143 

(OMB#: 0938–0575). 

Frequency: Reporting—Every three 

years. 

Affected Public: State, Local or Tribal 

governments, Business or other forprofit and Not-for-profit institutions. 

Number of Respondents: 150. 

Total Annual Responses: 50. 

Total Annual Hours: 150. 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection. 

Title of Information Collection: 

Expanded Coverage for Diabetes 

Outpatient Self-Management Training 

Services and Supporting Regulations 

Contained in 42 CFR 410.141, 410.142, 

410.143, 410.144, 410.145, 410.146, 

414.63. 

Use: According to the National Health 

and Nutrition Examination Survey 

(NHANES), as many as 18.7 percent of 

Americans over age 65 are at risk for 

developing diabetes. The goals in the 

management of diabetes are to achieve 

normal metabolic control and reduce 

the risk of micro- and macro-vascular 

complications. Numerous epidemiologic 

and interventional studies point to the 

necessity of maintaining good glycemic 

control to reduce the risk of the 

complications of diabetes. In expanding 

the Medicare program to include 

diabetes outpatient self-management 

training services, the Congress intended 

to empower Medicare beneficiaries with 

diabetes to better manage and control 

their conditions. The Conference Report 

indicates that the conferees believed 

that ‘‘this provision will provide 

significant Medicare savings over time 

due to reduced hospitalizations and 

complications arising from diabetes.’’

(H.R. Conf. Rep. No. 105–217, at 701 

(1997)). 

Form Number: CMS–R–247 (OMB#: 

0938–818). 

Frequency: Recordkeeping and 

Reporting—On occasion. 

Affected Public: Business or other forprofit institutions. 

Number of Respondents: 2008. 

Total Annual Responses: 8,032; Total 

Annual Hours: 88,519. 

3. Type of Information Collection 

Request: New collection. 

Title of Information Collection: Data 

Collection for Medicare Facilities 

Performing Carotid Artery Stenting with 

Embolic Protection in Patients at High 

Risk for Carotid Endarterectomy. 

Use: CMS provides coverage for 

carotid artery stenting (CAS) with 

embolic protection for patients at high 

risk for carotid endarterectomy and who 

also have symptomatic carotid artery 

stenosis between 50% and 70% or have 

asymptomatic carotid artery stenosis ≥ 

80% in accordance with the Category B 

IDE clinical trials regulation (42 CFR 

405.201), a trial under the CMS Clinical 

Trial Policy (NCD Manual § 310.1, or in 

accordance with the National Coverage 

Determination on CAS post approval 

studies (Medicare NCD Manual 20.7). 

Accordingly, CMS considers coverage 

for CAS reasonable and necessary 

{section 1862 (A)(1)(a) of the Social 

Security Act}. However, evidence for 

use of CAS with embolic protection for 

patients at high risk for carotid 

endarterectomy and who also have 

symptomatic carotid artery stenosis ≥ 

70% who are not enrolled in a study or 

trial is less compelling. To encourage 

responsible and appropriate use of CAS 

with embolic protection, CMS issued a 

Decision Memo for Carotid Artery 

Stenting on March 17, 2005, indicating 

that CAS with embolic protection for 

patients at high risk for carotid 

endarterectomy and who also have 

symptomatic carotid artery stenosis ≥ 

70% will be covered only if performed 

in facilities that have been determined 

to be competent. In accordance with this 

criteria CMS considers coverage for CAS 

reasonable and necessary (section 

1862(A)(1)(a) of the Social Security Act). 

Form Number: CMS–10199 (OMB#: 

0938–NEW). 

Frequency: Reporting—On. 

Affected Public: Business or other forprofit, Not-for-profit institutions. 

Number of Respondents: 1,000. 

Total Annual Responses: 1,000. 

Total Annual Hours: 500. 

4. Type of Information Collection 

Request: New collection. 

Title of Information Collection: 

Payment Error Rate Measurement 

(PERM) of Eligibility in Medicaid and 

the State Children’s Health Insurance 

Program (SCHIP). 

Use: The Improper Payments 

Information Act (IPIA) of 2002 requires 

CMS to produce national error rates for 

Medicaid and the State Children’s 

Health Insurance Program (SCHIP). To 

comply with the IPIA, CMS will use a 

national contracting strategy in part to 


sroberts on PROD1PC70 with NOTICES
52080 Federal Register / Vol. 71, No. 170 / Friday, September 1, 2006 / Notices 

produce error rates for Medicaid and 

SCHIP fee-for-service and managed care 

improper payments. The Federal 

contractor will review states on a 

rotational basis so that each state will be 

measured for improper payments, in 

each program, once and only once every 

three years. 

Subsequent to the first publication, 

we determined that we will measure 

Medicaid and SCHIP in the same State. 

Therefore, states will measure Medicaid 

and SCHIP eligibility in the same year 

measured for fee-for-service and 

managed care. We believe this approach 

will advantage States through 

economies of scale (e.g. administrative 

ease and shared staffing for both 

programs reviews). We also determined 

that interim case completion timeframes 

and reporting are critical to the integrity 

of the reviews and to keep the reviews 

on schedule to produce a timely error 

rate. An additional revision is that the 

sample sizes were increased slightly in 

order to produce an equal sample size 

per strata each month. Finally, this 

information collection request does, to a 

certain extent, duplicate Medicaid 

eligibility reviews under the Medicaid 

Eligibility Quality Control (MEQC) as 

required by section 1903(u) of the Social 

Security Act (of the Act) and we 

proposed this option in the first 

publication of this information request. 

However, CMS has not finalized its 

analysis of the associated legal and 

policy matters regarding the option to 

use the payment error rate measurement 

(PERM) reviews to satisfy MEQC 

statutory and regulatory requirements. 

We are concerned that using the PERM 

eligibility reviews to satisfy 

requirements for the MEQC program 

under 1903(u) of the Act would 

necessarily require that the data derived 

from the reviews be used to determine 

potential disallowances of Federal funds 

under the MEQC program. Therefore, 

we are still considering whether or not 

to make this option available to States. 

We expect to make a final decision 

before the start of the eligibility reviews 

in FY 2007. However, in response to 

State resource concerns, CMS will 

provide States the option to contract out 

the PERM eligibility reviews to entities 

not actively involved in the state’s 

eligibility determination and enrollment 

activities. The supporting statement 

reflects those changes. 

As outlined in the October 5, 2005, 

interim final rule (70 FR 58260), CMS 

convened an eligibility workgroup 

comprised of the Department of Health 

and Human Services, the Office of 

Management and Budget (OMB) and 

representatives from two states. The 

Office of Inspector General (OIG) 

participated in an advisory capacity. 

The workgroup was charged to make 

recommendations for measuring 

Medicaid and SCHIP improper 

payments based on eligibility errors 

within the confines of current statute, 

with minimal impact on States’

resources and considering public 

comments on the August 27, 2004, 

proposed rule and the October 5, 2005, 

interim final rule. Based on the 

eligibility workgroup’s 

recommendations and public 

comments, we developed an eligibility 

review methodology that we expect will 

provide consistency in the reviews of 

active (i.e., beneficiaries receiving 

Medicaid or SCHIP) and negative cases 

(i.e., beneficiaries whose benefits were 

denied or terminated) as well as achieve 

the confidence and precision 

requirements at the national level 

required by the IPIA. 

Form Number: CMS–10184 (OMB#: 

0938–NEW). 

Frequency: Reporting—On occasion 

and Monthly. 

Affected Public: Business or other forprofit, Not-for-profit institutions. 

Number of Respondents: 34. 

Total Annual Responses: 1,326. 

Total Annual Hours: 535,670. 

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. 

Written comments and 

recommendations for the proposed 

information collections must be mailed 

or faxed within 30 days of this notice 

directly to the OMB desk officer: OMB 

Human Resources and Housing Branch, 

Attention: Carolyn Lovett, New 

Executive Office Building, Room 10235, 

Washington, DC 20503. Fax Number: 

(202) 395–6974. 

Dated: August 25, 2006. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 06–7291 Filed 8–31–06; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1535–N] 

RIN 0938–AO26 

Medicare Program; Hospice Wage 

Index for Fiscal Year 2007 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

annual update to the hospice wage 

index as required by statute. This fiscal 

year 2007 update is effective from 

October 1, 2006 through September 30, 

2007. The wage index is used to reflect 

local differences in wage levels. The 

hospice wage index methodology and 

values are based on recommendations of 

a negotiated rulemaking advisory 

committee and were originally 

published in the August 8, 1997 Federal 

Register. 

EFFECTIVE DATE: This notice is effective 

on October 1, 2006. 

FOR FURTHER INFORMATION CONTACT: 

Terri Deutsch, (410) 786–9462. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. General 

1. Hospice Care 

Hospice care is an approach to 

treatment that recognizes that the 

impending death of an individual 

warrants a change in the focus from 

curative care to palliative care for relief 

of pain and for symptom management. 

The goal of hospice care is to help 

terminally ill individuals continue life 

with minimal disruption to normal 

activities while remaining primarily in 

the home environment. A hospice uses 

an interdisciplinary approach to deliver 

medical, social, psychological, 

emotional, and spiritual services 

through use of a broad spectrum of 

professional and other caregivers, with 

the goal of making the individual as 

physically and emotionally comfortable 

as possible. Counseling services and 

inpatient respite services are available 

to the family of the hospice patient. 

Hospice programs consider both the 

patient and the family as a unit of care. 

Section 1861(dd) of the Social 

Security Act (the Act) provides for 

coverage of hospice care for terminally 

ill Medicare beneficiaries who elect to 

receive care from a participating 

hospice. Section 1814(i) of the Act 


sroberts on PROD1PC70 with NOTICES