Federal Register / Vol. 78, No. 134 / Friday, July 12, 2013 / Notices 41931 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–2746, CMS– 

2728, CMS–R–39, CMS–10170, CMS–10156 

and CMS–10485] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Notice. 

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 (the 

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 

60 days for public comment on the 

proposed action. Interested persons are 

invited to send comments regarding our 

burden estimates 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. 

DATES: Comments must be received by 

September 10, 2013. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number (OCN). To be 

assured consideration, comments and 

recommendations must be submitted in 

any one of the following ways: 

1. Electronically. You may send 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) that are 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 lll, Room C4–26–05, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. 

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 one of following: 

1. Access CMS’ Web site address at 

http://www.cms.hhs.gov/ 

PaperworkReductionActof1995. 

2. Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov. 

3. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786– 

1326 

SUPPLEMENTARY INFORMATION: 

Contents 

This notice sets out a summary of the 

use and burden associated with the 

following information collections. More 

detailed information can be found in 

each collection’s supporting statement 

and associated materials (see 

ADDRESSES). 

CMS–2746 End Stage Renal Disease 

Death Notification 

CMS–2728 End Stage Renal Disease 

Medical Evidence Report Medicare 

Entitlement and/or Patient 

Registration 

CMS–R–39 Home Health Conditions of 

Participation (CoP) and Supporting 

Regulations 

CMS–10170 Retiree Drug Subsidy 

(RDS) Payment Request and 

Instructions 

CMS–10156 Retiree Drug Subsidy 

(RDS) Application and Instructions 

CMS–10485 Evaluation of the MultiPayer Advanced Primary Care 

Practice (MAPCP) Demonstration: 

Provider Survey 

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 

requires federal agencies to publish a 

60-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. 

Information Collections 

1. Type of Information Collection 

Request: Revision of a previously 

approved collection; Title of 

Information Collection: End Stage Renal 

Disease Death Notification; Use: The 

End Stage Renal Disease (ESRD) Death 

Notification (CMS–2746) is completed 

by all Medicare-approved ESRD 

facilities upon the death of an ESRD 

patient. Its primary purpose is to collect 

fact of death and cause of death of ESRD 

patients. Certain other identifying 

information (e.g., name, Medicare claim 

number, and date of birth) is required 

for matching purposes. Federal 

regulations require that the ESRD 

Networks examine the mortality rates of 

every Medicare-approved facility within 

its area of responsibility. The death form 

provides the necessary data to assist the 

ESRD Networks in making decisions 

that result in improved patient care and 

in cost-effective distribution of ESRD 

resources. The data is used by the ESRD 

Networks to verify facility deaths and to 

monitor facility performance. Form 

Number: CMS–2746 (OCN: 0938–0448); 

Frequency: On occasion; Affected 

Public: Business or other for-profit, Notfor-profit institutions; Number of 

Respondents: 5,964; Total Annual 

Responses: 75,000; Total Annual Hours: 

37,500. (For policy questions regarding 

this collection contact Michelle Tucker 

at 410–786–0736.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: End Stage Renal 

Disease Medical Evidence Report 

Medicare Entitlement and/or Patient 

Registration; Use: The End Stage Renal 

Disease (ESRD) Medical Evidence 

Report is completed for all ESRD 

patients either by the first treatment 

facility or by a Medicare-approved 

ESRD facility when it is determined by 

a physician that the patient’s condition 

has reached that stage of renal 

impairment that a regular course of 

kidney dialysis or a kidney transplant is 

necessary to maintain life. The data 

reported on the CMS–2728 is used by 

the federal government, ESRD 

Networks, treatment facilities, 

researchers and others to monitor and 

assess the quality and type of care 

provided to end stage renal disease 

beneficiaries. The data collection 

captures the specific medical 

information required to determine the 

Medicare medical eligibility of End 

Stage Renal Disease claimants. Form 

mstockstill on DSK4VPTVN1PROD with NOTICES

41932 Federal Register / Vol. 78, No. 134 / Friday, July 12, 2013 / Notices 

Number: CMS–2728 (OCN#: 0938– 

0046); Frequency: Occasionally; 

Affected Public: Individuals or 

households; Number of Respondents: 

130,000; Total Annual Responses: 

130,000; Total Annual Hours: 97,500. 

(For policy questions regarding this 

collection contact Michelle Tucker at 

410–786–0736.) 

3. Type of Information Collection 

Request: Reinstatement with change of a 

currently approved collection; Title of 

Information Collection: Home Health 

Conditions of Participation (CoP) and 

Supporting Regulations; Use: The 

information collection requirements 

contained in this request are part of the 

requirements classified as the 

conditions of participation (CoPs) which 

are based on criteria prescribed in law 

and are standards designed to ensure 

that each facility has properly trained 

staff to provide the appropriate safe 

physical environment for patients. 

These particular standards reflect 

comparable standards developed by 

industry organizations such as the Joint 

Commission on Accreditation of 

Healthcare Organizations, and the 

Community Health Accreditation 

Program. The primary users of this 

information will be state agency 

surveyors, the regional home health 

intermediaries, CMS and home health 

agencies (HHAs) for the purpose of 

ensuring compliance with Medicare 

CoPs as well as ensuring the quality of 

care provided by HHA patients. Form 

Numbers: CMS–R–39 (OCN: 0938– 

0365); Frequency: Occasionally; 

Affected Public: Business or for-profits, 

not-for-profit institutions, and State, 

Local or Tribal governments; Number of 

Respondents: 13,577; Total Annual 

Responses: 20,202,576; Total Annual 

Hours: 6,422,694. (For policy questions 

regarding this collection contact 

Danielle Shearer at 410–786–6617.) 

4. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Retiree 

Drug Subsidy (RDS) Payment Request 

and Instructions; Use: Under section 

1860D–22 of the Social Security Act and 

implementing regulations at 42 CFR part 

423 subpart R, plan sponsors (e.g., 

employers, unions) who offer 

prescription drug coverage meeting 

specified criteria to their qualified 

covered retirees are eligible to receive a 

28 percent tax-free subsidy for allowable 

drug costs. Plan sponsors must submit 

required prescription drug cost data and 

other information in order to receive the 

subsidy. Subpart R stipulates that plan 

sponsors may elect to submit RDS 

payment requests on a monthly, 

quarterly, interim annual, or annual 

basis; once selected, the payment 

frequency may not be changed during 

the plan year. Form Number: CMS– 

10170 (OCN: 0938–0977); Frequency: 

Occasionally; Affected Public: Private 

sector (business or other for-profits and 

not-for-profit institutions); Number of 

Respondents: 4,500; Total Annual 

Responses: 4,500; Total Annual Hours: 

679,500. (For policy questions regarding 

this collection contact John W. 

Campbell at 410–786–0542.) 

5. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Retiree 

Drug Subsidy (RDS) Applications and 

Instructions; Use: Under the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 and 

implementing regulations at 42 CFR part 

423, subpart R plan sponsors (e.g., 

employers, unions) who offer 

prescription drug coverage to their 

qualified covered retirees are eligible to 

receive a 28 percent tax-free subsidy for 

allowable drug costs. In order to qualify, 

plan sponsors must submit a complete 

application with a list of retirees for 

whom it intends to collect the subsidy. 

Once CMS reviews and analyzes the 

information on the application and the 

retiree list, notification will be sent to 

the plan sponsor about its eligibility to 

participate in the RDS program. Form 

Number: CMS–10156 (OCN: 0938– 

0957); Frequency: Yearly and monthly; 

Affected Public: Private sector (business 

or other for-profits and not-for-profit 

institutions); Number of Respondents: 

4,500; Total Annual Responses: 4,500; 

Total Annual Hours: 288,000. (For 

policy questions regarding this 

collection contact John W. Campbell at 

410–786–0542.) 

6. Type of Information Collection 

Request: New Collection (Request for a 

new OMB control number); Title of 

Information Collection: Evaluation of 

the Multi-Payer Advanced Primary Care 

Practice (MAPCP) Demonstration: 

Provider Survey; Use: On September 16, 

2009, the Department of Health and 

Human Services announced the 

establishment of the Multi-payer 

Advanced Primary Care Practice 

(MAPCP) Demonstration, under which 

Medicare joined Medicaid and private 

insurers as a payer participant in statesponsored patient-centered medical 

home (PCMH) initiatives. We selected 

eight states to participate in this 

demonstration: Maine, Vermont, Rhode 

Island, New York, Pennsylvania, North 

Carolina, Michigan, and Minnesota. 

We are proposing to conduct this 

provider survey to understand how 

participating practices’ structures and 

functions vary, particularly with respect 

to their adoption of different 

components of the PCMH model of care. 

Researchers evaluating the MAPCP 

Demonstration plan to combine these 

survey data with claims data to conduct 

statistical analyses that identify which 

particular medical home care processes 

are associated with the largest gains in 

health care quality and reductions in 

health care cost trends. Form Number: 

CMS–10485 (OCN: 0938–NEW); 

Frequency: Annually; Affected Public: 

Individuals and households; Number of 

Respondents: 5,799; Total Annual 

Responses: 5,799; Total Annual Hours: 

1,450. (For policy questions regarding 

this collection contact Suzanne Wensky 

at 410–786–0226.) 

Dated: July 9, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–16740 Filed 7–11–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–10108, CMS– 

10115, and CMS–10130] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

ACTION: Notice. 

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 a 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 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 

mstockstill on DSK4VPTVN1PROD with NOTICES