Federal Register / Vol. 72, No. 66 / Friday, April 6, 2007 / Notices 17169 

Health of People with Intellectual 

Disabilities.’’

Contact Person for More Information: 

Juliana Cyril, Ph.D., Associate Director for 

Policy and Peer Review, Centers for Disease 

Control and Prevention, 1600 Clifton Road 

NE, Mailstop D72, Atlanta, GA 30333, 

Telephone 404.639.4639. 

The Director, Management Analysis 

and Services Office, has been delegated 

the authority to sign Federal Register 

notices pertaining to announcements of 

meetings and other committee 

management activities, for both CDC 

and the Agency for Toxic Substances 

and Disease Registry. 

Elaine L. Baker, 

Acting Director, Management Analysis and 

Services Office, Centers for Disease Control 

and Prevention. 

[FR Doc. E7–6444 Filed 4–5–07; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10003, CMS–

901A and D, CMS–9044, CMS–R–193 and 

CMS–10066] 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Notice of Denial 

of Medical Coverage (NDMC), and the 

Notice of Denial of Payment (NDP) and 

supporting regulations in 42 CFR 

422.568; Use: Section 1852(g)(1)(B) of 

the Statute requires Medicare Health 

organizations (Medicare Advantage, 

cost, and Health Care Prepayment Plans) 

to provide determinations to deny 

coverage (i.e., medical services or 

payment) in writing and include a 

statement in understandable language of 

the reasons for the denial and a 

description of the reconsideration and 

appeals processes. These notices fulfill 

the regulatory requirement. Form 

Number: CMS–10003 (OMB#: 0938–

0829); Frequency: Reporting: Yearly; 

Affected Public: Business or other forprofit and not-for-profit institutions; 

Number of Respondents: 454; Total 

Annual Responses: 105,138; Total 

Annual Hours: 26285. 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: CMS 

Application for Federal Qualification 

(901A); CMS Medicare Agreement 

Application (901D) and Supporting 

Regulations in 42 CFR Section 417.143 

and 422.6; Use: Prepaid health plans 

must meet certain regulatory 

requirements to be federally qualified 

health maintenance organizations or to 

enter into a contract with CMS to 

provide health benefits to Medicare 

beneficiaries. The application forms are 

used by CMS to collect information 

about a health plan to determine their 

compliance with Federal regulations. 

Form Number: CMS–901A and D 

(OMB#: 0938–0470); Frequency: 

Reporting: Once; Affected Public: 

Business or other for-profit and not-forprofit institutions; Number of 

Respondents: 55; Total Annual 

Responses: 55; Total Annual Hours: 

2,200. 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare ESRD 

Exceptions; Use: This information is 

collected in accordance with section 

2145 of the Omnibus Budget 

Reconciliation Act of 1981 and section 

623 of the Medicare Prescription Drug 

Improvement and Modernization Act of 

2003. End Stage Renal Disease (ESRD) 

facilities can file for an exception to its 

composite payment rate. CMS uses the 

information submitted to determine 

whether an ESRD facility qualifies for a 

rate increase and the amount of the 

increase. Form Number: CMS–9044 

(OMB#: 0938–0296); Frequency: 

Reporting: Occasionally; Affected 

Public: Business or other for-profit and 

not-for-profit institutions; Number of 

Respondents: 10; Total Annual 

Responses: 10; Total Annual Hours: 

400. 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare and 

Medicare Advantage Programs; 

Notification Procedures for Hospital 

Discharges—Important Message from 

Medicare Use: Requirements that 

hospitals notify beneficiaries in 

inpatient hospital settings of their rights 

as a hospital patient including their 

discharge appeal rights are referenced in 

Section 1866(a)(1)(M) of the Social 

Security Act (The Act). The authority 

for the right to an expedited 

determination is set forth at Section 

1869(c)(3)(C)(iii)(III) of the Act. Under 

sections 42 CFR 405.1205 and 422.620, 

the hospital must deliver valid, written 

notice, the Important Message from 

Medicare (IM), of a patient’s rights as a 

hospital patient including the discharge 

appeal rights, within 2 calendar days of 

admission. A follow-up copy of the 

signed IM is given again as far as 

possible in advance of discharge, but no 

more than 2 calendar days before. 

Follow-up notice is not required if the 

provision of the admission IM, falls 

within 2 calendar days of discharge. 

Several changes are being proposed to 

the IM, including but not limited to the 

following: 1. Patient Information 

section: CMS removed the ‘‘Date of 

Notice’’ line. 2. Your Rights as Hospital 

Inpatient section: (a) There are several 

proposed clarifying language updates. 

(b) CMS added a bullet stating that the 

beneficiary can call the Quality 

Improvement Organization (QIO) for 

quality of care concerns based on 

information currently contained in the 

Medicare and You 2007 booklet. 3. Your 

Hospital Discharge and Medicare 

Appeal Rights section: CMS added a 

bullet stating that the beneficiary may 

call 1–800 Medicare and added 

supporting rational for when to call. 4. 

CMS added instructions for the 

beneficiary or representative to both 

sign and date the notice and, 5. CMS 

added an ‘‘Additional Information’’

space requesting that hospitals be able 

to add signature lines for hospital staff 

documentation. Form Number: CMS–R–

193 (OMB#: 0938–0692); Frequency: 

Reporting: Yearly; Affected Public: 

Business or other for-profit and not-forprofit institutions; Number of 

Respondents: 6000; Total Annual 

Responses: 13,000,000; Total Annual 

Hours: 3,250,000. 

5. Type of Information Collection 

Request: New Collection; Title of 

Information Collection: Medicare and 

Medicare Advantage Programs; 

Notification Procedures for Hospital 


pwalker on PROD1PC71 with NOTICES
17170 Federal Register / Vol. 72, No. 66 / Friday, April 6, 2007 / Notices 

Discharges—Detailed Notice of 

Discharge; Use: The authority for the 

right to an expedited determination is 

set forth at Section 1869(c)(3)(C)(iii)(III) 

of the Social Security Act. This 

collection has been revised and now 

pertains to sections 42 CFR 405.1206 

and 42 CFR 422.622. When a Quality 

Improvement Organization (QIO) 

notifies a hospital or Medicare 

Advantage (MA) organization that a 

beneficiary/enrollee has requested an 

expedited determination, the hospital or 

MA organization must deliver a detailed 

notice to the beneficiary/enrollee by 

noon of the day after the QIO’s 

notification. In addition, the title has 

been revised, and the wording of the 

notice has been revised to more clearly 

convey the purpose of the notice. This 

revised notice fulfills the regulatory 

requirement; Form Number: CMS–

10066 (OMB#: 0938–New); Frequency: 

Yearly; Affected Public: Business or 

other for-profit and not-for-profit 

institutions; Number of Respondents: 

6057; Total Annual Responses: 130,000; 

Total Annual Hours: 130,000. 

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: March 29, 2007. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E7–6310 Filed 4–5–07; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Substance Abuse and Mental Health 

Services Administration 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

Periodically, the Substance Abuse and 

Mental Health Services Administration 

(SAMHSA) will publish a summary of 

information collection requests under 

OMB review, in compliance with the 

Paperwork Reduction Act (44 U.S.C. 

Chapter 35). To request a copy of these 

documents, call the SAMHSA Reports 

Clearance Officer on (240) 276–1243. 

Proposed Project: National Evaluation 

of the Comprehensive Community 

Mental Health Services for Children 

and Their Families Program: Phase 

IV—(OMB No. 0930–0257)—Revision 

The Substance Abuse and Mental 

Health Services Administration 

(SAMHSA), Center of Mental Health is 

responsible for the national evaluation 

of the Comprehensive Community 

Mental Health Services for Children and 

Their Families Program that will collect 

data on child mental health outcomes, 

family life, and service system 

development and performance. 

The national evaluation of the 

Comprehensive Community Mental 

Health Services for Children and Their 

Families Program will collect data on 

child mental health outcomes, family 

life, and service system development 

and performance. Data will be collected 

on 27 service systems, and roughly 5922 

children and families. Data collection 

for this evaluation is conducted over a 

five-year period. The core of service 

system data will be collected every 18 

months throughout the 5-year 

evaluation period, with a sustainability 

survey conducted in selected years. 

Service delivery and system variables of 

interest include the following: Maturity 

of system of care development, 

adherence to the system of care program 

model, and client service experience. 

The length of time that individual 

families will participate in the study 

ranges from 18 to 36 months depending 

on when they enter the evaluation. 

Child and family outcomes of interest 

will be collected at intake and during 

subsequent follow-up sessions at sixmonth intervals. The outcome measures 

include the following: child 

symptomatology and functioning, 

family functioning, material resources, 

and caregiver strain. Time-limited 

studies addressing the cultural 

competence of services and the role of 

primary care providers in systems of 

care will be conducted at selected 

points during the evaluation period. 

Internet-based technology will be used 

for collecting data via Web-based 

surveys and for data entry and 

management. The average annual 

respondent burden is estimated below 

for the final three years of data 

collection. The estimate reflects the 

average number of respondents in each 

respondent category, the average 

number of responses per respondent per 

year, the average length of time it will 

take for each response, and the total 

average annual burden for each category 

of respondent, and for all categories of 

respondents combined. 

This revision to the currently 

approved information collection 

activities includes: (1) The addition of a 

Primary Care Study and (2) the addition 

of a Treatment Effectiveness Study. The 

Primary Care Study seeks to investigate 

the role of primary health care 

practitioners (PCPs) in systems of care 

and to further understand the impact of 

services provided within primary care 

on child and family outcomes. One goal 

of this study is to identify strategies that 

help primary care and mental health 

care providers to work together 

effectively. Another is to identify ways 

to integrate PCPs into systems of care. 

The treatment effectiveness study will 

examine the relative impact of 

community-based treatments focused 

within system of care sites. This study 

will focus on a community-based 

practice that has not accumulated 

research evidence, but rather through 

community-based implementation has 

accumulated practice-based evidence. 

Instrument Respondent Number of 

respondents 

Total average number 

of responses per 

respondent 

Hours per 

response 

Total burden 

hours 

System of Care Assessment 

Interview Guides and Data Collection Forms .......................... Key site informants 1 648 2 1.000 1296 

Interagency Collaboration Scale (IACS) .................................. Key site informants 648 2 0.133 173 

Caregiver Information Questionnaire (CIQ–IC) ........................ Caregiver .............. 3 5,922 1 0.283 1676 

Caregiver Information Questionnaire Followup (CIQ–FC) ....... Caregiver .............. 5,922 3 0.200 3553 


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