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[Federal Register Volume 72, Number 66 (Friday, April 6, 2007)]
[Notices]
[Pages 17169-17170]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-6310]

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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 for-profit 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-for-profit 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-for-profit 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

[[Page 17170]]

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 
E-mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to [email protected], 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
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