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[Federal Register Volume 62, Number 165 (Tuesday, August 26, 1997)]
[Notices]
[Pages 45263-45264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22588]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-484, HCFA-R-200]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Health Care Financing Administration, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), 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 functions;

[[Page 45264]]

(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 without change; Title of Information Collection: 
Attending Physician's Certification of Medical Necessity for Home 
Oxygen Therapy and Supporting Regulations 42 CFR 410.38 and 42 CFR 
424.5; Form Number: HCFA-484 (OMB approval # 0938-0534); Use: To 
determine oxygen is reasonable and necessary pursuant to Medicare 
Statute, Medicare claims for home oxygen therapy must be supported by 
the treating physician's statement and other information including 
estimate length of need (# of months), diagnosis codes (ICD-9) and:
    1. Results and date of the most recent arterial blood gas 
PO2 and/or oxygen saturation tests.
    2. The most recent arterial blood gas PO2 and/or oxygen 
saturation test performed EITHER with the patient in a chronic stable 
state as an outpatient, OR within two days prior to discharge from an 
inpatient facility to home.
    3. The most recent arterial blood gas PO2 and/or oxygen 
saturation test performed at rest, during exercise, or during sleep.
    4. Name and address of the physician/provider performing the most 
recent arterial blood gas PO2 and/or oxygen saturation test.
    5. If ordering portable oxygen, information regarding the patient's 
mobility within the home.
    6. Identification of the highest oxygen flow rate (in liters per 
minute) prescribed.
    7. If the prescribed liters per minute (LPM), as identified in item 
6, are greater than 4 LPM, provide the results and date of the most 
recent arterial blood gas PO2 and/or oxygen saturation test 
taken on 4 LPM.
    If the PO2=56-59, or the oxygen saturation=89%, then 
evidence of the beneficiary meeting at least one of the following 
criteria must be provided.
    8. The patient having dependent edema due to congestive heart 
failure.
    9. The patient having cor pulmonale or pulmonary hypertension, as 
documented by P pulmonale on an EKG or by an echocardiogram, gated 
blood pool scan or direct pulmonary artery pressure measurement.
    10. The patient having a hematocrit greater than 56%.
    Form HCFA-484 obtains all pertinent information and promotes 
national consistency in coverage determinations; Frequency: Other (as 
needed); Affected Public: Individuals/households, business or other for 
profit, and not for profit institutions; Number of Respondents: 
300,000; Total Annual Responses: 300,000; Total Annual Hours Requested: 
50,000.
    2. Type of Information Request: Extension of a currently approved 
collection without change; Title of Information Collection: HEDIS 3.0 
(Health Plan Data and Information Set), including the Health of Seniors 
and Consumer Assessment of Health Plans Study (CAHPS) surveys and 
supporting regulations 42 CFR 417.470, and 42 CFR 417.126; Form Number: 
HCFA-R-200 (OMB approval #0938-0701); Use: HEDIS and CAHPS will be used 
for 3 purposes: (1) To provide summary comparative data to the Medicare 
beneficiary to assist them in choosing among health plans; (2) to 
provide information to health plans for internal quality improvement 
activity; and (3) to provide HCFA, as purchaser, information useful for 
monitoring quality of and access to care provided by the plans; 
Frequency: Annually; Affected Public: Individuals or Households, non-
profit and for profit HMOs which contract with HCFA to provide managed 
health care to Medicare beneficiaries; Number of Respondents: 293,834; 
Total Annual Responses: 293,834 Total Annual Hours Requested: 181,520.
    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 and phone number, to 
P[email protected], or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information 
collections must be mailed within 60 days of this notice directly to 
the HCFA Paperwork Clearance Officer designated at the following 
address: HCFA, Office of Information Services, Information Technology 
Investment Management Group, Division of HCFA Enterprise Standards, 
Attention: John P. Burke III, Room C2-26-17, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: August 19, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Information Technology Investment Management Group, Division of HCFA 
Enterprise Standards.
[FR Doc. 97-22588 Filed 8-25-97; 8:45 am]
BILLING CODE 4120-03-P
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