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[Federal Register Volume 79, Number 168 (Friday, August 29, 2014)]
[Notices]
[Pages 51569-51571]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-20589]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10147, CMS-2540-10, CMS-265-11, CMS-10106 and 
CMS-10537]

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

ACTION: Notice.

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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 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 
technology to minimize the information collection burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by September 29, 2014.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 or Email: 
OIRAsubmission@omb.eop.gov.
    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.

[[Page 51570]]

    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: 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 (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-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 that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Prescription Drug Coverage and Your Rights; Use: Through the delivery 
of this standardized notice, Part D plan sponsors' network pharmacies 
are in the best position to inform enrollees (at the point of sale) 
about how to contact their Part D plan if their prescription cannot be 
filled and how to request an exception to the Part D plan's formulary. 
The notice restates certain rights and protections related to the 
enrollees Medicare prescription drug benefits, including the right to 
receive a written explanation from the drug plan about why a 
prescription drug is not covered.
    Form Number: CMS-10147 (OMB control number: 0938-0975); Frequency: 
Occasionally; Affected Public: Private sector--Business or other for-
profits; Number of Respondents: 56,000; Total Annual Responses: 
37,620,000; Total Annual Hours: 626,749. (For policy questions 
regarding this collection contact Kathryn M. Smith at 410-786-7623).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Skilled Nursing 
Facility and Skilled Nursing Facility Health Care Complex Cost Report; 
Use: Providers of services participating in the Medicare program are 
required under sections 1815(a), 1833(e) and 1861(v)(1)(A) of the 
Social Security Act (42 USC 1395g) to submit annual information to 
achieve settlement of costs for health care services rendered to 
Medicare beneficiaries. In addition, regulations at 42 CFR 413.20 and 
413.24 require adequate cost data and cost reports from providers on an 
annual basis. Form CMS-2540-10 is used by Skilled Nursing Facilities 
(SNFs) and Skilled Nursing Facility Complexes participating in the 
Medicare program to report health care costs to determine the amount of 
reimbursable costs for services rendered to Medicare beneficiaries.
    Form Number: CMS-2540-10 (OMB control number: 0938-0463); 
Frequency: Yearly; Affected Public: Private Sector--Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
14,185; Total Annual Responses: 14,185; Total Annual Hours: 2,865,370. 
(For policy questions regarding this collection contact Amelia Citerone 
at 410-786-3901.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Independent Renal 
Dialysis Facility Cost Report and Supporting Regulations; Use: 
Providers of services participating in the Medicare program are 
required under sections 1815(a) and 1861(v)(1)(A) of the Social 
Security Act (42 U.S.C. 1395g) to submit annual information to achieve 
settlement of costs for health care services rendered to Medicare 
beneficiaries. In addition, regulations at 42 CFR 413.20 and 413.24 
require adequate cost data and cost reports from providers on an annual 
basis. The Form CMS-265-11 cost report is needed to determine a 
provider's reasonable costs incurred in furnishing medical services to 
Medicare beneficiaries.
    Form Number: CMS-265-11 (OMB control number: 0938-0263); Frequency: 
Yearly; Affected Public: Private Sector--Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 5,677; Total 
Annual Responses: 5,677; Total Annual Hours: 369,005. (For policy 
questions regarding this collection contact Gail Duncan at 410-786-
7278.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Medicare Authorization to Disclose Personal Health 
Information; Use: Unless permitted or required by law, the Health 
Insurance Portability and Accountability Act (HIPAA) Privacy Rule 
(Sec.  164.508) prohibits Medicare (a HIPAA covered entity) from 
disclosing an individual's protected health information without a valid 
authorization. In order to be valid, an authorization must include 
specified core elements and statements. Medicare will make available to 
Medicare beneficiaries a standard, valid authorization to enable 
beneficiaries to request the disclosure of their protected health 
information. This standard authorization will simplify the process of 
requesting information disclosure for beneficiaries and minimize the 
response time for Medicare. Form CMS-10106, the Medicare Authorization 
to Disclose Personal Health Information, will be used by Medicare 
beneficiaries to authorize Medicare to disclose their protected health 
information to a third party. Form Number: CMS-10106 (OMB control 
number: 0938-0930); Frequency: Occasionally; Affected Public: 
Individuals or Households; Number of Respondents: 1,298,329; Total 
Annual Responses: 1,298,329; Total Annual Hours: 324,582. (For policy 
questions regarding this collection contact Sam Jenkins at 410-786-
3261.)
    5. Type of Information Collection Request: New collection (Request 
for a new control number); Title of Information Collection: National 
Implementation of the Hospice Experience of Care Survey (CAHPs Hospice 
Survey); Use: We are requesting a three-year clearance from the Office 
of Management and Budget (OMB) under the Paperwork Reduction Act of 
1995 to implement the Hospice Experience of Care Survey (HECS), also 
called the Consumer Assessment of Healthcare Providers and Systems 
(CAHPS[supreg]) Hospice Survey, and to conduct an assessment of the 
effects of survey administration mode. Under Contract Number HHSM-500-
2014-00350G, the project team will implement and analyze a hospice 
experience of care survey for primary caregivers (i.e., bereaved family 
members or close friends) of patients who died while receiving hospice 
care (``decedents''). Specifically, we will: (1) Implement a survey to 
collect data on experiences of hospice care, and (2) conduct an 
experiment to examine effects of survey mode (i.e., mail-only, 
telephone-only, and mail with telephone follow-up).
    This survey supports the National Quality Strategy developed by the 
U.S. Department of Health and Human Services (HHS) that was called for 
under the Affordable Care Act to create national aims and priorities to 
guide local, state, and national efforts to

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improve the quality of health care. This strategy has established six 
priorities that support a three-part aim focusing on better care, 
better health, and lower costs through improvement. The six priorities 
include: Making care safer by reducing harm caused by the delivery of 
care; ensuring that each person and family are engaged as partners in 
their care; promoting effective communication and coordination of care; 
promoting the most effective prevention and treatment practices for the 
leading causes of mortality, starting with cardiovascular disease; 
working with communities to promote wide use of best practices to 
enable healthy living; and making quality care more affordable for 
individuals, families, employers, and governments by developing and 
spreading new health care delivery models. Because the hospice survey 
focuses on experiences of care, implementation of the survey supports 
the following national priorities for improving care: Engaging patients 
and families in care and promoting effective communication and 
coordination. In addition, national implementation and public reporting 
of hospice survey results will provide data on experiences with hospice 
care that enable consumers to make meaningful comparisons between 
hospices across the nation.
    Form Number: CMS-10537 (OMB control number: 0938-New); Frequency: 
Occasionally; Affected Public: Individuals or Households; Number of 
Respondents: 561,026; Total Annual Responses: 561,026; Total Annual 
Hours: 98,179.55. (For policy questions regarding this collection 
contact Lori Teichman at 410-786-6684.)

    Dated: August 26, 2014.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2014-20589 Filed 8-28-14; 8:45 am]
BILLING CODE 4120-01-P
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