Federal Register / Vol. 62, No. 247 / Wednesday, December 24, 1997 / Notices 67389

The six month start up period,

beginning January 1, 1998 will enable

plans to accomplish the requirements of

the BBA by the end of the start-up

period, or June 30, 1998. Special

procedures have been identified to

ensure that hospital encounter data are

submitted for discharges occurring on or

after July 1, 1997 and before June 30,

1998. The special procedures for the

start up period include the following:

1. In order to provide plans with an

estimate of their Average Payment Rate

(APR) by March, 1999, HCFA must

receive data on hospital discharges that

occurred on or after July 1, 1997 and

before December 31, 1997, as well as

encounter data on discharges that occur

during the start up period, or January 1,

1998 through June 30, 1998. Currently,

most plans do not have the capacity to

submit data electronically to a fiscal

intermediary (FI), and the FIs are not

capable of receiving these data.

Therefore, during this period only,

unless an alternative approach is

approved by HCFA, hospitals must

submit completed UB–92s for the Plan’s

enrollees. These pseudo-claims must be

submitted to the hospital’s regular fiscal

intermediary. This is a current

requirement for hospitals, and they are

expected to comply with this

requirement throughout this period.

Plans must provide hospitals with the

Medicare identification number of all

enrollees admitted who have Medicare

coverage.

If hospitals are unable to submit these

data on behalf of the plan during the

start-up period, an alternate method of

submitting the data may be developed

by HCFA. If such a method is

developed, it would require the plans to

submit a subset of data elements that are

found on the UB–92. Possible data

elements include the following: Plan

Contract Number; HIC (or Medicare

Identification Number); enrollee’s name;

enrollee’s state and county of residence;

enrollee’s birthdate and gender;

Medicare Provider Number for the

Hospital; claim from and thru date;

admission date; and principal and

secondary diagnoses codes. HCFA will

specify the data elements, submission

route, and format for these data.

2. During the start up period, the plan

is expected to establish an electronic

data linkage to a FI to be determined by

HCFA. By June 30, 1998, the Plan is

expected to have completed this

linkage, including testing of the linkage,

and to be capable of transmitting

hospital encounter data to a FI. All data

submitted after July 1, 1998 will be

transmitted using this linkage. (See

Attachment 1 for additional information

on the transmission of data to HCFA.)

Each plan and/or contract will use a

single FI.

HCFA will establish a series of

interim deadlines to ensure that plans

are making sufficient progress toward

accomplishing this linkage no later than

June 30, 1998. HCFA will assist plans in

initiating discussions with their FI.

After plans have established linkages

to a FI, hospitals will submit HCFA–

1450 (UB–92) forms to the managed care

plan. The HCFA–1450 (UB92) form is

identical to the one used by hospitals in

billing for Medicare fee-for-service

claims. After receiving the pseudo claim

from the hospital, the plan attaches the

plan identifier, which is the HCFA

assigned managed care organization

(MCO) Contract Number, and submits

the pseudo-claim electronically to the

fiscal intermediary (FI). The data

processing flow by the FI is very similar

to current claims processing for the feefor-service system, except that no

payment is authorized to the plan.

Pseudo claims will flow though the FI

to our Common Working File (CWF) and

will be retained by HCFA;

Frequency: On occasion;

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

Federal government;

Number of Respondents: 6,700;

Total Annual Responses: 1.9 million;

Total Annual Hours: 32,833.

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, phone number,

and HCFA form number(s) referenced

above, to Paperwork@hcfa.gov, or call

the Reports Clearance Office on (410)

786–1326.

Interested persons are invited to send

comments regarding the burden or any

other aspect of these collections of

information requirements. However, as

noted above, comments on these

information collection and

recordkeeping requirements must be

mailed and/or faxed to the designee

referenced below, by 12/29/97:

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 10235, New Executive

Office Building, Washington, DC

20503, Fax Number: (202) 395–6974

or (202) 395–5167, Attn: Allison

Herron Eydt, HCFA Desk Officer.

Dated: December 16, 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. 97–33556 Filed 12–23–97; 8:45 am]

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

Announcement of Office of

Management and Budget (OMB)

Control Numbers for Agency

Information Collections Approved

Under the Paperwork Reduction Act of

1995

AGENCY: Health Care Financing

Administration.

This notice announces and displays

OMB control numbers for Health Care

Financing Administration (HCFA)

information collections that have been

approved by OMB.

Under OMB’s regulations

implementing the Paperwork Reduction

Act (PRA), 44 U.S.C. 3501, each agency

that proposes to collect information

must submit its proposal for OMB

review and approval in accordance with

5 C.F.R. Part 1320. Once OMB has

approved an agency’s proposed

collection of information and issues a

control number, the agency must

display the control number.

OMB regulations provide for

alternative methods of displaying OMB

control numbers. In the case of

collections of information published in

regulations, display is to be ‘‘provided

in a manner that is reasonably

calculated to inform the public.’’ To

meet this requirement an agency may

display such information in the Federal

Register by publishing such information

in the preamble or the regulatory text,

or in a technical amendment to the

regulation, or in a separate notice

announcing OMB approval of the

collection of information.

To comply with this requirement

HCFA has chosen to publish this notice

announcing OMB approval of the

collections of information published in

regulations. As stated above, this notice

announces and displays the assigned

OMB control numbers for HCFA’s

information collections that have been

approved by OMB.

42 CFR OMB control Nos.

403.210 ........................................................................................................................................................................... 0938–0640
67390 Federal Register / Vol. 62, No. 247 / Wednesday, December 24, 1997 / Notices

42 CFR OMB control Nos.

405.262 ........................................................................................................................................................................... 0938–0267

405.374 ........................................................................................................................................................................... 0938–0270

405.427 ........................................................................................................................................................................... 0938–0155

405.711 ........................................................................................................................................................................... 0938–0045

405.807 ........................................................................................................................................................................... 0938–0033

405.821 ........................................................................................................................................................................... 0938–0034

405.1632 ......................................................................................................................................................................... 0938–0454

405.1701–.1726 .............................................................................................................................................................. 0938–0273

405.2100–.2171 .............................................................................................................................................................. 0938–0386

405.2110, 405.2112 ........................................................................................................................................................ 0938–00657 & 0658

405.2133 ......................................................................................................................................................................... 0938–0046 & 0447 & 0448

405.2135–.2171 .............................................................................................................................................................. 0938–0360

405.2401 ......................................................................................................................................................................... 0938–0685

406.13 ............................................................................................................................................................................. 0938–0080

406.15 ............................................................................................................................................................................. 0938–0501

406.28, 407.27 ................................................................................................................................................................ 0938–0025

407.10, .11 ...................................................................................................................................................................... 0938–0245

407.18 ............................................................................................................................................................................. 0938–0679

407.40 ............................................................................................................................................................................. 0938–0035

408.6 ............................................................................................................................................................................... 0938–0041

409.40–.50, 410.36 ......................................................................................................................................................... 0938–0357

410.1 ............................................................................................................................................................................... 0938–0679

410.38 ............................................................................................................................................................................. 0938–0534

410.40 ............................................................................................................................................................................. 0938–0042 & 0685

410.69 ............................................................................................................................................................................. 0938–0685

410.170 ........................................................................................................................................................................... 0938–0357

411.4–.15 ........................................................................................................................................................................ 0938–0357

411.15 ............................................................................................................................................................................. 0938–0224 & 0357

411.20–411.206 .............................................................................................................................................................. 0938–0565

411.404, 411.406 ............................................................................................................................................................ 0938–0465

411.408 ........................................................................................................................................................................... 0938–0566

412.20–.32 ...................................................................................................................................................................... 0938–0358

412.40–.62 ...................................................................................................................................................................... 0938–0359

412.44, 412.46 ................................................................................................................................................................ 0938–0445

412.92 ............................................................................................................................................................................. 0938–0477

412.105 ........................................................................................................................................................................... 0938–0456

412.106 ........................................................................................................................................................................... 0938–0691

412.116 ........................................................................................................................................................................... 0938–0269

412.256 ........................................................................................................................................................................... 0938–0573

413.13 ............................................................................................................................................................................. 0938–0463

413.16 ............................................................................................................................................................................. 0938–0583

413.17, 413.20 ................................................................................................................................................................ 0938–0202

413.20, 413.24 ................................................................................................................................................................ 0938–0022 & 0037 & 0050

& 0102 & 0107 & 0301 &

0463 & 0511

413.56 ............................................................................................................................................................................. 0938–0463

413.64 ............................................................................................................................................................................. 0938–0269

413.157 ........................................................................................................................................................................... 0938–0463

413.170 ........................................................................................................................................................................... 0938–0296

414.40 ............................................................................................................................................................................. 0938–0008

414.330 ........................................................................................................................................................................... 0938–0372

414.451, 414.452, 414.456, 414.460 .............................................................................................................................. 0938–0685

416.43 ............................................................................................................................................................................. 0938–0506

416.47 ............................................................................................................................................................................. 0938–0266 & 0506

417.1–.106 ...................................................................................................................................................................... 0938–0469

417.124 ........................................................................................................................................................................... 0938–0472

417.126 ........................................................................................................................................................................... 0938–0701

417.143, 417.408 ............................................................................................................................................................ 0938–0470

417.436 ........................................................................................................................................................................... 0938–0610

417.470 ........................................................................................................................................................................... 0938–0701

417.479, 417.500 ............................................................................................................................................................ 0938–0700

417.801 ........................................................................................................................................................................... 0938–0610

418.22, 418.24, 418.28, 418.30, 418.56, 418.58, 418.70, 418.74, 418.80, 418.83, 418.96, 418.100 .......................... 0938–0302

420.200–.206 .................................................................................................................................................................. 0938–0086

421.100 ........................................................................................................................................................................... 0938–0357

422.430 ........................................................................................................................................................................... 0938–0390

424.5 ............................................................................................................................................................................... 0938–0534

424.20 ............................................................................................................................................................................. 0938–0454

424.22 ............................................................................................................................................................................. 0938–0357 & 0589

424.32 ............................................................................................................................................................................. 0938–0008

424.57 ............................................................................................................................................................................. 0938–0685

424.73 ............................................................................................................................................................................. 0938–0685

424.123 ........................................................................................................................................................................... 0938–0484

424.124 ........................................................................................................................................................................... 0938–0042
Federal Register / Vol. 62, No. 247 / Wednesday, December 24, 1997 / Notices 67391

42 CFR OMB control Nos.

430.10–.20 ...................................................................................................................................................................... 0938–0193

430.12 ............................................................................................................................................................................. 0938–0610 & 0673

431.20 ............................................................................................................................................................................. 0938–0610

431.1–431.865 ................................................................................................................................................................ 0938–0062

431.8 ............................................................................................................................................................................... 0938–0300

431.17 ............................................................................................................................................................................. 0938–0467

431.110 ........................................................................................................................................................................... 0938–0390

431.107 ........................................................................................................................................................................... 0938–0610

431.306 ........................................................................................................................................................................... 0938–0502

431.630 ........................................................................................................................................................................... 0938–0445

431.800 ........................................................................................................................................................................... 0938–0094

431.802–.822 .................................................................................................................................................................. 0938–0246

431.814 ........................................................................................................................................................................... 0938–0146 & 0147

431.820 ........................................................................................................................................................................... 0938–0144

431.865 ........................................................................................................................................................................... 0938–0094 & 0246

431.940–431.965 ............................................................................................................................................................ 0938–0467

433.68, 433.74 ................................................................................................................................................................ 0938–0618

433.110–.131 .................................................................................................................................................................. 0938–0487

433.110, 433.112–433.114, 433.116, 433.117, 433.119, 433.121, 433.122, 433.127, 433.130, 433.131 ................... 0938–0247

433.138 ........................................................................................................................................................................... 0938–0502

433.139 ........................................................................................................................................................................... 0938–0502

434.27 ............................................................................................................................................................................. 0938–0572

434.28 ............................................................................................................................................................................. 0938–0610

434.44, 434.67, 434.70 ................................................................................................................................................... 0938–0700

435.1–435.1011 .............................................................................................................................................................. 0938–0062

435.217, 435.726, 435.735 ............................................................................................................................................. 0938–0449

435.940–.965 .................................................................................................................................................................. 0938–0467

440.1–.270 ...................................................................................................................................................................... 0938–0062

440.10 ............................................................................................................................................................................. 0938–0449

440.30 ............................................................................................................................................................................. 0938–0685

441.250–.300 .................................................................................................................................................................. 0938–0481

441.302 ........................................................................................................................................................................... 0938–0449

441.303 ........................................................................................................................................................................... 0938–0272

442.1–.119 ...................................................................................................................................................................... 0938–0062 & 0379

442.10–.119 .................................................................................................................................................................... 0938–0355

442.30 ............................................................................................................................................................................. 0938–0678

447.31 ............................................................................................................................................................................. 0938–0287

447.53 ............................................................................................................................................................................. 0938–0429

447.253 ........................................................................................................................................................................... 0938–0523

447.255 ........................................................................................................................................................................... 0938–0193

447.272 ........................................................................................................................................................................... 0938–0618

447.280 ........................................................................................................................................................................... 0938–0624

447.299 ........................................................................................................................................................................... 0938–0618

455.100–.106 .................................................................................................................................................................. 0938–0086

456.650–.657 .................................................................................................................................................................. 0938–0061

456.654 ........................................................................................................................................................................... 0938–0445

456.700, 456.705, 456.709, 456.711, 456.712 .............................................................................................................. 0938–0659

466.71, 466.73, 466.74, 466.78, 466.80, 466.94 ........................................................................................................... 0938–0445

473.18, 473.34, 473.36, 473.42 ...................................................................................................................................... 0938–0443

476.104, 476.105, 476.116, 476.134 .............................................................................................................................. 0938–0426

482.1–.66 ........................................................................................................................................................................ 0938–0380

482.2–.57 ........................................................................................................................................................................ 0938–0382

482.12, 482.22 ................................................................................................................................................................ 0938–0328

482.27 ............................................................................................................................................................................. 0938–0328 & 0698

482.41 ............................................................................................................................................................................. 0938–0242

482.30, 482.41, 482.43, 482.53, 482.56, 482.57, 482.60–.62 ....................................................................................... 0938–0328 & 0378

482.66 ............................................................................................................................................................................. 0938–0328 & 0624

483.10 ............................................................................................................................................................................. 0938–0610

483.70 ............................................................................................................................................................................. 0938–0242

483.400–.480 .................................................................................................................................................................. 0938–0062 & 0678

483.440, 483.450, 483.460 ............................................................................................................................................. 0938–0366

483.470 ........................................................................................................................................................................... 0938–0242

484.1–.52 ........................................................................................................................................................................ 0938–0365

484.10 ............................................................................................................................................................................. 0938–0610

484.18 ............................................................................................................................................................................. 0938–0357

484.48 ............................................................................................................................................................................. 0938–0519

484.52 ............................................................................................................................................................................. 0938–0687

485.56, 485.58, 485.60, 485.64, 485.66 ........................................................................................................................ 0938–0267

485.701–.729 .................................................................................................................................................................. 0938–0273 & 0065

485.709, 485.711, 485.717, 485.719, 485.721, 485.723, 485.725, 485.727, 485.729 .................................................. 0938–0336

486.100–.110 .................................................................................................................................................................. 0938–0338

486.150–.163 .................................................................................................................................................................. 0938–0258 & 0071

486.155, 486.161, 486.163 ............................................................................................................................................. 0938–0336

486.301–.325 .................................................................................................................................................................. 0938–0391, 0512 & 0688
67392 Federal Register / Vol. 62, No. 247 / Wednesday, December 24, 1997 / Notices

42 CFR OMB control Nos.

488.1–.28 ........................................................................................................................................................................ 0938–0355

488.4 ............................................................................................................................................................................... 0938–0690

488.18 ............................................................................................................................................................................. 0938–0667

488.26 ............................................................................................................................................................................. 0938–0379

488.60 ............................................................................................................................................................................. 0938–0360

489.20 ............................................................................................................................................................................. 0938–0667

489.21 ............................................................................................................................................................................. 0938–0357

489.24 ............................................................................................................................................................................. 0938–0667

489.27 ............................................................................................................................................................................. 0938–0692

489.40–.41 ...................................................................................................................................................................... 0938–0383

489.102 ........................................................................................................................................................................... 0938–0610

491.1–.11 ........................................................................................................................................................................ 0938–0074

491.2 ............................................................................................................................................................................... 0938–0685

491.9 ............................................................................................................................................................................... 0938–0334

493.1–.2001 .................................................................................................................................................................... 0938–0151, 0170, 0544,

0581, 0612 & 0653

493.501, 493.506, 493.513, 493.515 .............................................................................................................................. 0938–0686

493.1840 ......................................................................................................................................................................... 0938–0655

498.40–.95 ...................................................................................................................................................................... 0938–0486 & 0567

1003.100, 1003.101, 1003.103 ....................................................................................................................................... 0938–0700

1004.40, 1004.50, 1004.60, 1004.70 .............................................................................................................................. 0938–0444

45 CFR OMB control Nos.

146.111, .115, .117, .150, .152, .160, .180 .................................................................................................................... 0938–0702

148.120, .122, .124, .128 ................................................................................................................................................ 0938–0703

Dated: December 17, 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. 97–33555 Filed 12–23–97; 8:45 am]

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Office of Inspector General

Criteria for Implementing Permissive

Exclusion Authority Under Section

1128(b)(7) of the Social Security Act

AGENCY: Office of Inspector General

(OIG), HHS.

ACTION: Notice.

SUMMARY: This notice sets forth the nonbinding guidelines, to be used by the

OIG in assessing whether to impose a

permissive exclusion in accordance

with section 1128(b)(7) of the Social

Security Act. These guidelines identify

specific factors with regard to whether

an individual’s or entity’s continued

participation in the Medicare, Medicaid

and other Federal health care programs

will pose a risk to the programs or

program beneficiaries, and explain how

these factors would be used by the OIG

to assess a permissive exclusion

decision.

FOR FURTHER INFORMATION CONTACT:

Joel Schaer, Office of Counsel to the

Inspector General (202) 619–0089.

SUPPLEMENTARY INFORMATION:

I. Background

Purpose and Rationale

Section 1128(b)(7) of the Social

Security Act (the Act) authorizes the

Secretary, and by delegation the

Inspector General, to exclude a provider

from Medicare, Medicaid and the other

Federal health care programs for

engaging in conduct described in

sections 1128A and 1128B of the Act.

These latter provisions establish

administrative and criminal sanctions,

respectively, against individuals and

entities that (1) submit, or cause to be

submitted, false or fraudulent claims to

Medicare and the Federal and State

health care programs; or (2) offer, pay,

solicit or receive remuneration in return

for the referral of business reimbursed

by Medicare or Medicaid, a violation of

the Medicare and Medicaid antikickback statute. Exclusions in

accordance with section 1128(b)(7) of

the Act, based on such conduct, are

permissive in nature, that is, the

Secretary has the discretion whether to

exclude or not to exclude. Respondents

in these administrative exclusion

proceedings have the right to a hearing

before a Department of Health and

Human Services administrative law

judge prior to the imposition of an

exclusion.

On October 24, 1997, the OIG

published a proposed policy statement

in the Federal Register (62 FR 55410) in

the form of non-binding guidelines to be

used by the OIG in assessing whether to

impose a permissive exclusion in

accordance with section 1128(b)(7) of

the Act. We indicated that these draft

criteria were designed to allow for the

more effective development of OIG

investigations and investigative plans;

establish an objective basis for the OIG’s

permissive exclusion decisions;

evaluate a provider’s trustworthiness to

continue to conduct business with the

Medicare, Medicaid and other Federal

health care programs; and positively

influence providers’ future behavior

through the development of corporate

integrity programs and other conduct

contemplated by the exclusion criteria.

The factors listed in these proposed

guidelines were derived from two

principal sources—the regulations

governing exclusions under sections

1128(b)(7) and 1128A of the Act (42 CFR

parts 1001 and 1003), and the decisions

of the Departmental Appeals Board

(DAB) in exclusion matters. The factors

derived from DAB decisions reflected

the analysis of the remedial purpose of

program exclusion that is, to protect

Federal health care programs by

determining whether the respondent is

sufficiently trustworthy to participate.

Structure of Permissive Exclusion

Criteria

The proposed exclusion criteria were

organized into four general categories of

factors bearing on the trustworthiness of

a provider that has allegedly engaged in

health care fraud and abuse—

• The first category addressed the

circumstances and seriousness of the