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[Federal Register Volume 80, Number 25 (Friday, February 6, 2015)]
[Notices]
[Pages 6726-6727]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-02414]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers CMS-10410, CMS-R-74, CMS-2552-10 and CMS-855R]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services.

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 (the 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 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates 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 must be received by April 7, 2015.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number (OCN). To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) that are accepting comments.
    2. By regular mail. You may mail written comments to the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number ______, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.
    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.
    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:

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-10410 Medicaid Program; Eligibility Changes under the Affordable 
Care Act of 2010
CMS-R-74 Income and Eligibility Verification System Reporting and 
Supporting Regulations
CMS-2552-10 Hospital and Hospital Health Care Complex Cost Report
CMS-855R Medicare Enrollment Application: Reassignment of Medicare 
Benefits

    Under the 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 requires federal agencies 
to publish a 60-day notice in the Federal Register concerning each 
proposed collection of information, including each proposed extension 
or reinstatement of an existing

[[Page 6727]]

collection of information, before submitting the collection to OMB for 
approval. To comply with this requirement, CMS is publishing this 
notice.

Information Collection

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Program; 
Eligibility Changes under the Affordable Care Act of 2010; Use: The 
eligibility systems are essential to the goal of increasing coverage in 
insurance affordability programs while reducing administrative burden 
on states and consumers. The electronic transmission and automation of 
data transfers are key elements in managing the expected insurance 
affordability program caseload that started in 2014. Accomplishing the 
same work without these information collection requirements would not 
be feasible. Form Number: CMS-10410 (OMB control number 0938-1147); 
Frequency: Occasionally; Affected Public: Individuals or households, 
and State, Local, and Tribal Governments; Number of Respondents: 
25,500,096; Total Annual Responses: 76,500,149; Total Annual Hours: 
21,278,142. (For policy questions regarding this collection contact 
Brenda Sheppard at 410-786-8534).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Income and 
Eligibility Verification System Reporting and Supporting Regulations; 
Use: A state Medicaid agency that currently obtains and uses 
information from certain sources, or with more frequency than 
specified, could continue to do so to the extent that the verifications 
are useful and not redundant. An agency that has found it effective to 
verify all wage or benefit information with another agency or with the 
recipient is encouraged to continue these practices if it chooses. On 
the other hand, the agency may implement an approved targeting plan 
under 42 CFR 435.953. The agency's experience should guide its decision 
whether to exceed these regulatory requirements on income and 
eligibility verification. While states may target resources when 
verifying income of course, agencies are still held accountable for 
their accuracy in eligibility determinations. Form Number: CMS-R-74 
(OMB control number 0938-0467); Frequency: Occasionally; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 50; 
Total Annual Responses: 71; Total Annual Hours: 134,865. (For policy 
questions regarding this collection contact Brenda Sheppard at 410-786-
8534).
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Hospital and 
Hospital Health Care Complex Cost Report; 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.
    We are requesting the Office of Management and Budget review and 
approve this revision to the Form CMS-2552-10, Hospital and Hospital 
Health Care Complex Cost Report. These cost reports are filed annually 
by hospitals participating in the Medicare program to determine the 
reasonable costs incurred to provide medical services to patients. The 
revisions made to the hospital cost report are in accordance with the 
statutory requirement for hospice payment reform in Sec.  3132 of the 
Patient Protection and Affordable Care Act (ACA) (March 23, 2010) and 
the statutory requirement establishing a prospective payment system for 
Federally Qualified Health Centers in Sec.  10501(i)(3)(A) of the ACA, 
codified in section 1834(o) of the Act. Form Number: CMS-2552-10 (OMB 
control number 0938-0050); Frequency: Yearly; Affected Public: State, 
Local, or Tribal Governments, private sector (for-profit and not-for-
profit institutions); Number of Respondents: 6,157; Total Annual 
Responses: 6,157; Total Annual Hours: 4,143,661. (For policy questions 
regarding this collection contact Gail Duncan at 410-786-7278).
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare 
Enrollment Application: Reassignment of Medicare Benefits; Use: The 
primary function of the CMS 855R enrollment application is to allow 
physicians and non-physician practitioners to reassign their Medicare 
benefits to a group practice and to gather information from the 
individual that tells us who he/she is, where he or she renders 
services, and information necessary to establish correct claims 
payment. The goal of periodically evaluating and revising the CMS 855R 
enrollment application is to simplify and clarify the information 
collection without jeopardizing our need to collect specific 
information.
    At this time, CMS is making very few minor revisions to the CMS 
855R (Reassignment of Benefits) Medicare enrollment application (OMB 
No. 0938-1179). Two sections within the form are being reversed to 
maintain sync with online and paper forms. The previously approved CMS 
855R section 2 collected information regarding the individual 
practitioner who is reassigning benefits and section 3 collected 
information regarding the organization/group receiving the reassigned 
benefits. These two sections have been reversed so that section 2 now 
collects information on the regarding the organization/group receiving 
the reassigned benefits and section 3 now collects information on the 
individual practitioner who is reassigning benefits. No information or 
data collection within these sections was revised. The sections were 
merely re-sequenced and re-numbered to maintain sync between online and 
paper forms. With the exception of this section reversal and adding the 
word ``optional'' to sections 4 and 5 (primary practice location and 
contact person information), there are no other revisions. These 
revisions offer no new data collection in this revision package. The 
addition of the optional choice in sections 4 and 5 could potentially 
reduce the burden to providers who choose not to complete either or 
both optional sections. Form Number: CMS-855R (OMB control number 0938-
1179); Frequency: Occasionally; Affected Public: State, Local, or 
Tribal Governments, private sector (for-profit and not-for-profit 
institutions); Number of Respondents: 379,619; Total Annual Responses: 
379,619; Total Annual Hours: 94,905. (For policy questions regarding 
this collection contact Kim McPhillips at 410-786-5374).

    Dated: February 3, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-02414 Filed 2-5-15; 8:45 am]
BILLING CODE 4120-01-P
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