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[Federal Register Volume 80, Number 94 (Friday, May 15, 2015)]
[Notices]
[Pages 27971-27972]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-11798]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-437A & CMS-437B]

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 July 14, 2015.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. 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-437A & CMS-437B State Agency Sheets for Verifying Exclusions From 
the Inpatient Prospective Payment System and Supporting Regulations

    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 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: Revision of a currently 
approved collection. Title of Information Collection: State Agency 
Sheets for Verifying Exclusions from the Inpatient Prospective Payment 
System and Supporting Regulations Use: For first time verification 
requests for exclusion from the Inpatient Prospective Payment System 
(IPPS), a hospital/unit must notify the Regional Office (RO) servicing 
the State in which it is located that it believes it meets the criteria 
for exclusion from the IPPS. Currently, all new inpatient 
rehabilitation facilities (IRFs) must provide written certification 
that the inpatient population it intends to serve will meet the 
requirements of the IPPS exclusion criteria for IRFs. They must also 
complete the Form CMS-437A if they are a rehabilitation unit or 
complete Form CMS-437B if they are a rehabilitation hospital. This 
information is submitted to the State Agency (SA) no later than 5 
months before the date the hospital/unit would become subject to IRF-
PPS.
    We propose to continue to use the Criteria Worksheets (Forms CMS-
437A and CMS-437B) for verifying first-time exclusions from the IPPS, 
for complaint surveys, for its annual 5 percent validation sample, and 
for facility self-attestation. These forms are related to the survey 
and certification and Medicare approval of the IPPS-excluded 
rehabilitation units and rehabilitation hospitals.
    For rehabilitation hospitals and rehabilitation units already 
excluded from the IPPS, annual onsite re-verification surveys by the SA 
are not required. These hospitals and units will be provided with a 
copy of the appropriate CMS-437 Worksheet at least 5-months prior to 
the beginning of its cost reporting period, so that the hospital/unit 
official may complete and sign an attestation statement and complete 
and return the appropriate CMS-437A or CMS-437B at least 5-months prior 
to the beginning of its cost reporting period. Fiscal Intermediaries 
will continue to verify, on an annual basis, compliance with the 60 
percent rule (42 CFR 412.29(b)(2)) for rehabilitation hospitals and 
rehabilitation units through a sample of medical records and the SA 
will verify the medical director requirement.
    The SA will maintain the documents unless instructed otherwise by 
the RO.

[[Page 27972]]

The SA will notify the RO at least 60 days prior to the end of the 
rehabilitation hospital's/unit's cost reporting period of the IRF's 
compliance or non-compliance with the payment requirements. The 
information collected on these forms, along with other information 
submitted by the IRF is necessary for determining exclusion from the 
IPPS. Hospitals and units that have already been excluded need not 
reapply for exclusion. These facilities will automatically be 
reevaluated yearly to determine whether they continue to meet the 
exclusion criteria.
    Form Number: CMS-437A and CMS-437B (OMB Control Number: 0938-0986); 
Frequency: Yearly; Affected Public: Private Sector (Business or other 
for-profits); Number of Respondents: 478; Total Annual Responses: 478; 
Total Annual Hours: 120. (For policy questions regarding this 
collection contact James Cowher at 410-786-1948).

    Dated: May 12, 2015.
William N. Parham, III
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-11798 Filed 5-14-15; 8:45 am]
 BILLING CODE 4120-01-P
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