[Federal Register Volume 77, Number 65 (Wednesday, April 4, 2012)]
[Notices]
[Page 20404]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-8013]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-437A and CMS-437B]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS) 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; (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: 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 in 42 CFR Parts 412.20-412.29. 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.
    CMS proposes 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 120 days 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 120 days prior 
to the beginning of its cost reporting period. Fiscal Intermediaries 
(FIs) 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. 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.
    In this PRA package, both forms have been revised. Form Number: 
CMS-437A and CMS-437B (OCN 0938-0986). Frequency: Yearly. Affected 
Public: Private Sector (Business or other for-profits). Number of 
Respondents: 1,164. Total Annual Responses: 1,164. Total Annual Hours: 
291. (For policy questions regarding this collection contact Georgia 
Johnson at 410-786-6859. For all other issues call 410-786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS' 
Web Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 
or Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#184879687d6a6f776a73587b756b3670706b367f776e"><span class="__cf_email__" data-cfemail="5606372633242139243d16353b25783e3e2578313920">[email protected]</span></a>, or call 
the Reports Clearance Office on (410) 786-1326.
    In commenting on the proposed information collections please 
reference the document identifier or OMB control number. To be assured 
consideration, comments and recommendations must be submitted in one of 
the following ways by June 4, 2012:
    1. Electronically. You may submit 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) 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 CMS-437A and CMS-437B (OCN 0938-0986), Room C4-26-05, 
7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: March 28, 2012.
Martique Jones,
Director, Regulations Development Group, Division B Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2012-8013 Filed 4-3-12; 8:45 am]
BILLING CODE 4120-01-P


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