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[Federal Register Volume 76, Number 29 (Friday, February 11, 2011)]
[Notices]
[Pages 7863-7864]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-3057]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-222, CMS-1771, CMS-10008, CMS-10368, and CMS-
R-21]

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: Extension of currently 
approved collection; Title of Information Collection: Independent Rural 
Health Center/Freestanding Federally Qualified Health Center Cost 
Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24; Use: 
Providers of service in the Medicare program are required to submit 
annual information to achieve reimbursement for health care services 
rendered to Medicare beneficiaries. The Form CMS-222 cost report is 
needed to determine the amount of reasonable cost due to the providers 
for furnishing medical services to Medicare beneficiaries; Form Number: 
CMS-222 (OMB 0938-0107); Frequency: Yearly; Affected Public: 
Business or other for-profit and not-for-profit institutions; Number of 
Respondents: 5812; Total Annual Responses: 5812; Total Annual Hours: 
290,600.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Attending 
Physicians Statement and Documentation of Medicare Emergency and 
Supporting Regulations in 42 CFR 424.103; Use: 42 CFR 424.103(b) 
requires that before a nonparticipating hospital may be paid for 
emergency services rendered to a Medicare beneficiary, a statement must 
be submitted that is sufficiently comprehensive to support that an 
emergency existed. Form CMS-1771 contains a series of questions 
relating to the medical necessity of the emergency. The attending 
physician must attest that the hospitalization was required under the 
regulatory emergency definition (42 CFR 424.101) and give clinical 
documentation to support the claim. Form Number: CMS-1771 (OMB 
0938-0023); Frequency: Yearly; Affected Public: Private sector--
business or other for-profit and not-for-profit institutions; Number of 
Respondents: 100; Total Annual Responses: 200; Total Annual Hours: 50.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Process and 
Information Required to Determine Eligibility of Drugs, Biologicals, 
and Radiopharmaceutical Agents for Transitional Pass-Through Status 
Under the Hospital Outpatient Prospective Payment System (OPPS); Use: 
Section 1833(t)(6) of the Social Security Act provides for temporary 
additional payments or ``transitional pass-through payments'' for 
certain drugs and biological agents. Interested parties such as 
hospitals, pharmaceutical companies, and physicians can apply for 
transitional pass-through payment for drugs and biologicals used with 
services covered under the OPPS. CMS uses this information to determine 
if the criteria for making a transitional pass-through payment are met 
and if an interim Healthcare Common Procedure Coding System (HCPCS) 
code for a new drug or biological is necessary. Form Number: CMS-10008 
(OMB: 0938-0802); Frequency: Once; Affected Public: Private 
sector--business or other for-profit; Number of Respondents: 30; Total 
Annual Responses: 480; Total Annual Hours: 480.
    4. Type of Information Collection Request: New collection (request 
for a new OMB control number); Title of Information Collection: Dental 
Action Plan Template for Medicaid and CHIP Programs; Form No.: CMS-
10368 (OMB: 0938-NEW); Use: CMS is responsible for 
administering the Federal Medicaid program and the Children's Health 
Insurance Program (CHIP). As part of the Federal Medicaid program, CMS 
oversees the Early and Periodic Screening, Diagnostic, and Treatment 
(EPSDT) benefit to assure that all requirements are met. The provision 
of dental services to EPSDT-eligible individuals is required under 
section 1905(r)(3) of the Social Security Act. In addition, section 
1902(a)(43)(D)(iii) requires that CMS collect information on dental 
services furnished to eligible individuals. Section 501(e) of CHIPRA 
imposed new data reporting requirements for the CHIP program by 
requiring certain dental data to be reported in 2011 on the CHIP annual 
report. Dental data for CHIP is unavailable as the requirement to 
report this data is new for CHIP programs. CMS intends to use the 
information provided in the template to help inform us of the States 
activities undertaken to achieve the national oral health goals for 
Medicaid and CHIP. CMS will use the information to routinely follow-up 
with States on the achievement of their goals and activities and will 
share that information with other States; Frequency: Once; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 69; 
Total Annual Responses: 69; Total Annual Hours: 4,485. (For policy 
questions regarding this collection contact Cindy Ruff at 410-786-5916. 
For all other issues call 410-786-1326.)
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Withholding 
Medicare Payments to Recover Medicaid Overpayments and Supporting 
Regulations in 42 CFR

[[Page 7864]]

447.31; Form No.: CMS-R-21 (OMB: 0938-0287); Use: Section 2104 
of the Omnibus Reconciliation Act of 1981 (Pub. L. 97-35) provides CMS 
with the authority to withhold Federal Medicare payments to recover 
Medicaid overpayments that the Medicaid State Agency has been unable to 
recover. When the CMS Regional Office (RO) receives an overpayment case 
from a State Agency, the case file is examined to determine whether the 
conditions for withholding Medicare payments have been met. If the RO 
determines the case is appropriate for withholding Medicare payments, 
the RO will contact the institution's intermediary or individual's 
carrier to determine the amount of Medicare payments to which the 
entity would otherwise be entitled. The RO will then give notice to the 
intermediary/carrier to withhold the entity's Medicare payment; 
Frequency: Occasionally; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 54; Total Annual Responses: 27; 
Total Annual Hours: 81. (For policy questions regarding this collection 
contact Rory Howe at 410-786-4878. 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 at http://www.cms.hhs.gov/PaperworkReductionActof1995, or e-
mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to Paperwork@cms.hhs.gov, or call the 
Reports Clearance Office at 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 April 12, 2011:
    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, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-3057 Filed 2-10-11; 8:45 am]
BILLING CODE 4120-01-P
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