[Federal Register Volume 89, Number 180 (Tuesday, September 17, 2024)]
[Notices]
[Pages 76115-76116]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-21055]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-R-297/CMS-L564 and CMS-2088-17]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

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 (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 the necessity and utility of the proposed 
information collection for the proper performance of the agency's 
functions, the accuracy of the estimated burden, ways to enhance the 
quality, utility, and clarity of the information to be collected, and 
the use of automated collection techniques or other forms of 
information technology to minimize the information collection burden.

DATES: Comments must be received by November 18, 2024.

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, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.

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-R-297/CMS-L564 Medicare Request for Employment Information
CMS-2088-17 The Community Mental Health Center Cost Report

    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 Collections

    1. Type of Information Collection Request: Extension of a currently 
approved information collection; Title of Information Collection: 
Medicare Request for Employment Information; Use: Section 1837(i) of 
the Social Security Act (the Act) provides for a SEP for individuals 
who delay enrolling in Medicare Part B because they are covered by a 
group health plan based on their own or a spouse's current employment 
status. Disabled individuals with Medicare may also delay enrollment 
because they have large group health plan coverage based on their own 
or a family member's current employment status. When these individuals 
apply for Medicare Part B, they must provide proof that the group 
health plan coverage is (or was) based on current employment status. 
Form CMS L564 provides this proof so that SSA can determine eligibility 
for the SEP. Individuals eligible for the SEP can enroll in Part B 
without incurring a late enrollment penalty (LEP). Individuals may also 
use this form to prove that their group health plan coverage is based 
on current employment status and to have the assessed Medicare LEP 
reduced. Form Number: CMS-R-297/CMS-L564 (OMB control number: 0938-
0787); Frequency: Annually; Affected Public: Individuals or households, 
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 594,998; Total Annual Responses: 594,998; Total Annual 
Hours: 243,949. (For policy questions regarding this collection contact 
Candace Carter at 410-786-8466 or <a href="/cdn-cgi/l/email-protection#df9cbeb1bbbebcbaf19cbeadabbaad9fbcb2acf1b7b7acf1b8b0a9"><span class="__cf_email__" data-cfemail="bdfedcd3d9dcded893fedccfc9d8cffdded0ce93d5d5ce93dad2cb">[email protected]</span></a>.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Community Mental 
Health Center Cost Report Use: CMS requires the Form CMS-2088-17 to 
determine a provider's reasonable cost incurred in furnishing medical 
services to Medicare beneficiaries and reimbursement due to or from a 
provider. In addition, CMHCs may receive reimbursement through the cost 
report for Medicare reimbursable bad debts. CMS uses the Form CMS-2088-
17 for rate setting; payment refinement activities, including market 
basket analysis; Medicare Trust Fund projections; and to support 
program operations. The primary function of the cost report is to 
determine provider reimbursement for services rendered to Medicare 
beneficiaries. Each CMHC submits the cost report to its contractor for 
reimbursement determination.
    Section 1874A of the Act describes the functions of the contractor. 
CMHCs must follow the principles of cost reimbursement, which require 
they maintain sufficient financial records and statistical data for 
proper determination of costs. The S series of worksheets collects the 
provider's location, CBSA, date of certification, operations, and 
unduplicated census

[[Page 76116]]

days. The A series of worksheets collects the provider's trial balance 
of expenses for overhead costs, direct patient care services, and non-
revenue generating cost centers. The B series of worksheets allocates 
the overhead costs to the direct patient care and non-revenue 
generating cost centers using functional statistical bases. The 
Worksheet C computes the apportionment of costs between Medicare 
beneficiaries and other patients. The D series of worksheets are 
Medicare specific and calculate the reimbursement settlement for 
services rendered to Medicare beneficiaries. The Worksheet F collects 
the provider's revenues and expenses data from the provider's income 
statement. Form Number: CMS-2088-17 (OMB control number: 0938-0378); 
Frequency: Annually; Affected Public: Private Sector, Business or other 
for-profits, Not-for-profits institutions; Number of Respondents: 191; 
Total Annual Responses: 191; Total Annual Hours: 17,190. (For policy 
questions regarding this collection contact Jill Keplinger at 410-786-
4550.)

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-21055 Filed 9-16-24; 8:45 am]
BILLING CODE 4120-01-P


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