Federal Register / Vol. 63, No. 117 /Thursday, June 18, 1998 / Notices 33377

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[Form # HCFA–21, 21B, 21P, 21.11A, 21E,

64, 64.21, 64.21U, 64.21P, 64.21UP, 64EC,

64.21E, 64.9P, 64.10P, 64.11A, 64.9d]

Emergency Clearance: Public

Information Collection Requirements

Submitted to the Office of Management

and Budget (OMB)

In compliance with the requirement

of section 3506(c)(2)(A) of the

Paperwork Reduction Act of 1995, the

Health Care Financing Administration

(HCFA), Department of Health and

Human Services (DHHS), has submitted

to the Office of Management and Budget

(OMB) the following request for

Emergency review. We are requesting an

emergency review because the

collection of this information is needed

prior to the expiration of the normal

time limits under OMB’s regulations at

5 CFR, Part 1320. The Agency cannot

reasonably comply with the normal

clearance procedures because of the

need for States to report financial and

related statistical information pursuant

to the operation of their Medicaid

programs, under title XIX of the Social

Security Act, and their Children’s

Health Insurance Programs (CHIP)

under title XXI of the Act. States will

begin reporting information after the

end of the third quarter of Federal fiscal

year 1998 (after June 30, 1998). Without

the capacity for States to report this

information discussed below, the States

and HCFA will not be able to properly

implement the provisions enacted by

the Balanced Budget Act (BBA) of 1997

related to the CHIP.

HCFA is requesting OMB review and

approval of this collection within eleven

working days, with a 180-day approval

period. Written comments and

recommendations will be accepted from

the public if received by the individual

designated below, within ten working

days of publication of this notice in the

Federal Register.

During this 180-day period HCFA will

pursue OMB clearance of this collection

as stipulated by 5 CFR 1320.5.

(1) Type of Information Collection Request:

New Collection;

Title of Information Collection:

Children’s Health Insurance Program

(CHIP) Budget and Expenditure System

State Reporting Forms.

Form Nos.: HCFA–21, 21B, 21P,

21.11A, 21E;

Use: These forms will be used by

State CHIP agencies to report CHIP

program budget projections and actual

CHIP program benefits and

administrative expenditures, and the

numbers of children being served in the

CHIP program, to the Health Care

Financing Administration (HCFA). The

information provided by these new

forms will be used by HCFA to prepare

the grant awards to States for the CHIP,

to ensure that the appropriate level of

Federal payments for State expenditures

under the CHIP are made in accordance

with the CHIP-related BBA legislative

provisions of 1997, and to track,

monitor, and evaluate the numbers of

children being served by the CHIP.

Note: At this time Form HCFA–21E of this

package is for States to report the numbers

of children, by service delivery system, that

are served in the States’ CHIPs based on age

categories. However, we are continuing to

work with the States to develop an

appropriate format for States to report the

numbers of children, by service delivery

system, that are served in the CHIP based on

Federal poverty income level categories and

under the age categories previously

requested. When this format is finalized it

will be incorporated into Form HCFA–21E.

For a short description of the CHIP

reporting forms, see below:

• Form HCFA–21 Summary Sheet.

Quarterly Children’s Health Insurance

Program Statement of Expenditures for

Title XXI Summary Sheet. This form

summarizes the total expenditures in

the State’s CHIP reported by the State

for the reporting quarter.

• Form HCFA–21. Children’s Health

Expenditures by Type of Service for the

Title XXI Program, Expenditures in this

Quarter. States use this form to report

CHIP current quarter expenditures in

accordance with services categories

authorized under title XXI.

• Form HCFA–21B. Children’s Health

Insurance Program Budget Report for

the Title XXI Program State Expenditure

Plan. States use this form to report their

budget projections each quarter for their

Title XXI CHIPs for the current and

budget Federal fiscal years and broken

out by quarter.

• Form HCFA–21P. Children’s Health

Expenditures by Type of Service for the

Title XXI Program, Prior Period

Adjustments. States use this form to

report CHIP prior period adjustment

expenditures claimed in the submission

quarter in accordance with services

categories authorized under title XXI.

• Form HCFA–21.11A. ProviderRelated Donations and Health Care

Related Taxes, Fees, and Assessments

Received Under Section 1903(w) for

Title XXI. States use this form to report

CHIP-related State receipts of provider

related donations, and health care

related taxes, fees, and assessments.

• Form HCFA–21E. Children’s Health

Insurance Program, Number of Children

Served. States use this form to report the

numbers of children, by service delivery

system, that are served in the States’

CHIPs based on age categories.

Note: HCFA is working with States to

develop an appropriate format for States to

report numbers of children, by service

delivery system, that are served in the CHIP

based on Federal poverty income level

categories and under the age categories

previously requested. When the format is

finalized it will be incorporated into this

form.

Frequency: Quarterly;

Affected Public: State and Federal

government;

Number of Respondents: 56;

Total Annual Responses: 224;

Total Annual Hours: 7,840.

(2) Type of Information Collection

Request: Revision of a currently

approved collection; Title of

Information Collection: Quarterly

Medicaid Statement of Expenditures for

the Medical Assistance Program.

Form Nos.: HCFA–64, 64.21, 64.21U,

64.21P, 64.21UP, 64EC, 64.21E, 64.9,

64.10, 64.10P, 64.11a, 64.9d;

Use: These new forms are revisions of

the currently approved collection report

Form HCFA–64. These forms will be

used by State Medicaid agencies to

report their actual CHIP-related

Medicaid expenditures and the numbers

of CHIP-related children, and other

children being served in the Medicaid

program, to the Health Care Financing

Administration(HCFA). The forms will

be used by the HCFA to ensure that the

appropriate level of Federal payments

for the State’s CHIP-related Medicaid

program expenditures are made in

accordance with the CHIP and related

Medicaid provisions of the BBA of 1997,

and to track, monitor, and evaluate the

numbers of CHIP-related children and

other individuals being served by the

Medicaid program.

Note: At this time Forms HCFA–64.21E

and HCFA–64EC of this package are for

States to report the numbers of CHIP-related

children and other children, by service

delivery system, that are served in States’

Medicaid programs based on age categories.

However, we are continuing to work with the

States to develop an appropriate format for

States to report the numbers of children, by

service delivery system, that are served in the

States’ Medicaid programs based on Federal

poverty income level categories and under

the age categories previously requested.

When this format is finalized it will be

incorporated into Forms HCFA–21E and

HCFA–64EC.

For a short description of the CHIPrelated Medicaid reporting forms, see

below:
33378 Federal Register / Vol. 63, No. 117 /Thursday, June 18, 1998 / Notices

• HCFA–64 SUMMARY SHEET

Quarterly Medicaid Statement of

Expenditures for the Medical Assistance

Program, Summary Sheet. The form

HCFA–64 summary sheet is a one-page

summary sheet summarizing the total

expenditures reported for the quarter.

The remaining forms provide additional

detail and support the entries made on

the summary sheet.

• HCFA–64.9

Quarterly Medicaid Statement of

Expenditures for the Medical Assistance

Program, Expenditures in this Quarter.

The form HCFA–64.9 is comprised of

two pages that are used for detailing, by

category, current quarter program

expenditures by type of service (e.g.,

clinical services, dental services). The

total figures from the form HCFA–64.9

are transferred to the form HCFA–64

Summary Sheet, Line 6, columns (a) and

(b). A separate copy of the form HCFA–

64.9 must also be submitted for each

waiver granted to the State agency for

which expenditures have been incurred.

The total waiver figures are already

incorporated in the expenditures

reported on the ‘‘base’’ (one form) form

HCFA–64.9.

• HCFA–64.9p

Quarterly Medicaid Statement of

Expenditures for the Medical Assistance

Program, Prior Period Adjustment. The

form HCFA–64.9p supports claims or

adjustments for prior period (years)

which are transferred to the form

HCFA–64 summary sheet and noted on

Lines 7, 8, 10.A., and 10.B., columns (a)

and (b). It contains the same service

categories as the form HCFA–64.9. This

two-page form details the program

expenditures, by category, arraying the

expenditures by fiscal year. A separate

form HCFA–64.9p is prepared to

support each fiscal year and each line

entry (Lines 7, 8, 10.A., and 10.B.) on

the summary sheet. If the prior period

adjustment includes waiver-related

expenditures, a separate form HCFA–

64.9p must be filed for each waiver

including HCBS waivers.

• HCFA–64.9d

Allocation of Disproportionate Share

Hospital Payment Adjustments to

Applicable FFYs. The form HCFA–

64.9d has been created to track

payments of DSH by Federal Fiscal

Year. This one page form details, by

Inpatient Hospital Services and Mental

Health Facility Services, details the

allotment and DSH payments by Federal

Fiscal Years. This is authorized under

§ 1923(f) of the Act.

• HCFA–64.10

Expenditures for State and Local

Administration for the Medical

Assistance Program, Expenditures in

this Quarter. The form HCFA–64.10

supports administrative expenditures

reported on the summary sheet. This

one page form details, by category, the

current quarter expenditures for

administering the Medicaid program.

The total figures from the ‘‘base’’ form

HCFA–64.10 summary sheet. The State

agency must also file a separate form

HCFA–64.10 or each of its waivers

granted to the State agency for which

expenditures have been incurred. The

waiver expenditures reported on a

supporting form HCFA–64.10 are

already included with the overall

expenditures reported on the ‘‘base’’

form HCFA–64.10.

• HCFA–64.10p

Expenditures for State and Local

Administration for the Medical

Assistance Program, Prior Period

Adjustments. The form HCFA–64.10p is

similar to the form HCFA–64.10 except

that it addresses adjustments to prior

period expenditures. The totals from the

form HCFA–64.10p are transferred to

the form HCFA–64 summary sheet,

Lines 7, or 8. or 10.A., or 10.B., columns

(c) and (d). A separate form HCFA–

64.10p must be completed for each line

item entry, by fiscal year, on the

summary sheet.

• HCFA–64.11

Summary Total of Receipts from form

HCFA–64.11A. The form HCFA–64.11

has been created to summarize the

information reported on the various

HCFA–64.11a forms. This is authorized

under § 1903(w) of the Act.

• HCFA–64.11A

Actual Receipts by Plan Name. The

form HCFA–64.11a has been created to

report the actual receipts by plan names

form provider-related donation and

health care related taxes, fees and

assessments. This is authorized under

§ 1903(w) of the Act.

• There are no forms numbered 64.1

through 64.8 because of form

development and redevelopment over

the years. There are also no forms

detailing items 9.B. through 9.E. of the

summary sheet because there is no need

for further breakdown of these figures

for reimbursement calculations.

HCFA–64.21 Quarterly Medical

Assistance Expenditure By Children’s

Health Insurance Program Expenditure

Categories. States will use this form to

report current quarter expenditures for

children who are determined

presumptively eligible under section

1920A of the Act.

HCFA–64.21U Quarterly Medical

Assistance Expenditure Categories by

Children’s Health Insurance Program

Expenditure Categories. States will use

this form to report current quarter

expenditures described under section

1905(u)(2) and 1905(u)(3) of the Act.

HCFA–64.21P Quarterly Medical

Assistance Expenditures By Children’s

Health Insurance Program expenditure

categories. States will use this form to

report prior period expenditures for

children who are determined

presumptively eligible under section

1920A of the Act.

HCFA–64.21UP Quarterly Medical

Assistance Expenditures by Children’s

Health Insurance Program Expenditure

Categories, Prior Period Expenditures.

States will use this form to report prior

period expenditures described under

section 1905(u)(2) and (3) of the Act.

HCFA–64.21E Number of Children

Served Related to Children’s Health

Insurance Program. States use this form

to report the numbers of CHIP-related

children, by service delivery system,

that are served in the States’ Medicaid

programs based on age categories.

Note: HCFA is working with States to

develop an appropriate format for States to

report numbers of CHIP-related children, by

service delivery system, that are served in the

States’ Medicaid programs related to CHIP

based on Federal poverty income level

categories and under the age categories

previously requested. When the format is

finalized it will be incorporated into this

form.

HCFA–64EC Number of Children

Served Related to Children’s Health

Insurance Program. States use this form

to report the numbers of children (other

than CHIP-related children), by service

delivery system, that are served in the

States’ Medicaid programs based on age

categories.

Note: HCFA is working with States to

develop an appropriate format for States to

report numbers of children (other than CHIPrelated children), by service delivery system,

that are served in the Medicaid program

based on Federal poverty income level

categories and under the age categories

previously requested. When the format is

finalized it will be incorporated into this

form.

Frequency: Quarterly;

Affected Public: State and Federal

government;

Number of Respondents: 56;

Total Annual Responses: 224;

Total Annual Hours: 16,464.

To obtain copies of the supporting

statement and any related forms for the

proposed paperwork collections

referenced above, access HCFA’s Web
Federal Register / Vol. 63, No. 117 /Thursday, June 18, 1998 / Notices 33379

Site address at http://www.hcfa.gov/

regs/prdact95.htm, or E-mail your

request, including your address, phone

number, OMB number, and HCFA

document identifier, to

Paperwork@hcfa.gov, or call the Reports

Clearance Office on (410) 786–1326.

HCFA is requesting OMB review and

approval of these collections within

eleven working days of publication in

the Federal Register. However,

comments on these information

collections and record keeping

requirements must be received by the

designees referenced below, within ten

working days of publication in the

Federal Register: Office of Information

and Regulatory Affairs, Office of

Management and Budget, Room 10235,

New Executive Office Building,

Washington, DC 20503, Fax Number:

(202) 395–6974 or (202) 395–5167, Attn:

Laura Oliven , HCFA Desk Officer.

Dated: June 9, 1998.

John P. Burke III,

HCFA Reports Clearance Officer, HCFA,

Office of Information Services, Security and

Standards Group, Division of HCFA

Enterprise Standards.

[FR Doc. 98–16221 Filed 6–17–98; 8:45 am]

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Agency Information Collection

Activities: Proposed Collection:

Comment Request

In compliance with the requirement

for opportunity for public comment on

proposed data collection projects

(section 3506(c)(2)(A) of Title 44, United

States Code, as amended by the

Paperwork Reduction Act of 1995,

Public Law 104–13), the Health

Resources and Services Administration

(HRSA) will publish periodic

summaries of proposed projects being

developed for submission to OMB under

the Paperwork Reduction Act of 1995.

To request more information on the

proposed project or to obtain a copy of

the data collection plans, call the HRSA

Reports Clearance Officer on (301) 443–

1129.

Comments are invited on: (a) whether

the proposed collection of information

is necessary for the proper performance

of the functions of the agency, including

whether the information shall have

practical utility; (b) the accuracy of the

agency’s estimate of the burden of the

proposed collection of information; (c)

ways to enhance the quality, utility, and

clarity of the information to be

collected; and (d) ways to minimize the

burden of the collection of information

on respondents, including through the

use of automated collection techniques

or other forms of information

technology.

Proposed Project: HIV/AIDS Dental

Reimbursement Program

(OMB No. 0915–0151)—Extension

and Revision—This is a request for

extension and revision of the

instructions used by accredited dental

schools and post-doctoral dental

programs requesting reimbursement for

documented uncompensated costs for

providing oral health care for HIVinfected individuals. Awards are

authorized under section 776(b) of the

Public Health Service Act (42 U.S.C.

294n).

The HIV/AIDS Bureau needs to

collect this information to determine the

amount of the reimbursement award

that is made to each institution. The

information will also assist the Health

Resources and Services Administration

(HRSA) in understanding: (1) the extent

to which dental programs are involved

in the treatment of HIV-infected

individuals; (2) the type of individuals

seeking care; (3) the scope and extent of

HIV oral health services provided; (4)

the time and costs involved in providing

these services; and (5) how the funds

used by the institutions are allocated.

Comparisons are requested between

HIV and non-HIV infected patients to

enable HRSA to determine the impact

on dental programs of providing oral

health services to HIV-infected patients.

The hourly burden estimate has

increased substantially based on the

experience of the grantees in completing

the information required.

Collection

Number

of respondents

Hours

per response

Total

burden

hours

Reimbursement Request ........ 125 20 2,500

Send comments to HRSA Reports

Clearance Officer, Room 14–36,

Parklawn Building, 5600 Fishers Lane,

Rockville, MD 20857. Written comments

should be received within 60 days of

this Notice.

Dated: June 12, 1998.

Jane Harrison,

Director, Division of Policy Review and

Coordination.

[FR Doc. 98–16143 Filed 6–17–98; 8:45 am]

BILLING CODE 4160–15–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Statement of Organization, Functions

and Delegations of Authority

This notice amends Part R of the

Statement of Organization, Functions

and Delegations of Authority of the

Department of Health and Human

Services (DHHS), Health Resources and

Services Administration (60 FR 56605

as amended November 6, 1995, as last

amended at 63 FR 7422 dated February

13, 1998). This notice reflects the

establishment of the Health Resources

and Services Administration’s (HRSA)

five (5) Field Clusters in the Office of

Field Coordination (RS5). This notice

also updates the functional statements

for the Division of Facilities and Loans

(RR2) in the Office of Special Programs

(RR). The changes are as follows.

I. Under Part R, HRSA, establish a

new chapter as the ‘‘HRSA Field

Clusters (RS5F),’’ to read as follows:

Section RS5F–00 Mission

The HRSA Field Clusters are

comprised of the Northeast Cluster, the

Southeast Cluster, the Midwest Cluster,

the West Central Cluster and the Pacific

West Cluster. These clusters support the

Department’s mission of improving the

health of the Nation’s population by

administering HRSA field health

programs and activities to assure a

coordinated HRSA effort in support of

national health policies and State and

local needs within the field. The

clusters will assist HRSA in addressing

cross-cutting program issues and

initiatives to achieve program goals, and

in providing a HRSA focal point for

responding to the needs of State and

local governments, community agencies

and others involved in the planning or

provision of general health. This

organizational structure will support

intergovernmental activities which

respond to health issues on both the

State and local levels, help administer

health activities and programs to

provide prevention of health problems,

and assure access to and quality of

general health services.

Section RS5F–10 Organization

Each cluster is headed up by a Field

Coordinator who reports to the Director,

Office of Field Coordination, who

reports to the Associate Administrator

for Management and Program Support.

The clusters are organized as follows:

A. Northeast Cluster (RS5F1)

1. Philadelphia, PA.—lead city