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[Federal Register Volume 89, Number 236 (Monday, December 9, 2024)]
[Notices]
[Pages 97619-97620]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-28857]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-319, CMS-2088-17, CMS-224-14 and CMS-R-297/
CMS-L564]

Agency Information Collection Activities: Submission for OMB 
Review; 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 a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the burden estimate 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 on the collection(s) of information must be received by 
the OMB desk officer by January 8, 2025.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function. 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 Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(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 (44 U.S.C. 3506(c)(2)(A)) requires 
Federal agencies to publish a 30-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 that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Use: Title XIX and title 
XXI State agencies are required to submit the MEQC pilot planning 
document in accordance with Sec.  431.814(b), and the MEQC case level 
and CAP reports based on pilot findings in accordance with Sec. Sec.  
431.816 and 431.820, respectively.

[[Page 97620]]

The primary users of this information are State Medicaid (and where 
applicable CHIP) agencies and CMS. State agencies are expected to use 
the information collected for continuous quality improvement purposes. 
They will identify patterns of error in their eligibility processing 
operations and systems and take corrective actions to address issues 
and improve the eligibility determination process. CMS will use the 
data collected to identify and help those States that are most in need 
of technical assistance. CMS will also use the data set to identify 
potential weaknesses in Federal regulations. It will propose regulatory 
modifications designed to ensure that there are more effective quality 
controls in the eligibility determination process.; Form Number: CMS-
319 (OMB control number: 0938-0147); Frequency: Occasionally; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 35; 
Number of Responses: 647; Total Annual Hours: 9,840. (For policy 
questions regarding this collection contact Camiel Rowe at 410-786-
0069.)
    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 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.)
    3. Type of Information Collection Request: Extension of a 
previously approved collection; Title of Information Collection: 
Federally Qualified Health Center Cost Report Form; Use: The Form CMS-
224-14 cost report is needed to determine a provider's reasonable cost 
incurred in furnishing medical services to Medicare beneficiaries and 
to calculate the FQHC settlement amount. These providers, paid under 
the FQHC prospective payment system (PPS), may receive reimbursement 
outside of the PPS for Medicare reimbursable bad debts, pneumococcal, 
influenza, and COVID-19 vaccines, and monoclonal antibody products. CMS 
uses the Form CMS-224-14 for rate setting; payment refinement 
activities, including developing a FQHC market basket; Medicare Trust 
Fund projections; and to support program operations. Additionally, the 
Medicare Payment Advisory Commission (MedPAC) uses the FQHC Medicare 
cost report data to calculate Medicare margins; to formulate 
recommendations to Congress regarding the FQHC PPS; and to conduct 
additional analysis of the FQHC PPS. Form Number: CMS-224-14 (OMB 
control number: 0938-1298); Frequency: Yearly; Affected Public: Private 
Sector, State, Local, or Tribal Governments, Federal Government, 
Business or other for-profits, Not-for-Profit Institutions; Number of 
Respondents: 2,967; Total Annual Responses: 2,967; Total Annual Hours: 
172,086. (For policy questions regarding this collection contact LuAnn 
Piccione at 410-786-5423.)
    4. 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 [email protected]).

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-28857 Filed 12-6-24; 8:45 am]
BILLING CODE 4120-01-P
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