Federal Register / Vol. 70, No. 179 / Friday, September 16, 2005 / Notices 54749 

(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 a currently 

approved collection; Title of 

Information Collection: Inpatient 

Rehabilitation Assessment Instrument 

and Data Set for PPS for Inpatient 

Rehabilitation Facilities and Supporting 

Regulations in 42 CFR Sections 412.23, 

412.604, 412.606, 412.610, 412.614, 

412.618, 412.626, 413.64; Form Number: 

CMS–10036 (OMB#: 0938–0842); Use: 

This is a request to use the IRF–PAI 

(Inpatient Rehabilitation Facilities—

Patient Assessment Instrument) and its 

supporting manual for the 

implementation phase of the Inpatient 

Rehabilitation PPS (Prospective 

Payment System). This payment system 

is to cover both operating and capital 

costs for inpatient rehabilitation 

hospital services. It will apply to 

rehabilitation units of acute care 

hospitals as well as to rehabilitation 

hospitals, both of which are exempt 

from the current Medicare PPS which is 

generally applicable for inpatient 

hospital services. Use of this instrument 

will enable CMS to implement a 

classification and payment system for 

the legislatively mandated inpatient 

rehabilitation hospital and the 

aforementioned exempt units. 

Frequency: Recordkeeping, third party 

disclosure and reporting—On occasion; 

Affected Public: Business or other forprofit and Not-for-profit institutions; 

Number of Respondents: 1,165; Total 

Annual Responses: 390,000; Total 

Annual Hours: 421,939. 

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/ 

regulations/pra/, 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 on 

(410) 786–1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received at the address below, no 

later than 5 p.m. on November 15, 2005. 

CMS, Office of Strategic Operations and 

Regulatory Affairs, Division of 

Regulations Development, Attention: 

Bonnie L Harkless, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: September 1, 2005. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 05–18004 Filed 9–15–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–R–138, CMS–

339, CMS–1450] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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), Department of Health 

and Human Services, 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 function; 

(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 a currently 

approved collection; Title of 

Information Collection: Medicare 

Geographic Classification Review Board 

(MGCRB) Procedures and Supporting 

Regulations in 42 CFR 412.256 and 

412.230; Form Nos.: CMS–R–138 (OMB 

# 0938–0573); Use: Section 1886(d)(10) 

of the Social Security Act established 

the Medicare Geographic Classification 

Review Board (MGCRB), an entity with 

the authority to accept short-term 

hospital inpatient prospective payment 

system applications from hospitals 

requesting geographic reclassification 

for wage index or standardized payment 

amounts and to issue decisions on these 

requests. This regulation sets up the 

application process for prospective 

payment system hospitals that choose to 

appeal their geographic status to the 

MGCRB. This regulation also establishes 

procedural guidelines for the MGCRB; 

Frequency: Reporting—Annually; 

Affected Public: Business or other forprofit, Not-for-profit institutions; 

Number of Respondents: 500; Total 

Annual Responses: 500; Total Annual 

Hours: 500. 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare 

Provider Cost Report Reimbursement 

Questionnaire and Supporting 

Regulations in 42 CFR 413.20, 413.24, 

and 415.60; Form Nos.: CMS–339 (OMB 

# 0938–0301); Use: The purpose of Form 

CMS–339 is to assist the provider in 

preparing an acceptable cost report and 

to minimize subsequent contact 

between the provider and its 

intermediary. Form CMS–339 provides 

the basic data necessary to support the 

information in the cost report. This 

includes information the provider uses 

to develop the provider and professional 

components of physician compensation 

so that compensation can be properly 

allocated between the Part A and the 

Part B trust funds. CMS is currently 

working on eliminating Form CMS–339 

and including the applicable questions 

on the individual cost report forms. 

Because of the time required to include 

the applicable questions in each of the 

individual cost reports, CMS is revising 

the currently approved information 

collection; Frequency: Annually; 

Affected Public: Business or other forprofit, not-for-profit institutions, State, 

Local or Tribal Governments; Number of 

Respondents: 35,904; Total Annual 

Responses: 35,904; Total Annual Hours: 

618,210. 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Uniform Institutional Provider Bill and 

Supporting Regulations in 42 CFR 

424.5; Form No.: CMS–1450 (OMB 

#0938–0279); Use: Section 42 CFR 

424.5(a)(5) requires providers of services 

to submit claims prior to Medicare 

reimbursement. Charges are coded by 

revenue codes. The bill specifies 

diagnoses according to the International 

Classification of Diseases, Ninth Edition 

(ICD–9–CM) codes. Inpatient procedures 

are identified by ICD–9–CM codes, and 

outpatient procedures are described 

using the Healthcare Common 

Procedure Coding System (HCPCS). 

These are standard systems of 

identification for all major health 

insurance claims payers. Submission of 

information on the CMS–1450 permits 

Medicare intermediaries to receive 

consistent data for proper payment; 

54750 Federal Register / Vol. 70, No. 179 / Friday, September 16, 2005 / Notices 

Frequency: On occasion; Affected 

Public: Not-for-profit institutions, 

business or other for profit; Number of 

Respondents: 51,629; Total Annual 

Responses: 174,461,278; Total Annual 

Hours: 1,997,581. 

To obtain copies of the supporting 

statement and any related forms for 

these paperwork collections referenced 

above, access CMS Web site address at 

http://www.cms.hhs.gov/regulations/ 

pra/, 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 on (410) 786–

1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB Desk Officer at 

the address below, no later than 5 p.m. 

on October 17, 2005. OMB Human 

Resources and Housing Branch, 

Attention: Christopher Martin, New 

Executive Office Building, Room 10235, 

Washington, DC 20503. 

Dated: September 1, 2005. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 05–18052 Filed 9–15–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–1856/1893, 

CMS–R–254, CMS–10160, CMS–10154] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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), Department of Health 

and Human Services, 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 function; 

(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 a currently 

approved collection; Title of 

Information Collection: Request for 

Certification in the Medicare and/or 

Medicaid Program to Provide Outpatient 

Physical Therapy (OPT) and/or Speech 

Pathology Services, OPT Speech 

Pathology Survey Report and 

Supporting Regulations in 42 CFR 

485.701–485.729.; Form No.: CMS–

1856, CMS–1893 (OMB # 0938–0065); 

Use: The Medicare Program requires 

OPT providers to meet certain health 

and safety requirements. The request for 

certification form is used by State 

agency surveyors to determine if 

minimum Medicare eligibility 

requirements are met. The survey report 

form records the result of the on-site 

survey; Frequency: On occasion and 

Other—every 6 years; Affected Public: 

Business or other for-profit; Number of 

Respondents: 2,968; Total Annual 

Responses: 495; Total Annual Hours: 

866. 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: National 

Medicare Education Program (NMEP); 

Form No.: CMS–R–254 (OMB # 0938–

0738); Use: The NMEP was developed to 

inform people with Medicare, their 

family members, and other interested 

parties about their Medicare options. 

The Medicare Modernization Act of 

2003 expanded the program to include 

among other things, a new Prescription 

Drug Benefit; therefore, this package has 

been revised to include this 

information. The NMEP employs 

numerous communication channels to 

educate people with Medicare and help 

them make more informed decisions 

concerning the Medicare program 

benefits; health plan choices; 

supplemental health insurance; rights, 

responsibilities, and protections; and 

preventive health services. As part of 

the NMEP, CMS must provide 

information to this population about the 

Medicare program and their Health Plan 

options, as well as information about 

the new prescription drug coverage to 

help them choose the option that is right 

for them. This survey seeks to assess the 

awareness, knowledge, understanding 

and experiences of people with 

Medicare regarding the Medicare 

program overall and these new 

initiatives; Frequency: On occasion; 

Affected Public: Individuals or 

Households; Number of Respondents: 

5,700; Total Annual Responses: 5,700; 

Total Annual Hours: 1,425. 

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: The Consumer 

Assessment of Health Behaviors Survey; 

Form No.: CMS–10160 (OMB # 0938–

NEW); Use: New focus on personalizing 

messages by relating health care choices 

with individual beliefs may help guide 

these educational efforts. The intent of 

this survey is to understand the role 

personal responsibility plays when 

people with Medicare make health care 

decisions; Affected Public: Individuals 

or households; Number of Respondents: 

1580; Total Annual Responses: 1580; 

Total Annual Hours: 395. 

4. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Physician 

Assessment of Hospital Quality Reports; 

Form No.: CMS–10154 (OMB # 0938–

NEW); Use: This assessment will 

monitor the attitudes and behaviors of 

physicians as they relate to the concerns 

of their patients who have been exposed 

to hospital quality-of-care reports at 

CMS’s Web Site; Affected Public: 

Individuals or households; Number of 

Respondents: 1730; Total Annual 

Responses: 1730; Total Annual Hours: 

346. 

To obtain copies of the supporting 

statement and any related forms for 

these paperwork collections referenced 

above, access CMS Web site address at 

http://www.cms.hhs.gov/regulations/ 

pra/, 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 on (410) 786–

1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB Desk Officer at 

the address below, no later than 5 p.m. 

on October 17, 2005. 

OMB Human Resources and Housing 

Branch, Attention: Christopher 

Martin, New Executive Office 

Building, Room 10235, Washington, 

DC 20503. 

Dated: September 8, 2005. 

Michelle Short, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 05–18508 Filed 9–15–05; 8:45 am] 

BILLING CODE 4120–01–P