[Federal Register Volume 70, Number 208 (Friday, October 28, 2005)]
[Notices]
[Pages 62122-62124]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-21517]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-0021, CMS-838, CMS-10134, CMS-R-137, CMS-R-
257, CMS-29/CMS-30, CMS-10150, CMS-381, CMS-10161, CMS-10162, and 
10136]


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: Withholding 
Medicare Payments to Recover Medicaid Overpayments and Supporting 
Regulations in 42 CFR 447.31; Use: Overpayments may occur in either the 
Medicare and Medicaid program, at times resulting in a situation where 
an institution or person that provides services owes a repayment to one 
program while still receiving reimbursement from the other. Certain 
Medicaid providers which are subject to offsets for the collection of 
Medicaid overpayments may terminate or substantially reduce their 
participation in Medicaid, leaving the State Medicaid Agency unable to 
recover the amounts due. These information collection requirements give 
CMS the authority to recover Medicaid overpayments by offsetting 
payments due to a provider under the program. Form Number: CMS-R-0021 
(OMB <greek-i>0938-0287); Frequency: Reporting--On occasion; Affected 
Public: State, Local or Tribal Government; Number of Respondents: 54; 
Total Annual Responses: 27; Total Annual Hours: 81.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Credit 
Balance Reporting Requirements and Supporting Regulations in 42 CFR 
405.371, 405.378, and 413.20; Form Number: CMS-838 (OMB <greek-i>0938-
0600); Use: Section 1815(a) of the Social Security Act authorizes the 
Secretary to request information from providers which is necessary to 
properly administer the Medicare program. Quarterly credit balance 
reporting is needed to monitor and control the identification and 
timely collection of improper payments. The reporting requirements 
provide CMS with the authority to impose sanctions such as the 
suspension of program payments in accordance with 42 CFR 413.20(e) and 
405.371 if providers do not report credit balances on a timely basis. 
Furthermore, once a credit balance has been identified on a CMS-838 
form and demand for payment is made, CMS has the authority to charge 
interest if the amount is not repaid within 30 days in accordance with 
42 CFR 405.378. The collection of credit balance information is needed 
to ensure that millions of dollars in improper program payments are 
collected. Approximately 48,300 health care providers will be required 
to submit a quarterly credit balance report that identifies the amount 
of improper payments they received that are due to Medicare. The 
intermediaries will monitor the reports to ensure these funds are 
collected; Frequency: Quarterly; Affected Public: Not-for-profit 
institutions, Business or other for-profit; Number of Respondents: 
48,300; Total Annual Responses: 193,200; Total Annual Hours: 579,600.

[[Page 62123]]

    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Physician Group 
Practice (PGP) Standardized Ambulatory Care Quality Measure Collection 
Initiative; Use: The Benefits Improvement & Protection Act of 2000 
mandated the PGP Demonstration and gave the Secretary discretion to use 
quality measures to assess physician performance in order to reward 
physicians for improvements in the quality and efficiency of health 
care. This demonstration is intended to strengthen the Medicare program 
by offering innovative models to people on Medicare that improve 
quality and access and lower costs. As a result, Medicare beneficiaries 
will directly benefit from these innovative models. The demonstration 
represents the first pay for performance project for physician group 
practices and will enable comparisons across groups and geography; Form 
Number: CMS-10134 (OMB <greek-i>0938-0942); Frequency: Annually; 
Affected Public: Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 10; Total Annual Responses: 10; 
Total Annual Hours: 790.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Internal Revenue 
Service/Social Security Administration/Centers for Medicare and 
Medicaid Services Data Match and Supporting Regulations in 42 CFR 
411.20-491.206; Form Number: CMS-R-137 (OMB <greek-i>0938-0565); Use: 
The Data Match project and information collection activity provides a 
``check and balance'' against the Medicare program relying solely on a 
single information collection system. It gives CMS the opportunity to 
pursue collection of identified mistaken payments (within legal 
constraints) and to update incorrect status indicators to prevent 
further incorrect suspensions or mistaken payment or denial. Employers 
identified through a match of IRS, SSA, and Medicare records will be 
contacted concerning group health plan coverage of identified 
individuals to ensure compliance with Medicare Secondary Payer 
provisions, in accordance with the Medicare statute found at 42 U.S.C. 
1395y(b); Frequency: Reporting--Annually; Affected Public: Business or 
other for-profit, Not-for-profit institutions, Farms, Federal 
Government, State, Local or Tribal Government; Number of Respondents: 
341,065; Total Annual Responses: 341,065; Total Annual Hours: 
1,986,810.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Advantage Disenrollment Form to original Medicare; Form Number: CMS-R-
257 (OMB <greek-i>0938-0741); Use: Section 4001 of the Balanced Budget 
Act of 1997 amended the Social Security Act to add Section 1851, 
including 1851(c)(1) which required the establishment of a procedure 
and form to make and change Medicare Advantage elections, which include 
disenrollment. The disenrollment form provides beneficiaries an option 
to submit a disenrollment to a neutral third party, process the 
disenrollment action as a change of election and to elicit the reasons 
for disenrollment in order to discern and report disenrollment rates; 
Frequency: On occasion and Other (one-time only); Affected Public: 
Individuals or Households, Business or other for-profit, Not-for-profit 
institutions, and Federal Government; Number of Respondents: 50,000; 
Total Annual Responses: 50,000; Total Annual Hours: 3,300.
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Certification as Rural Health Clinic and Rural Health Clinic Survey 
Report Form and Supporting Regulations in 42 CFR 491.1-491.11; Form 
Number: CMS-29 and CMS-30 (OMB <greek-i>0938-0074); Use: The form CMS-
29 is utilized as an application to be completed by suppliers of Rural 
Health Clinic (RHC) services requesting participation in the Medicare/
Medicaid programs. This form initiates the process of obtaining a 
decision as to whether the conditions for certification are met as a 
supplier of RHC services. It also promotes data reduction or 
introduction to and retrieval from the Online Survey and Certification 
and Reporting System (OSCAR) by CMS Regional Offices (RO). The Form 
CMS-30 is an instrument used by the State survey agency to record data 
collected in order to determine RHC compliance with individual 
conditions of participation and to report it to the Federal government. 
The form is primarily a coding worksheet designed to facilitate data 
reduction (keypunching) and retrieval into OSCAR at the CMS ROs. The 
form includes basic information on compliance (i.e., met, not met and 
explanatory statements) and does not require any descriptive 
information regarding the survey activity itself; Frequency: 
Reporting--Annually; Affected Public: State, Local or Tribal 
Government; Number of Respondents: 698; Total Annual Responses: 698; 
Total Annual Hours: 1,222.
    7. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Collection of 
Drug Pricing and Network Pharmacy Data from Medicare Prescription Drug 
Plans (PDPs and MA-PDs) and Supporting Regulations in 42 CFR 423.48; 
Form Number: CMS-10150 (OMB <greek-i>0938-0951); Use: Both stand alone 
prescription drug plans (PDPs) and Medicare Advantage Prescription Drug 
(MA-PDs) plans will be required to submit drug pricing and pharmacy 
network data to CMS. These data will be made publicly available to 
Medicare beneficiaries through the new Medicare prescription drug plan 
finder tool that will be launched in the fall of 2005 on http://www.medicare.gov. The purpose of the data is to enable beneficiaries to 
compare, learn, select and enroll in a plan that best meets their 
needs; Frequency: Reporting--Weekly; Affected Public: Business or other 
for-profit; Number of Respondents: 350; Total Annual Responses: 18,200; 
Total Annual Hours: 36,400.
    8. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Identification of 
Extension Units of Outpatient Physical Therapy/Outpatient Speech 
Pathology (OPT/OSP) Providers and Supporting Regulations in 42 CFR 
Sections 485.701-485.729; Form Number: CMS-381 (OMB <greek-i>0938-
0273); Use: Medicare provides OPT/OSP providers to be surveyed to 
determine compliance with Federal regulations. All locations where OPT/
OSP providers furnish services must meet these requirements. The CMS-
381 is the form used to identify all the OPT/OSP locations. Frequency: 
Reporting--Annually; Affected Public: Business or other for-profit; 
Number of Respondents: 2960; Total Annual Responses: 2960; Total Annual 
Hours: 740.
    9. Type of Information Collection Request: New Collection; Title of 
Information Collection: New Freedom Initiative--Web-based Reporting 
System for Grantees; Form Number: CMS-10161 (OMB <greek-i>0938-NEW); 
Use: CMS currently awards competitive grants to States and other 
eligible entities for the purpose of designing and implementing 
effective and enduring improvements in community-based long-term 
services and supporting systems. We currently require grantees to 
report quarterly, semi-annual, and or annually, depending on the grant 
type. CMS requires the information obtained

[[Page 62124]]

through web-based grantee reporting for two reasons: (1) In order to 
effectively monitor the grants, and; (2) to report to Congress and 
other interested stakeholders the progress and obstacles experienced by 
the grantees. The grantees are the respondents to the web-based 
reporting system; Frequency: Reporting--Quarterly, Semi-annually, and 
Annually; Affected Public: State, Local or Tribal Government and Not-
for-profit institutions; Number of Respondents: 298; Total Annual 
Responses: 836; Total Annual Hours: 6,440.
    10. Type of Information Collection Request: New Collection; Title 
of Information Collection: Medicare Care Improvement Survey; Use: The 
purpose of this beneficiary survey is to obtain information about 
beneficiary behavioral change, physical functioning and satisfaction 
with the Chronic Care Improvement (CCI) programs. Legislation requires 
that all of the aforementioned data elements be collected, as they 
provide information that is critical to the decision-making process as 
it pertains to the expansion of the pilot programs. The chronic care 
improvement programs are to be designed to incorporate relevant 
features from private sector programs but also be sufficiently flexible 
to adapt to the unique needs of their Medicare populations. This survey 
is required to support the legislative mandate to evaluate the Chronic 
Care Improvement Programs. Beneficiary participation in the CCI-I 
program will be voluntary and will not change the scope, duration or 
amount of Medicare fee-for-service (FFS) benefits currently received by 
FFS Medicare beneficiaries; Form Number: CMS-10162 (OMB <greek-i>0938-
NEW); Frequency: Reporting--On occasion; Affected Public: Individuals 
or Households; Number of Respondents: 9,449; Total Annual Responses: 
9,449; Total Annual Hours: 2,636.
    11. Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Medicare Care Management Performance (MCMP) Demonstration--Standardized 
Ambulatory Care Quality Collection Initiative; Use: The MCMP 
Demonstration was authorized by Section 649 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). 
This project requires the Secretary to establish a pay-for-performance 
3-year pilot with physicians to promote the adoption and use of health 
information technology to improve the quality of patient care for 
chronically ill Medicare patients. This demonstration represents the 
first pay for performance project fostering the adoption of health 
information technology in small physician group practices and will 
enable a test of the concept to improve the quality and efficiency of 
care in Fee-for-Service Medicare; Form Number: CMS-10136 (OMB 
<greek-i>0938-0941); Frequency: Annually; Affected Public: Business or 
other for-profit and Not-for-profit institutions; Number of 
Respondents: 800; Total Annual Responses: 800; Total Annual Hours: 
19,200.
    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 <a href="/cdn-cgi/l/email-protection#6737061702151008150c27040a14490f0f1449000811"><span class="__cf_email__" data-cfemail="3c6c5d4c594e4b534e577c5f514f1254544f125b534a">[email protected]</span></a>, or call the Reports 
Clearance Office and (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 November 28, 
2005. OMB Human Resources and Housing Branch, Attention: CMS Desk 
Officer, New Executive Office Building, Room 10235, Washington, DC 
20503.

    Dated: October 21, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-21517 Filed 10-27-05; 8:45 am]
BILLING CODE 4120-01-P


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