[Federal Register Volume 75, Number 103 (Friday, May 28, 2010)]
[Notices]
[Pages 30030-30031]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-12624]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10314, CMS-264-94, CMS-1728-94, CMS-10240 and 
CMS-P-0015A]


Agency Information Collection Activities: Proposed Collection; 
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) 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 functions; (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: New collection; Title of 
Information Collection: Medicare Savings Program Protection from 
Medicaid Estate Recovery--State Plan Pre-print under Title XIX. Form 
No: CMS-10314 (OMB<greek-i> 0938-New); Use: Section 115 of the Medicare 
Improvements for Patients and Providers Act (MIPPA)--2008, provides new 
protections from Medicaid estate recovery for limited categories of 
dual eligibles age 55 and over. To offer these protections, States have 
to amend their Medicaid State plans to reflect these new limits on 
estate recovery. To reduce paperwork burden and expedite this process, 
CMS is providing States with a pre-printed document (i.e., a State plan 
preprint) which neither needs nor requires any insertion of language or 
even completion of a check-off box. As Section 115 simply mandates 
compliance (there is no option not to comply), States only need return 
the preprint page (as prepared by CMS) to CMS, as a requested amendment 
to their State Plan. This is a one-time only submission, with little 
burden imposition and complete electronic routing to and from States. 
Frequency: Reporting--Once; Affected Public: State, Local or Tribal 
Governments; Number of Respondents: 51; Total Annual Responses: 51; 
Total Annual Hours: 102. (For policy questions regarding this 
collection contact Nancy Dieter at 410-786-7219. For all other issues 
call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Independent Renal 
Dialysis Facility Cost Report; Use: The Independent Renal Dialysis 
Facility Cost Report, is filed annually by providers participating in 
the Medicare program to identify the specific items of cost and 
statistics of facility operation that independent renal dialysis 
facilities are required to report. Form Number: CMS-265-94 
(OMB<greek-i>: 0938-0236); Frequency: Yearly; Affected Public: Business 
or other for-profits and Not-for-profit institutions; Number of 
Respondents: 5,508; Total Annual Responses: 5,508; Total Annual Hours: 
275,400. (For policy questions regarding this collection contact Gail 
Duncan at 410-786-7278. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Home Health 
Agency Cost Report; Use: These cost report forms are filed annually by 
freestanding providers participating in the Medicare program to effect 
year end cost settlement for providing services to Medicare 
beneficiaries. The data submitted on the cost reports supports 
management of Federal programs. Providers receiving Medicare 
reimbursement must provide adequate cost data based on financial and 
statistical records which can be verified by qualified auditors. The 
data from these cost reporting forms will be used for the purpose of 
evaluating current levels of Medicare reimbursement. Form Number: CMS-
1728-94 (OMB<greek-i>: 0938-0022); Frequency: Yearly; Affected Public: 
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 7,479; Total Annual Responses: 7,479; Total Annual 
Hours: 1,690,254. (For policy questions regarding this collection 
contact Angela Havrilla at 410-786-4516. For all other issues call 410-
786-1326.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Data Collection 
for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration; Use: 
The goal of the NHVBP Demonstration is to use financial incentives to 
improve the quality of care in nursing homes. The main purpose of the 
NHVBP data collection effort is to gather information that will enable 
CMS to determine which nursing homes will be eligible to receive 
incentive payments under the NHVBP Demonstration. Information will be 
collected from nursing homes participating in the demonstration on an 
ongoing basis. CMS will collect payroll-based staffing, agency staffing 
and resident census information to help assess the quality of care in 
participating nursing homes. CMS will determine which homes qualify for 
an incentive payment based on their relative performance in terms of 
quality. Form Number: CMS-10240 (OMB<greek-i>: 0938-1039); Frequency: 
Quarterly; Affected Public: Business or other for-profits and Not-for-
profit institutions; Number of Respondents: 178; Total Annual 
Responses: 712; Total Annual

[[Page 30031]]

Hours: 5,530. (For policy questions regarding this collection contact 
Ron Lambert at 410-786-6624. For all other issues call 410-786-1326.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare Current 
Beneficiary Survey; Use: The Medicare Current Beneficiary Survey (MCBS) 
serves to measure what impact the changes have on the program and its 
beneficiaries. The MCBS is a comprehensive data collection effort that 
fills an information gap in the Centers for Medicare and Medicaid 
Services, and is depended on to help manage the program. Being able to 
examine various characteristics and to chart evolving trends offers 
policy makers a reliable tool for making informed decisions. The MCBS 
is used to identify potential new policy direction or modifications to 
the Medicare program and once those program enhancements are 
implemented, monitor the impact of those changes. The central goals of 
the MCBS are to determine medical care expenditures and sources of 
payment for all services, including copayments, deductibles, and non-
covered services; to ascertain all types of health insurance coverage 
and relate coverage to actual payments; and to trace processes over 
time, such as changes in health status, spending down to Medicaid 
eligibility, and the impacts of program changes. Form Number: CMS-P-
0015A (OMB<greek-i>: 0938-0568); Frequency: Yearly; Affected Public: 
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 16,217; Total Annual Responses: 48,650; Total Annual 
Hours: 57,062. (For policy questions regarding this collection contact 
William Long at 410-786-7927. For all other issues call 410-786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS' 
Web Site at http://www.cms.hhs.gov/PaperworkReductionActof1995, or E-
mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#5606372633242139243d16353b25783e3e2578313920"><span class="__cf_email__" data-cfemail="efbf8e9f8a9d98809d84af8c829cc187879cc1888099">[email protected]</span></a>, or call the 
Reports Clearance Office on (410) 786-1326.
    In commenting on the proposed information collections please 
reference the document identifier or OMB control number. To be assured 
consideration, comments and recommendations must be submitted in one of 
the following ways by July 27, 2010:
    1. Electronically. You may submit 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) 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.

    Dated: May 21, 2010.
Martique Jones,
Director, Regulations Development Division-B, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2010-12624 Filed 5-27-10; 8:45 am]
BILLING CODE 4120-01-P


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