[Federal Register Volume 73, Number 193 (Friday, October 3, 2008)]
[Notices]
[Pages 57630-57631]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-23414]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10001, CMS-10009, CMS-10272 and CMS-10242]


Agency Information Collection Activities: Proposed Collection; 
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) 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: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Portability and Accountability Act (HIPAA) Nondiscrimination Provisions 
and Supporting Regulations in 45 CFR 146.121(h) and 121(i)(2)(i); Use: 
If coverage has been denied to any individual because the sponsor of a 
self-funded non-Federal governmental plan had exempt the plan from the 
nondiscrimination requirements under 45 CFR 146.180 ``Treatment of Non-
Federal Governmental Plans'', and the plan sponsor subsequently chooses 
to bring the plan into compliance, the plan sponsor must comply with 
the requirements under 45 CFR 146.121(i)(2)(i) ``Special Transitional 
Rule for Self-Funded Non-Federal Governmental Plans Exempted under 45 
CFR 146.180''. To bring the plan into compliance with the requirements, 
the plan must notify the individual that the plan will be coming into 
compliance, afford the individual an opportunity to enroll, specify the 
effective date of compliance, and inform the individual regarding any 
enrollment restrictions that may apply under the terms of the plan once 
the plan is in compliance. Form Number: CMS-10001 (OMB<greek-i> 0938-
0827); Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 18; Total Annual Responses: 18; 
Total Annual Hours: 194.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Portability and Accountability Act (HIPAA) Nondiscrimination Provisions 
and Supporting Regulations in 45 CFR 146.121(f)(2)(v)(A); Use: Section 
146.121 of the regulations requires Health plans or issuers to disclose 
in all plan materials the terms of certain wellness programs including 
the availability of a reasonable alternative standard. Plan 
participants and their dependents need this information to understand 
the rights they have under HIPAA. States and the Federal government may 
need the information supplied by issuers to properly perform their 
regulatory functions. Form Number: CMS-10009 (OMB<greek-i> 0938-0819); 
Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 2,600; Total Annual Responses: 
2,600; Total Annual Hours: 1,300.
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: Hospital Leadership Quality Assessment Tool 
(HLQAT); Use: In 2006, the Hospital Leadership Collaborative (HLC) 
launched a public-private partnership to develop a CMS-endorsed self-
assessment tool, ``The Hospital Leadership and Quality Assessment 
Tool'' (HLQAT) to assist hospitals in the improvement of quality 
through enhanced hospital governance,

[[Page 57631]]

executive, physician, and clinical engagement. Hospitals leaders will 
take the HLQAT instrument via Web-based technology. This function will 
be carried out in conjunction with CMS and the Quality Improvement 
Organization (QIO) 9th Scope of Work (SOW), to convey the importance of 
this effort in relation to Medicare and other public priorities. This 
administration of the HLQAT seeks responses from approximately a dozen 
leaders in each hospital, including physicians (e.g., CEO, CMO), board 
members, director-level, and mid-level clinical managers--these 
responses can provide a multi-level representation of hospital 
leadership showing its commitment to institutional change. Form Number: 
CMS-10272 (OMB<greek-i> 0938-New); Frequency: Occasionally; Affected 
Public: Private Sector--Business or Other for-profits; Number of 
Respondents: 18,000; Total Annual Responses: 36,000; Total Annual 
Hours: 44,820.
    4. Type of Information Collection Request: New collection; Title of 
Information Collection: Emergency and Non-Emergency Ambulance 
Transports and Beneficiary Signature Requirements in 42 CFR 424.36(b); 
Use: In the CY 2008 Physician Fee Schedule (PFS) final rule with 
comment period, we created an additional exception to the beneficiary 
signature requirements in Sec.  424.36(b) for emergency ambulance 
transports (72 FR 66406). The exception allows ambulance providers and 
suppliers to sign the claim on behalf of the beneficiary, at the time 
of transport, provided that certain documentation requirements are met. 
Following publication of the CY 2008 PFS final rule with comment 
period, ambulance provider and supplier stakeholders requested that we 
extend the exception in Sec.  424.36(b)(6) to non-emergency ambulance 
transports, in instances where the beneficiary is physically or 
mentally incapable of signing the claim form.
    The current submission of this information collection request 
relates to the collection of documentation pertaining to non-emergency 
ambulance transports. In addition, we are updating the collection of 
information that relates to the collection of documentation pertaining 
to emergency ambulance transports. Form Number: CMS-10242 (OMB<greek-i> 
0938-1049); Frequency: Occasionally; Affected Public: Private Sector--
Business or Other for-profits and Not-for-profit institutions; Number 
of Respondents: 9,000; Total Annual Responses: 13,185,835; Total Annual 
Hours: 1,098,819.
    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#247445544156534b564f644749570a4c4c570a434b52"><span class="__cf_email__" data-cfemail="90c0f1e0f5e2e7ffe2fbd0f3fde3bef8f8e3bef7ffe6">[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 December 2, 2008.
    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: September 26, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E8-23414 Filed 10-2-08; 8:45 am]
BILLING CODE 4120-01-P


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