[Federal Register Volume 60, Number 148 (Wednesday, August 2, 1995)]
[Notices]
[Pages 39403-39404]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-18942]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration


Public Information Collection Requirements Submitted for Public 
Comment and Recommendations

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), Department of Health and Human Services (HHS), 
is publishing the following summaries of proposed collections for 
public comment.
    1. Type of Information Collection Request: Reinstatement, with 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Peer Review Organization 
(PRO) Reporting Forms; Form Nos.: HCFA 613-627; Use: PROs are 
authorized to review inpatient and outpatient services for quality of 
care provided and to eliminate unreasonable, unnecessary, and 
inappropriate care provided to Medicare beneficiaries. The PROs are 
required to report the results of the review to HCFA. Frequency: 
Monthly, quarterly; Affected Public: Business or other for profit; 
Number of Respondents: 53; Total Annual Hours: 10,759.
    2. Type of Information Collection Request: New Collection; Title of 
Information Collection: Evaluation of the Oregon Medicaid Reform 
Demonstration, Baseline Survey; Form No.: HCFA R-179; Use: The baseline 
survey is one component in the evaluation of the Oregon Medicaid Reform 
Demonstration (OMRD), a demonstration authorized under section 115 of 
the Social Security Act. The purpose of the survey is to gather 
information on the health status, past utilization, and level of 
satisfaction of a sample of newly enrolled OMRD recipients, in a way 
that allows followup contact, and maximizes the likelihood of 
preenrollment recall. Frequency: Annually; Affected Public: Individuals 
or households; Number of Respondents: 2,667; Total Annual Hours: 500.
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements in HSQ 108-F, Assumption of Responsibilities; 
Form No.: HCFA R-71; Use: Rule establishes the review functions to be 
performed by the PRO and outlines the relationships among PROs, 
providers, practitioners, beneficiaries, fiscal intermediaries, and 
carriers. Frequency: Monthly, quarterly; Affected Public: Business or 
other for profit; Number of Respondents: 53; Total Annual Hours: 
46,653.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medical Records 
Review Under Prospective Payment System (PPS); Form No.: HCFA R-50; 
Use: PROs are authorized to conduct medical review activities under the 
PPS. In order to conduct medical review activities, we depend upon 
hospitals to make available specific records. Frequency: Annually; 
Affected Public: Business or other for profit; Number of Respondents: 
6,412; Total Annual Hours: 22,400.
    5. Type of Information Collection Request: New Collection; Title of 
Information Collection: Evaluation of the Medicare Cataract Surgery 
Alternate Payment Demonstration; Form No.: HCFA-R-177; Use: To test the 
feasibility of a negotiated bundled payment for the entire episode of 
cataract surgery with an intraocular lens implant and, provide insight 
into appropriateness indicators and effective quality assurance and 
utilization review mechanisms for cataract surgery. Frequency: 
Annually; Affected Public: Business or other for profit institutions; 
Number of Respondents: 1,686; Total Annual Hours: 506.
    6. Type of Information Collection Request: Reinstatement, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Home Health Agency Survey and 
Deficiencies Report, Home Health Functional Assessment Instrument; Form 
Nos.: HCFA-1572, HCFA-1515; Use: In order to participate in the 
Medicare program as a home health agency (HHA) provider, the HHA must 
meet Federal standards. These forms are used to record information 
about patients' health and provider compliance with requirement and 
report information to the Federal Government. Frequency: Annually; 
Affected Public: Business or other for profit; Number of Respondents: 
8,622; Total Annual Hours: 129,330.
    7. Type of Information Collection Request: Reinstatement, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Survey Team Composition and 
Workload Report; Form No.: HCFA-670; Use: This form will provide 
information on resource utilization applicable to survey activity in 
the Medicare/Medicaid provider/supplier types and Clinical Laboratory 
Improvement Amendment (CLIA) laboratories. This information will assist 
HCFA in determining Federal reimbursement for surveys conducted. 
Frequency: Annually; Affected Public: State, local, or tribal 
governments; Number of Respondents: 53; Total Annual Hours: 71,667.
    8. Type of Information Collection Request: New collection; Title of 
Information Collection: Field Testing of the Uniform Needs Assessment 
Instrument; Form No.: HCFA-R-180; Use: The validity, reliability, and 
administrative feasibility of the Uniform Needs Assessment instrument 
will be 

[[Page 39404]]
tested in a small-scale trial. Also, a high risk screener will be 
developed to identify hospital patients in need of extensive discharge 
planning. Testing will be done in two phases approximately 1 year 
apart. Each phase will involve 12 provider sites, 420 patients, and 840 
total assessments. Frequency: Annually; Affected Public: Individuals or 
households, business or other for profit, and not-for-profit 
institutions; Number of Respondents: 420; Total Annual Hours: 1,050.
    To request copies of the proposed paperwork collections referenced 
above, call the Reports Clearance Office on (410) 786-1326. Written 
comments and recommendations for the proposed information collections 
should be sent within 60 days of this notice directly to the HCFA 
Paperwork Clearance Officer designated at the following address: HCFA, 
Office of Financial and Human Resources, Management Planning and 
Analysis Staff, Attention: John Burke, Room C2-26-17, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

    Dated: July 24, 1995.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 95-18942 Filed 8-1-95; 8:45 am]
BILLING CODE 4120-03-P