[Federal Register Volume 64, Number 41 (Wednesday, March 3, 1999)]
[Notices]
[Page 10305]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-5220]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-484]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Health Care Financing Administration.
    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, 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.
    Type of Information Collection Request: Extension of a currently 
approved collection;
    Title of Information Collection: Attending Physician's 
Certification of Medical Necessity for Home Oxygen Therapy and 
Supporting Regulations in 42 CFR 410.38 and 424.5;
    Form No.: HCFA-484 (OMB# 0938-0534);
    Use: To determine if oxygen is reasonable and necessary pursuant to 
Medicare Statute, Medicare claims for home oxygen therapy must be 
supported by the treating physician's statement and other information 
including estimate length of need (# of months), diagnosis codes (ICD-
9) and:
    1. Results and date of the most recent arterial blood gas PO\2\ 
and/or oxygen saturation tests.
    2. The most recent arterial blood gas PO\2\ and/or oxygen 
saturation test performed EITHER with the patient in a chronic stable 
state as an outpatient, OR within two days prior to discharge from an 
inpatient facility to home.
    3. The most recent arterial blood gas PO\2\ and/or oxygen 
saturation test performed at rest, during exercise, or during sleep.
    4. Name and address of the physician/provider performing the most 
recent arterial blood gas PO\2\ and/or oxygen saturation test.
    5. If ordering portable oxygen, information regarding the patient's 
mobility within the home.
    6. Identification of the highest oxygen flow rate (in liters per 
minute) prescribed.
    7. If the prescribed liters per minute (LPM), as identified in item 
6, are greater than 4 LPM, provide the results and date of the most 
recent arterial blood gas PO\2\ and/or oxygen saturation test taken on 
4 LPM.
    If the PO\2\ = 56-59, or the oxygen saturation = 89%, then evidence 
of the beneficiary meeting at least one of the following criteria must 
be provided.
    8. The patient having dependent edema due to congestive heart 
failure.
    9. The patient having cor pulmonale or pulmonary hypertension, as 
documented by pulmonale on an EKG or by an echocardiogram, gated blood 
pool scan or direct pulmonary artery pressure measurement.
    10. The patient having a hematocrit greater than 56%.
    Form HCFA-484 obtains all pertinent information and promotes 
national consistency in coverage determinations;
    Frequency: Other (as needed);
    Affected Public: Business or other for-profit, and Federal 
Government;
    Number of Respondents: 500,000;
    Total Annual Responses: 500,000;
    Total Annual Hours: 50,000.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access HCFA's 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail 
your request, including your address, phone number, OMB number, and 
HCFA document identifier, to P[email protected], or call the Reports 
Clearance Office on (410) 786-1326. Written comments and 
recommendations for the proposed information collections must be mailed 
within 60 days of this notice directly to the HCFA Paperwork Clearance 
Officer designated at the following address: HCFA, Office of 
Information Services, Security and Standards Group, Division of HCFA 
Enterprise Standards, Attention: Dawn Willinghan, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: February 23, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-5220 Filed 3-2-99; 8:45 am]
BILLING CODE 4120-03-P