[Federal Register Volume 68, Number 95 (Friday, May 16, 2003)]
[Notices]
[Pages 26618-26620]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-12227]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-77, CMS-1537, CMS-10067, CMS-R-200, CMS-R-
247, CMS-1515/1572, and CMS-668B]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare and 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 and Medicaid 
Services (CMS) (formerly known as the Health Care Financing 
Administration (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 functions;

[[Page 26619]]

(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: Limitation on 
Liability and Information Collection Requirements Referenced in 42 CFR 
411.404, 411.406, and 411.408; Form No.: CMS-R-77) (OMB 0938-
0465); Use: The Medicare program requires to provide written 
notification of noncovered services to beneficiaries by the providers, 
practitioners and suppliers. The notification gives the beneficiary, 
provider, practitioner or supplier knowledge that Medicare will not pay 
for items or services mentioned in the notification. After this 
notification, any future claim for the same or similar services will 
not be paid by the program and the affected parties will be liable for 
the noncovered services.; Frequency: Other: as needed; Affected Public: 
Individuals or Households; Number of Respondents: 900,898; Total Annual 
Responses: 3,603,592; Total Annual Hours: 300,299.
    2. Type of Information Collection Request: Reinstatement, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Medicare/Medicaid Hospital 
Survey Report Form and Supporting Regulations in 42 CFR 482.2 through 
482.57; Form No.: CMS-1537 (OMB 0938-0382); Use: Section 
1861(e) of the Social Security Act (the Act) provides that hospitals 
participating in Medicare under the Act must meet specific 
requirements. These requirements are presented as Condition of 
Participation. State agencies must determine compliance with these 
conditions through the use of this report form.; Frequency: Other: 3-5 
years; Affected Public: State, Local, or Tribal Government, Business or 
other for-profit, Not-for-profit institutions; Number of Respondents: 
3323; Total Annual Responses: 3323; Total Annual Hours: 553.
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: Pharmacy Plus Template for Low Income Seniors 
under Medicaid; Form No.: CMS-10067 (OMB 0938-0889); Use: The 
template for the Pharmacy Plus program for low income seniors under 
Medicaid will enable states to apply, via a standard format, to provide 
a drug benefit to elderly recipients; use of this format will expedite 
the process of obtaining CMS review and approval of an application; 
Frequency: Other: 3 years after initial submission for the 1915(c) 
waiver; 5 years after initial submission for the 1115 demonstration; 
Affected Public: State Government; Number of Respondents: 51; Total 
Annual Responses: 25; Total Annual Hours: 115.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Health Plan 
Employer Data and Information Set (HEDIS) and Health Outcome Survey 
(HOS) and supporting regulations at 42 CFR 422.152; Form No.: CMS-R-
200) (OMB 0938-0701); Use: The Centers for Medicare and 
Medicaid Services (formerly HCFA) collects quality performance measures 
in order to hold the Medicare managed care industry accountable for the 
care being delivered, to enable quality improvement, and to provide 
quality information to Medicare beneficiaries in order to promote 
informed choice. It is critical to CMS's mission that we collect and 
disseminate information that will help beneficiaries choose among 
health plans, contribute to improved quality of care through 
identification of improvement opportunities, and assist CMS in carrying 
out its oversight and purchasing responsibilities.; Frequency: 
Annually; Affected Public: Business or other for-profit, Not-for-profit 
institutions, and Individuals or Households; Number of Respondents: 
166,709; Total Annual Responses: 70,992; Total Annual Hours: 498,436.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Expanded Coverage 
for Diabetes Outpatient Self-Management Training Services and 
Supporting Regulations Contained in 42 CFR 410.141-410.145 and 414.63.; 
Form No.: CMS-R-247) (OMB 0938-0818); Use: 42 CFR 410.141-
410.145 and 414.63 provide for uniform coverage of diabetes outpatient 
self-management training services. These services include educational 
and training services furnished to a beneficiary with diabetes by an 
entity approved to furnish the services. The physician or qualified 
nonphysician practitioner treating the beneficiary's diabetes certifies 
that these services are needed as part of a comprehensive plan of care. 
The regulations set forth the quality standards that an entity is 
required to meet in order to participate in furnishing diabetes 
outpatient self-management training services.; Frequency: On occasion; 
Affected Public: Business or other for-profit; Number of Respondents: 
1708; Total Annual Responses: 6832; Total Annual Hours: 53,013.5.
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Home Health 
Agency Survey and Deficiencies Report, Home Health Functional 
Assessment Instrument and Supporting Regulations in 42 CFR Part 484.1--
484.52; Form No.: CMS-1515/1572 (OMB 0938-0355); 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 
requirements; Frequency: Annually; Affected Public: Business or other 
for-profit, Not-for-profit institutions; Number of Respondents: 7,000; 
Total Annual Responses: 14,000; Total Annual Hours: 14,000.
    7. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Post Laboratory 
Survey Questionnaire--Laboratory, and Supporting Regulations in 42 CFR 
493; Form No.: CMS-668B (OMB 0938-0653); Use: To provide an 
opportunity and a mechanism for CLIA laboratories surveyed by CMS or 
CMS'' agent to express their satisfaction and concerns about the CLIA 
survey process; Frequency: Biennially; Affected Public: Business or 
other for-profit, Not-for-profit institutions; Number of Respondents: 
22,500; Total Annual Responses: 11,250; Total Annual Hours: 2,813.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS's 
Web Site address at http://cms.hhs.gov/regulations/pra/default.asp, or 
E-mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to [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 CMS Paperwork Clearance 
Officer designated at the following address: CMS, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development 
and Issuances, Attention: Dawn Willinghan, Room: C5-14-03, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850


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    Dated: May 8, 2003.
Dawn Willinghan,
CMS Reports Clearance Officer, Division of Regulations Development and 
Issuances, Office of Strategic Operations and Strategic Affairs.
[FR Doc. 03-12227 Filed 5-15-03; 8:45 am]
BILLING CODE 4120-03-P