[Federal Register Volume 68, Number 137 (Thursday, July 17, 2003)]
[Notices]
[Pages 42414-42415]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-18059]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10024]


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; (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: Revision of a currently 
approved collection; Title of Information Collection: Medicare Health 
Survey (MHS) and Data Collection for Administering the PACE Health 
Survey to Beneficiaries Enrolled in PACE and the Dual Eligible 
Demonstrations; Form No.: CMS-10024 (OMB 0938-0844); Use: The 
Centers for Medicare & Medicaid Services has developed a survey, the 
PHS, that is similar to the Health Outcomes Survey (HOS). This survey 
was approved for PACE and the Wisconsin Partnership Program (WPP) on 
March 14, 2003. OMB also approved the use of the PHS to beneficiaries 
enrolled in Minnesota Senior Health Options and Minnesota Disability 
Health Options (MSHO/MnDHO) on June 3, 2003 for a 6-month period. This

[[Page 42415]]

PRA submission combines OMB approval for PACE, WPP 0938-0844 with OMB 
approval for MSHO/MnDHO 0938-0899 and requests to administer the PHS to 
beneficiaries enrolled in MassHealth SCO as well as administer the PHS 
in year 2005. The main purpose of the PHS is to collect health status 
information that may be used to adjust Medicare payment to MSHO/MnDHO 
health plan organizations. It has been successfully pilot-tested to 
assess response rates and accuracy of responses under different 
distribution approaches. The pilot test enabled CMS to select an 
approach whereby PACE and Dual Eligible Demonstration enrollees will be 
sent surveys to fill out and can request assistance from family or 
professionals; Frequency: Annually; Affected Public: Individuals or 
Households and Not-for-profit institutions; Number of Respondents: 
15,859; Total Annual Responses: 10,785; Total Annual Hours: 1,798.
    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.

    Dated: July 10, 2003.
Dawn Willinghan,
CMS Reports Clearance Officer, Division of Regulations Development and 
Issuances, Office of Strategic Operations and Strategic Affairs.
[FR Doc. 03-18059 Filed 7-16-03; 8:45 am]
BILLING CODE 4120-03-P