[Federal Register Volume 68, Number 192 (Friday, October 3, 2003)]
[Notices]
[Page 57467]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-25063]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10024, CMS-2384, CMS-R-64]


Agency Information Collection Activities: Submission for OMB 
Review; 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 (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.
    1. 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 
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.
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Third Party 
Premium Billing Request and Supporting Regulations in 42 CFR 408.6 and 
408.202; Form No.: CMS-2384; Use: The Third Party Premium Billing 
Request is used as an authorization to designate that a family member 
or other interested party receive the Medicare Premium Bill and pay it 
on behalf of a Medicare beneficiary. Section 408.202 requires a State 
to get written authorization from Medicare beneficiaries for CMS to 
send billing notices directly to the State or local government agency 
and to release any information required under the SMI premium surcharge 
agreement; Frequency: On occasion; Affected Public: Individuals or 
households; Number of Respondents: 17,350; Total Annual Hours: 6,446.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Indirect Medical 
Education (IME) and Supporting Regulations in 42 CFR 412.105; Form No.: 
HCFA-R-64 (OMB 0938-0456); Use: This collection of information 
on interns and residents (IR) is needed to properly calculate Medicare 
program payments to hospitals that incur indirect costs for medical 
education. The agency's Intern and Resident Information System uses the 
information for producing automated reports of duplicate full-time 
equivalent IRs for IME. The reports provide contractors with 
information to ensure that hospitals are properly reimbursed for IME, 
and help eliminate duplicate reporting of IR counts which inflate 
payments. The collection of this information affects 1,350 hospitals 
which participate in approved medical education programs; Frequency: 
Annually; Affected Public: Not-for-profit institutions, and Business or 
other for-profit; Number of Respondents: 1,350; Total Annual Responses: 
1,350; Total Annual Hours: 2,700. To obtain copies of the supporting 
statement and any related forms for the proposed paperwork collections 
referenced above, access CMS 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 30 days of this notice directly to 
the OMB desk officer: OMB Human Resources and Housing Branch, 
Attention: Brenda Aguilar, New Executive Office Building, Room 10235, 
Washington, DC 20503.

    Dated: September 25, 2003.
Julie Brown,
CMS Reports Clearance Officer, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-25063 Filed 10-2-03; 8:45 am]
BILLING CODE 4120-03-P