[Federal Register Volume 68, Number 249 (Tuesday, December 30, 2003)]
[Notices]
[Pages 75261-75262]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-32045]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-39, CMS-R-243, CMS-R-131, and CMS-10103]


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 (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: Extension of a currently 
approved collection; Title of Information Collection: Home health 
Medicare Conditions of Participation (CoP) Information Collection 
Requirements and Supporting Regulations in 42 CFR 484.10, 484.12, 
484.14, 484.16, 484.18, 484.36, 484.48, and 484.52; Form No.: CMS-R-39 
(OMB 0938-0365); Use: 42 CFR 484 outlines Home Health Agency 
Medicare CoP to ensure HHAs meet the Federal patient health and safety 
regulations; Frequency: Annually; Affected Public: Business or other 
for-profit, not-for-profit institutions, Federal Government, and State, 
Local or Tribal Government; Number of Respondents: 7,122; Total Annual 
Responses: 7,122; Total Annual Hours: 854,891.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Agreement Application, Health Care Prepayment Plan and Supporting 
Regulations in 42 CFR 417.800-417.840.; Form No.: CMS-R-243 
(OMB 0938-0768); Use: An organization must meet certain 
requirements to be a Health Care Prepayment Plan that is eligible for a 
Medicare Section 1833 agreement. The application is the collection form 
to obtain the information from an organization that would allow CMS 
staff to determine compliance with the regulations.; Frequency: One-
time Submission; Affected Public: Business or other for-profit, not-
for-profit institutions, and State, Local or Tribal Government; Number 
of Respondents: 15; Total Annual Responses: 15; Total Annual Hours: 
1,125.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Advanced 
Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 
411.406, and 411.408.; Form No.: CMS-R-131 (OMB 0938-0566); 
Use: Physicians, practitioners, suppliers, and providers

[[Page 75262]]

furnishing Part A or Part B items or services may bill a patient for 
items of services denied by Medicare as not reasonable and necessary, 
under Medicare program standards (Section 1862(a)(1) of title XVIII of 
the Social Security Act (the Act), or under one of several other 
statutory bases (Section 1862(a)(9), Section 1814(a)(2)(C), Section 
1835(a)(2)(A), Section 1861(dd)(3)(A), Section 1834(j)(1), Section 
1834(a)(15), and Section 1834(a)(17)(B) of the Act), if they informed 
the patient, prior to furnishing the items or services and the patient, 
after being so informed, agreed to pay for the items or services.; 
Frequency: As-needed; Affected Public: Business or other for-profit, 
not-for-profit institutions, and Individuals or households; Number of 
Respondents: 1,084,932; Total Annual Responses: 21,171,480; Total 
Annual Hours: 1,764,290.
    4. Type of Information Request: New Collection; Title of 
Information Collection: Evaluation of PACE as a Permanent Program and a 
For-Profit Demonstration; Form No.: CMS-10103 (OMB 0938-NEW); 
Use: The Balanced Budget Act of 1997 (BBA) established PACE as a 
permanent Medicare program and a state option under Medicaid. It also 
mandated a for-profit demonstration and a study of the ``quality and 
cost'' of the permanent program ``under the Medicare and Medicaid 
programs.'' All PACE Demonstration sites must convert to permanent 
program sites in 2003. This evaluation will build on the efforts made 
in the first PACE evaluation (final reports in 2000). Data will be 
gathered to assess changes in access to care, patient satisfaction, 
mortality, organizational/operational changes, patient characteristics, 
outcomes, quality, etc. that have resulted from the BBA legislation. 
Patient surveys, site surveys, and claims and utilization data gathered 
at 12 sites will help answer these study questions. Mathematica Policy 
Research, Inc. is awarded a contract (No. 500-00-0033) to perform this 
evaluation. A final report is expected in the summer of 2006.; 
Frequency: Other: One-time; Affected Public: Individuals or Households, 
Not-for-profit institutions; Number of Respondents: 2,996; Total Annual 
Responses: 2,996; Total Annual Hours: 1,723.
    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: Melissa Musotto, Room C5-14-03, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

    Dated: December 18, 2003.
Melissa Musotto,
Acting, Paperwork Reduction Act Team Leader, Office of Strategic 
Operations and Strategic Affairs, Division of Regulations Development 
and Issuances.
[FR Doc. 03-32045 Filed 12-29-03; 8:45 am]
BILLING CODE 4120-03-P