[Federal Register Volume 69, Number 89 (Friday, May 7, 2004)]
[Notices]
[Pages 25592-25593]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-10389]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-53, CMS-R-118 and CMS-10107]


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: Extension of a currently 
approved collection; Title of Information Collection: Imposition of 
Cost Sharing Charges Under Medicaid and Supporting Regulations 
contained in 42 CFR 447.53; Form No.: CMS-R-53 (OMB 0938-
0429); Use: The information collection requirements contained in 42 CFR 
447.53 require the States to include in their Medicaid State Plan their 
cost sharing provisions for the medically and categorically needy. The 
State Plan is the method in which States inform staff of State 
policies, standards, procedures and instructions; Frequency: 
Occasionally; Affected Public: State, Local or Tribal Government; 
Number of Respondents: 52; Total Annual Responses: 2; Total Annual 
Hours: 20.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Quality 
Improvement (formerly Peer Review) Organization Contracts: Solicitation 
of Statements of Interest from In-State Organizations, General Notice 
and Supporting Regulations in 42 CFR 475.102, 475.103, 475.104, 475.105 
and 475.106; Form No.: CMS-R-118 (OMB 0938-0526); Use: This 
notice is a solicitation of sources for the procurement of medical 
review services. The information is required for potential contractors 
to demonstrate that they meet the statutory requirements as Peer Review 
Organizations (also known as Quality Improvement Organizations). 
Compliance with these requirements is voluntary; Frequency: Other: As 
needed, not recurring; Affected Public: Business or other for-profit; 
Number of Respondents: 53; Total Annual Responses: 53; Total Annual 
Hours: 1.
    3. Type of Information Collection Request: New Collection; Title of 
Information Collection: Instrument/Tool for Refinement of a Prospective 
Payment System for Patints in Inpatient Psychiatric Hospitals, and 
units: a pilot test; Form No.: CMS-10107 (OMB 0938-NEW); Use: 
This is a request to pilot test an instrument to refine the PPS for 
inpatient psychiatric facilities. This testing will include assessing 
the feasibility of administering this instrument, and testing the 
reliability, validity, time and process of administration.; Frequency: 
Other: per stay per diem; Affected Public: Business or other for-
profit, not-for-profit institutions, and State, Local or Tribal 
Government; Number of Respondents: 1,120; Total Annual Responses: 
1,120; Total Annual Hours: 2,464.
    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 permament 
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 syrveys, and claims and utilization data gathered 
at 12 sites will help answer these study questions. Mathematics 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;

[[Page 25593]]

Frequency: Other: One-time; Affected Public: Individuals or households, 
not-for-profit institutions; Number of Respondents: 2,753; Total Annual 
Responses: 2,753; Total Annual Hours: 1,330.
    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: April 29, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Regulatory Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 04-10389 Filed 5-6-04; 8:45 am]
BILLING CODE 4120-03-P