[Federal Register Volume 69, Number 182 (Tuesday, September 21, 2004)]
[Notices]
[Pages 56430-56432]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-21027]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-249, CMS-906, CMS-2088-92, CMS-R-48, CMS-
382, CMS-484 and CMS-846-849, 854, 10125, 10126]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

[[Page 56431]]

    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 currently 
approved collection.
    Title of Information Collection: Hospice Cost Report and Supporting 
Regulations Contained in 42 CFR 413.20 and 413.24.
    Use: The hospice cost report is the mechanism used to collect data 
from providers for rate evaluations for the Prospective Payment System 
(PPS). Once CMS obtains this information, we will update the PPS as 
mandated by Congress.
    Form Number: CMS-R-249 (OMB: 0938-0758).
    Frequency: Annually.
    Affected Public: Not-for-profit Institutions and Business or other 
for-profit.
    Number of Respondents: 1,720.
    Total Annual Responses: 1,720.
    Total Annual Hours: 302,720.
    2. Type of Information Collection Request: Extension of currently 
approved collection.
    Title of Information Collection: Fiscal Soundness Reporting 
Requirements and Supporting Regulations in 42 CFR 417.126, 422.502(f) 
and 422.516(a).
    Use: CMS needs this information to establish on-going fiscal 
soundness of the Managed Care Organizations and Insurance Companies.
    Form Number: CMS-906 (OMB: 0938-0469).
    Frequency: Quarterly and Annually.
    Affected Public: Business or other for-profit.
    Number of Respondents: 150.
    Total Annual Responses: 750.
    Total Annual Hours: 150.
    3. Type of Information Collection Request: Extension of currently 
approved collection.
    Title of Information Collection: Outpatient Rehabilitation Cost 
Report and Supporting Regulations Contained in 42 CFR 413.20 and 
413.24.
    Use: This form is used by community mental health centers to report 
their health care costs to determine the amount of reimbursement for 
services furnished to Medicare beneficiaries.
    Form Number: CMS-2088-92 (OMB: 0938-0037).
    Frequency: Annually.
    Affected Public: Business or other for-profit; Not-for profit 
Institutions, State, Local or Tribal governments.
    Number of Respondents: 618.
    Total Annual Responses: 618.
    Total Annual Hours: 61,800.
    4. Type of Information Collection Request: Extension of a currently 
approved collection.
    Title of Information Collection: Hospital Conditions of 
Participation (COP) and Supporting Regulations in 42 CFR 482.12, 
482.13, 482.21, 482.22, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53, 
482.56, 482.57, 482.60, 482.61, 482.62, 485.618 and 485.631.
    Use: Hospitals seeking to participate in the Medicare and Medicaid 
programs must meet the Conditions of Participation (COP) for Hospitals, 
42 CFR Part 482. The information collection requirements contained in 
this package are needed to implement the Medicare and Medicaid COP for 
hospitals and critical access hospitals (CAHs).
    Form Number: CMS-R-48 (OMB 0938-0328).
    Frequency: Annually.
    Affected Public: Business or other for-profit, Not-for-profit 
institutions, Federal Government, and State, Local or Tribal Gov.
    Number of Respondents: 6,085.
    Total Annual Responses: 6,085.
    Total Annual Hours: 5,627,513.
    5. Type of Information Collection Request: Revision of currently 
approved collection.
    Title of Information Collection: ESRD Beneficiary Selection and 
Supporting Regulations Contained in 42 CFR 414.330.
    Use: ESRD facilities have each new home dialysis patient select one 
of two methods to handle Medicare reimbursement. The intermediaries pay 
for the beneficiaries selecting Method I and the carriers pay for the 
beneficiaries selecting Method II. This system was developed to avoid 
duplicate billing by both intermediaries and carriers.
    Form Number: CMS-382 (OMB: 0938-0372).
    Frequency: Other: one time only.
    Affected Public: Individuals or Households, Business or other for-
profit, and Not-for profit Institutions.
    Number of Respondents: 7,400.
    Total Annual Responses: 7,400.
    Total Annual Hours: 617.
    6. Type of Information Collection Request: Revision of currently 
approved collection.
    Title of Information Collection: Oxygen.
    Use: This form is used to determine if oxygen is reasonable and 
necessary pursuant to Medicare Statute. Medicare claims for home oxygen 
therapy must be supported by the treating physician's statement and 
other information including estimate length of need ( of 
months), diagnosis codes (ICD-9) etc.
    Form Number: CMS-484 (OMB: 0938-0534).
    Frequency: Other-as needed.
    Affected Public: Business or other for-profit.
    Number of Respondents: 11,000.
    Total Annual Responses: 1,200,000.
    Total Annual Hours: 497,000.
    7. Type of Information Collection Request: Revision of currently 
approved collection.
    Title of Information Collection: Durable Medical Equipment Regional 
Carrier, Certificate of Medical Necessity and Supporting Documentation.
    Use: The information collected on these forms is needed to 
correctly process claims and ensure proper claim payment. Suppliers and 
physicians will complete these forms and as needed supply additional 
routine supporting documentation necessary to process claims. In 
addition to the other revisions in this collection, it is important to 
note the introduction of two new CMS form numbers. CMS form numbers 
851, 852, and 853 have been replaced with DIFs and have been issued new 
CMS form numbers. CMS form number 851 is now CMS form number 10125. CMS 
form numbers 852 and 853 have now combined into a single DIF with CMS 
form number 10126.
    Form Number: CMS-846-849, 854, 10125,10126 (OMB: 0938-
0679).
    Frequency: On occasion.
    Affected Public: Business or other for-profit.
    Number of Respondents: 51,000.
    Total Annual Responses: 5,400,000.
    Total Annual Hours: 1,215,000.
    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://www.cms.hhs.gov/regulations/pra/, or E-mail 
your request, including your address, phone number, OMB number, and CMS 
document

[[Page 56432]]

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: September 9, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 04-21027 Filed 9-20-04; 8:45 am]
BILLING CODE 4120-03-P