[Federal Register Volume 70, Number 15 (Tuesday, January 25, 2005)]
[Notices]
[Pages 3530-3531]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-1319]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Docket Identifier: CMS-10068, CMS-10128, CMS-484, CMS-846-849, 854,
10125, 10126]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & 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 & Medicaid
Services (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 function; (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: Assessing the
Division of Beneficiary Inquiry Customer Service's Performance for
Written Responses; Form No: CMS-10068 (OMB 0938-0894); Use:
The Division of Beneficiary Inquiry Customer Service (DBICS) will
collect information quarterly to assess the customer service provided
via written responses. DBICS will conduct the written survey through
mailings that will accompany actual responses. The envelopes will be
sent by Release Clerks so that the actual writer has no knowledge that
a particular response is being rated. The survey will be used to
measure overall satisfaction of the customer service that the DBICS
provides to Medicare beneficiaries and their representatives;
Frequency: Quarterly; Affected Public: Individuals or households;
Number of Respondents: 2,872; Total Annual Responses: 2,872; Total
Annual Hours: 287.
2. Type of Information Collection Request: New collection; Title of
Information Collection: Public Reporting on Quality Outcomes National
Survey of Hospital Executives (``PRO QUO''); Use: CMS seeks to survey
hospitals quality improvement executives in spring 2005 to assess
awareness of CMS Hospital Quality Initiatives and related publicity,
and to assess impact of these initiatives on hospitals and their
quality improvement programs. Findings will be used to enhance CMS
programs to assist hospitals in quality improvement. Form Number: CMS-
10128 (OMB: 0938-NEW); Frequency: Once; Affected Public: Not-
for-profit institutions and business or other for-profit; Number of
Respondents: 1,600; Total Annual Responses: 1,600; Total Annual Hours:
792.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Attending
Physician's Certification of Medical Necessity for Home Oxygen Therapy
and Supporting Regulations 42 CFR 410.38 and 42 CFR 424.5; Form No.:
0938-0534 (CMS-484); 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. Oxygen (and oxygen
equipment) is by far the largest single total charge of all items paid
under durable medical equipment coverage authority. Medicare has the
legal authority to collect sufficient information to determine payment
for oxygen, and oxygen equipment. The CMN provides a mechanism for
suppliers of Durable Medical Equipment and suppliers of Medical
Equipment and Supplies to demonstrate that the item being provided
meets the criteria for Medicare coverage. By revising the oxygen CMN
questions but adhering to the basic format, CMS can increase the
accuracy of the document while eliminating the need to re-educate CMN
users. In addition, to the above changes, the statement in Section D
stating, ``signature and date stamps are not acceptable'' will be
eliminated and no longer required.; Frequency: As needed; Affected
Public: Business of other for-profit; Number of Respondents: 11,000;
Total Annual Responses: 1,200,000; Total Annual Hours: 497,000.
4. Type of Information Collection Request: Revision of currently
approved collection; Title of Information Collection: Durable Medical
Equipment Regional Carrier, Certificate and 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. CMS Forms 841 and 842, Certificate of Medical Necessity (CMN):
Hospital Beds and CMN: Support Surface respectively, will be eliminated
and no longer be required. CMS Form 846, CMN: Pneumatic Compression
Devices, had changes to the title of the CMN form and the individual
questions on the form. CMS Forms 847-849, CMN: Osteogenesis
Stimulators, CMN: Transcutaneous Electrical Nerve Stimulator (TENS),
and CMN: Seat Lift Mechanism, respectively, all had changes to
individual questions on the forms. CMS Form 10125, DMERC Information
Form: External Infusion Pump, replaced CMS Form 851. CMS Form 10126,
DMERC Information Form: Enteral and Parenteral Nutrition, replaced CMS
Forms 852-853.; 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/
[[Page 3531]]
regulations/pra/, 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)
768-1326.
Written comments and recommendations for the proposed information
collection must be mailed within 30 days of this notice directly to the
OMB desk officer: OMB Human Resources and Housing Branch, Attention:
Christopher Martin, New Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: January 13, 2005.
Dawn Willingham,
Acting, CMS Paperwork Reduction Act Reports Clearance Officer, Office
of Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-1319 Filed 1-24-05; 8:45 am]
BILLING CODE 4120-03-M