[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