[Federal Register Volume 70, Number 15 (Tuesday, January 25, 2005)]
[Notices]
[Pages 3531-3532]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-1320]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-8003, CMS-10060, CMS-287, CMS-R-245, CMS-21/
CMS-21B, CMS-64, and CMS-R-209]


Agency Information Collection Activities: Proposed Collection; 
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) 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 and 
Community-Based Waiver Requests and Supporting Regulations in 42 CFR 
440.180 and 441.300-.310; Use: Under a Secretarial waiver, States may 
offer a wide array of home and community-based services to individuals 
who would otherwise require institutionalization. States requesting a 
waiver must provide certain assurances, documentation and cost & 
utilization estimates which are reviewed, approved and maintained for 
the purpose of identifying/verifying States' compliance with such 
statutory and regulatory requirements; Form Number: CMS-8003 
(OMB: 0938-0449); Frequency: Other: When a State requests a 
waiver or amendment to a waiver; Affected Public: State, Local or 
Tribal Government; Number of Respondents: 50; Total Annual Responses: 
132; Total Annual Hours: 7,930.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Quality 
Assessment and Performance Improvement (QAPI) Project Completion Report 
and Supporting Regulations in 42 CFR 422.152; Use: This project 
completion report derives from the Quality Improvement System for 
Managed Care (QISMC) Standards and Guidelines as required by the 
Balanced Budget Act of 1997 (as amended by Balanced Budget Refinement 
Act of 1999) and the related regulations, 42 CFR 422.152. These 
regulations established QISMC as a requirement for Medicare+Choice 
(M+C) Organizations by requiring improved health outcomes for enrolled 
beneficiaries. The provisions of QISMC specify that M+C organizations 
will implement and evaluate quality improvement projects. The form 
submitted herein will permit M+C organizations to report their 
completed projects to CMS in a standardized fashion for evaluation by 
CMS of the M+C Organization's compliance with regulatory provisions. 
This form will improve consistency and reliability in the CMS 
evaluation process, as well as provide a standardized structure for 
public use and review; Form Number: CMS-10060 (OMB: 0938-
0873); Frequency: Annually; Affected Public: Business or other for-
profit and Not-for-profit institutions; Number of Respondents: 155; 
Total Annual Responses: 155; Total Annual Hours: 620.
    3. Type of Information Request: Revision of a currently approved 
collection; Title of Information Collection: Home Office Cost Statement 
and Supporting Regulations in 42 CFR 413.17 and 413.20; Use: Home 
Office Cost Statement, is filed annually by Chain Home Offices to 
report the information necessary for the determination of Medicare 
reimbursement to components of chain organizations. Many providers of 
service participating in Medicare are reimbursed, at least partially, 
on the basis of the lesser of reasonable cost or customary services for 
services furnished to eligible beneficiaries. When providers obtain 
services, supplies or facilities from an organization related to the 
provider by common ownership or control, 42 CFR 413.17 requires that 
the provider include in its costs, the costs incurred by the related 
organization in furnishing such services, supplies or facilities. 
Revisions to this form include the addition of columns for more 
detailed reporting and the elimination of other columns that were 
deemed unnecessary; Form Number: CMB-287 (OMB 0938-0202); 
Frequency: Annually; Affected Public: Not-for-profit institutions and 
Business or other for-profit; Number of Respondents: 1,231; Total 
Annual Responses: 1,231; Total Annual Hours: 573,646.
    4. Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Medicare and Medicaid 
Programs; OASIS Collection Requirements as Part of the COPs for HHAs 
and Supporting Regulations in 42 CFR, Sections 484.55, 484.205, 
484.245, and 484.250; Use: This collection requires HHAs to use a 
standard core assessment data set, the OASIS, to collect information 
and to evaluate adult non-maternity patients. In addition, data from 
the OASIS will be used for purposes of case-mix adjusting patients 
under home health PPS, and will facilitate the production of necessary 
case-mix information at relevant time intervals in the patient's home 
health stay. Modifications were previously made to the OASIS forms to 
allow for the preservation of masking of personally identifiable 
information for the non-Medicare/non-Medicaid individuals; Form Number: 
CMS-R-245 (OMB 0938-0760); Frequency: Other: Upon patient 
assessment; Affected Public: Business or other for-profit, Not-for-
profit institutions, Federal Government, and State, Local or Tribal 
Gov.; Number of Respondents: 7,582; Total Annual Responses: 10,156,569; 
Total Annual Hours: 8,556,995.
    5. Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Quarterly Children's 
Health Insurance Program (CHIP) Statement of Expenditures for Title 
XXI; Use: States use forms CMS-21 and CMS-21B to report budget, 
expenditure, and related statistical information required for

[[Page 3532]]

implementation of the Children's Health Insurance Program. The 
information provided by these forms is used by CMS to prepare the grant 
awards to States for the Medicaid and CHIP programs, to ensure that the 
appropriate level of Federal payments for State expenditures under the 
Medicaid program and CHIP are made in accordance with the CHIP related 
Balanced Budget Act legislation provisions, and to track, monitor, and 
evaluate the numbers of related children being served by the Medicaid 
and CHIP programs; Form Number: CMS-21 and CMS-21B (OMB 0938-
0731); Frequency: Quarterly; Affected Public: State, Local or Tribal 
Gov.; Number of Respondents: 56; Total Annual Responses: 448; Total 
Annual Hours: 7,840.
    6. Type of Information Request: Revision of a currently approved 
collection; Title of Information Collection: Quarterly Medicaid 
Statement of Expenditures for the Medical Assistance Program; Use: The 
State Medicaid agencies use the form CMS-64 for the Medical Assistance 
Program to report their actual program benefit costs and administrative 
expenses to CMS. CMS uses this information to compute the Federal 
financial participation for the State's Medicaid Program costs. The 
structure of the current from CMS-64 has evolved from the previous 
forms used for reporting and has been revised. Classification, 
identification, and referencing used in the CMS-64 forms has been in 
place for several years, is readily understood and accepted by the 
report users, and is supported by strong sentiments in both CMS and the 
States to maintain the existing format. Therefore, our modifications 
have been made to maintain the current reporting format by 
incorporating all changes into the existing report structure; Form 
Number: CMS-64 (OMB 0938-0067); Frequency: Quarterly; Affected 
Public: State, Local or Tribal Gov.; Number of Respondents: 56; Total 
Annual Responses: 224; Total Annual Hours: 16,464.
    7. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare and 
Medicaid Programs; Use and Reporting OASIS Data as Part of the CoPs for 
HHAs and Supporting Regulations in 42 CFR 484.11 and 484.20; Form No.: 
CMS-R-209 (OMB 0938-0761); Use: HHAs are required to report 
data from the OASIS as a condition of participation. Specifically, the 
above named regulation sections provide guidelines for HHAs for the 
electronic transmission of the OASIS data as well as responsibilities 
of the State agency or OASIS contractor in collecting and transmitting 
this information to CMS. These requirements are necessary to achieve 
broad-based, measurable improvement, in the quality of care furnished 
through Federal programs, and to establish a prospective payment system 
for HHAs; Frequency: Monthly; Affected Public: Business or other-for-
profit, Federal Government, State, Local or Tribal Government, Not-for-
profit institutions; Number of Respondents: 7,582; Total Annual 
Responses: 93,621; Total Annual Hours: 921,271.
    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 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 Reduction Act Reports Clearance Officer designated at 
the address below: CMS, Office of Strategic Operations and Regulatory 
Affairs, Division of Regulations Development, Attention: Melissa 
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850.

    Dated: January 13, 2005.
Dawn Willinghan,
Acting, CMS Paperwork Reduction Act Reports Clearance Officer, Office 
of Strategic Operations and Regulatory Affairs, Regulations Development 
Group.
[FR Doc. 05-1320 Filed 1-24-05; 8:45 am]
BILLING CODE 4120-03-M