[Federal Register Volume 70, Number 47 (Friday, March 11, 2005)]
[Notices]
[Pages 12221-12222]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-4887]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10143, CMS-R-295, CMS-R-79, and CMS-R-10]


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: New collection; Title of 
Information Collection: Monthly State File of Medicaid/Medicare Dual 
Eligible Enrollees and Supporting Regulations in 42 CFR 423.900 through 
423.910; Use: The monthly file of dual eligible enrollees will be used 
to determine those duals with drug benefits for the phased-down State 
contribution process required by the Medicare Modernization Act of 2003 
(MMA). Section 103(a)(2) of the MMA addresses the phased-down State 
contribution (PDSC) process for the Medicare program. The reporting of 
the Medicare/Medicaid dual eligibles on

[[Page 12222]]

a monthly basis is necessary to implement those provisions, and to 
Support Part D subsidy determinations and auto-assignment of 
individuals to Part D plans. The PDSC is a partial recoupment from the 
States of ongoing Medicaid drug costs for dual eligibles assumed by 
Medicare under MMA, which absent the MMA would have been paid for by 
the States; Form Number: CMS-10143 (OMB: 0938-NEW); Frequency: 
Recordkeeping and Monthly reporting; Affected Public: State, Local or 
Tribal Government; Number of Respondents: 51; Total Annual Responses: 
612; Total Annual Hours: 10,710.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare CAHPS 
Disenrollment Surveys and Supporting Regulations in 42 CFR 417.126, 
417.470, 422.64, and 422.210; Use: This survey helps Medicare track a 
variety of consumer satisfaction measures relating to Medicare 
beneficiaries who leave their MA plans. The Centers for Medicare & 
Medicaid Services (CMS) has a responsibility to its Medicare 
beneficiaries to require that care provided by managed care 
organizations under contract to CMS is of high quality. One way of 
ensuring high quality care is through the development of performance 
measures and standardized satisfaction surveys that enable CMS to 
gather the data needed to evaluate the care provided to Medicare 
beneficiaries; Form Number: CMS-R-295 (OMB: 0938-0779); 
Frequency: Quarterly; Affected Public: Individuals or Households; 
Number of Respondents: 44,200; Total Annual Responses: 41,697; Total 
Annual hours: 17,823.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Payment 
Adjustment for Sole Community Hospitals and Supporting Regulations in 
42 CFR 412.92; Form No.: CMS-R-79 (OMB 0938-0477); Use: This 
collection provides that if a hospital that is classified as a sole 
community hospital (SCH) experiences, due to circumstances beyond its 
control, a decrease of more than 5 percent in its total number of 
discharges compared to the immediately preceding cost reporting period, 
the hospital may apply for a payment adjustment. To qualify for this 
adjustment to its payment rate an SCH must submit documentation, 
including cost information as requested by CMS, to the intermediary; 
Frequency: On occasion; Affected Public: Not-for-profit institutions, 
Business or other for-profit, and State, Local or Tribal Government; 
Number of Respondents: 40; Total Annual Responses: 40; Total Annual 
Hours: 160.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements Contained in BPD-718: Advance Directives 
(Medicare and Medicaid) and Supporting Regulations in 42 CFR 417.436, 
417.801, 422.128, 430.12, 431.20, 431.107, 438.6, 440.170, 483.10, 
484.10, and 489.102; Form No.: CMS-R-10 (OMB 0938-0610); Use: 
Steps have been taken at both the Federal and State level, to afford 
greater opportunity for the individual to participate in decisions made 
concerning the medical treatment to be received by an adult patient in 
the event that the patient is unable to communicate to others, a 
preference about medical treatment. The individual may make his 
preference known through the use of an advance directive, which is a 
written instruction prepared in advance, such as a living will or 
durable power of attorney. This information is documented in a 
prominent part of the individual's medical record. Advance directives 
as described in the Patient Self-Determination Act (enacted in 1991) 
have increased the individual's control over decisions concerning 
medical treatment. The advance directives requirement was enacted 
because Congress wanted individuals to know that they have a right to 
make health care decisions and to refuse treatment even when they are 
unable to communicate.; Frequency: On occasion; Affected Public: 
Business or other for-profit; Number of Respondents: 33,096; Total 
Annual Responses: 33,096; Total Annual Hours: 924,120.
    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 addressbelow:
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Melissa Musotto, Room 
C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of 
Strategic Operations and Regulatory Affairs, Regulations Development 
Group.
[FR Doc. 05-4887 Filed 3-10-05; 8:45 am]
BILLING CODE 4120-03-P