[Federal Register Volume 70, Number 82 (Friday, April 29, 2005)]
[Notices]
[Pages 22315-22316]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8712]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10123 & 10124, CMS-21/21B, CMS-64, CMS-R-43, 
CMS-R-209, and CMS-R-245]


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: New Collection; Title of 
Information Collection: Expedited Review notices and Supporting 
Regulations contained in 42 CFR 405.1200 and 405.1202; Use: These 
notices are used to inform beneficiaries that their provider services 
will end, and to provide beneficiaries who request an expedited 
determination with detailed information of why the services should end. 
This application requests approval of an information collection 
associated with CMS-4004-FC, [Medicare Program: Expedited Determination 
Procedures for Provider

[[Page 22316]]

Service Terminations.] The rule provides for an expedited appeal when a 
Medicare beneficiary receives notice from a provider of services that 
his or her Medicare covered services will be terminated. The rule 
allows beneficiaries to request an expedited determination by a Quality 
Improvement Organization on whether such services should continue. 
Providers affected by the rule include home health agencies, 
comprehensive outpatient rehabilitation facilities, and hospices; Form 
Numbers: CMS-10123 & 10124 (OMB 0938-NEW); Frequency: On 
occasion; Affected Public: Individuals or Households, Business or other 
for-profit, and Not-for-profit institutions; Number of Respondents: 
4,200,000; Total Annual Responses: 4,200,000; Total Annual Hours: 
379,400.
    2. 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 
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 
government; Number of Respondents: 56; Total Annual Responses: 448; 
Total Annual Hours: 7,840.
    3. Type of Information Request: Extension 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; Form 
Number: CMS-64 (OMB 0938-0067); Frequency: Quarterly; Affected 
Public: State, Local or Tribal Government; Number of Respondents: 56; 
Total Annual Responses: 224; Total Annual Hours: 18,144.
    4. Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Conditions of 
Participation for X-ray Suppliers and Supporting Regulations in 42 CFR 
486.104, 486.106, and 486.110; Use: The information is required to 
certify portable X-ray suppliers wishing to participate in the Medicare 
program. The information collection is needed to determine if portable 
X-ray suppliers are in compliance with published health and safety 
requirements. This is standard medical practice and is necessary in 
order to ensure the well-being and safety of patients and professional 
treatment accountability; Form Number: CMS-R-43 (OMB 0938-
0338); Frequency: Recordkeeping; Affected Public: Business or other 
for-profit, Not-for-profit institutions; Number of Respondents: 602; 
Total Annual Responses: 602; Total Annual Hours: 1,505.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare and 
Medicaid: Use and Reporting OASIS Data as Part of the Conditions of 
Participation (CoPs) for Home Health Agencies (HHAs) and Supporting 
Regulations in 42 CFR 484.11 and 484.20; 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; Form Numbers: CMS-R-209 
(OMB 0938-0761); Frequency: Monthly; Affected Public: Business 
or other for-profit, Not-for-profit institutions, Federal Government, 
and State, Local or Tribal Government; Number of Respondents: 7,582; 
Total Annual Responses: 93,621; Total Annual Hours: 921,271.
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare and 
Medicaid Programs OASIS Collection Requirements as Part of the 
Conditions of Participation for Home Health Agencies (HHAs) and 
Supporting Regulations in 42 CFR 484.55, 484.205, 484.245, 484.250; 
Use: Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare and 
Medicaid Programs OASIS Collection Requirements as Part of the 
Conditions of Participation for Home Health Agencies (HHAs) and 
Supporting Regulations in 42 CFR 484.55, 484.205, 484.245, 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 Numbers: 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 Government; Number of 
Respondents: 7,582; Total Annual Responses: 10,156,569; Total Annual 
Hours: 8,556,995.
    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 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: April 22, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 05-8712 Filed 4-28-05; 8:45 am]
BILLING CODE 4120-01-P