[Federal Register Volume 70, Number 130 (Friday, July 8, 2005)]
[Notices]
[Page 39513]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-13413]



[[Page 39513]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10164, CMS-855, CMS-R-257, and CMS-10064]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services.
    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: Electronic Data Interchange (EDI) Enrollment 
Form and Medicare EDI Registration Form; Form No.: CMS-10164 (OMB 
 0938-NEW); Use: Federal law requires that CMS take 
precautions to minimize the security risk to Federal information 
systems. Accordingly, CMS is requiring that trading partners who wish 
to conduct the Electronic Data Interchange (EDI) transactions provide 
certain assurances as a condition of receiving access to the Medicare 
system for the purpose of conducting EDI exchanges. Health care 
providers, clearinghouses, and health plans that wish to access the 
Medicare system are required to complete this form. The information 
will be used to assure that those entities that access the Medicare 
system are aware of applicable provisions and penalties; Frequency: 
Recordkeeping and reporting--other (one-time only); Affected Public: 
Business or other for-profit, not-for-profit institutions; Number of 
Respondents: 1,220,000; Total Annual Responses: 1,220,000; Total Annual 
Hours: 400,000.
    2. Type of Information Collection Request: New collection; Title of 
Information Collection: Medicare Carrier Provider/Supplier Enrollment 
Application; Form No.: CMS-855 (OMB  0938-0685); Use: This 
application is currently required of all health care providers/
suppliers who wish to enroll in the Medicare program. It is submitted 
at the time the applicant first requests a Medicare billing number. The 
application is used by Medicare contractors to collect data to assure 
the applicant has the necessary professional and/or business 
credentials to provide the health care services for which they intend 
to bill Medicare, including information that allows the Medicare 
contractor to correctly price, process and pay the applicant's claims. 
It also gathers information that allows Medicare contractors to ensure 
that the provider/supplier is not sanctioned from the Medicare program, 
or debarred, suspended or excluded from any other Federal agency or 
program; Frequency: Reporting--other (upon initial enrollment and 
revalidation); Affected Public: Business or other for-profit, 
individuals or households, not-for-profit institutions; Number of 
Respondents: 604,000; Total Annual Responses: 604,000; Total Annual 
Hours: 1,227,000.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Advantage Disenrollment Form to original Medicare; Form No.: CMS-R-257 
(OMB  0938-0741); Use: Section 4001 of the Balanced Budget Act 
of 1997 amended the Social Security Act to add section 1851, including 
1851(c)(1) which required the establishment of a procedure and form to 
make and change Medicare Advantage elections, which include 
disenrollment. The disenrollment form provides beneficiaries an option 
to submit a disenrollment to a neutral third party, process the 
disenrollment action as a change of election and to elicit the reasons 
for disenrollment in order to discern and report disenrollment rates; 
Frequency: On occasion and other (one-time only); Affected Public: 
Individuals or households, business or other for-profit, not-for-profit 
institutions, and Federal government; Number of Respondents: 50,000; 
Total Annual Responses: 50,000; Total Annual Hours: 3,300.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Minimum Data Set 
(MDS) for Swing Bed Hospitals and Supporting Regulations in 42 CFR 
483.20 and 413.337; Form No.: CMS-10064 (OMB  0938-0872); Use: 
As required under section 1888 (e)(7) of the Omnibus Reconciliation Act 
of 1987, swing bed hospitals must be reimbursed under the skilled 
nursing facility prospective payment system. CMS uses the MDS data to 
reimburse swing bed hospitals for SNF-level care furnished to Medicare 
beneficiaries. The MDS3.0 is currently being developed with plans for 
field testing to begin in 2006 with the expectation of completion in 
2007. At that time, CMS will analyze the data derived from the study, 
including the implementation of the new version of the MDS for swing 
bed hospitals. Since we do not have the MDS3.0 version available, we 
are requesting an extension for the current SB-MDS.; Frequency: 
Reporting--other (days 5, 14, 30, 60, and 90 of stay); Affected Public: 
Not-for-profit institutions, and State, local, and tribal governments; 
Number of Respondents: 820; Total Annual Responses: 92,789; Total 
Annual Hours: 51,314.
    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 to the address 
below: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: William N. Parham, III, 
PRA Analyst, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

    Dated: June 30, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 05-13413 Filed 7-7-05; 8:45 am]
BILLING CODE 4120-01-P