[Federal Register Volume 70, Number 203 (Friday, October 21, 2005)]
[Notices]
[Pages 61291-61292]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-20962]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10172, CMS-R-0107 and CMS-R-285]


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: Medicare Health Support Program Medical Records 
Abstraction; Form Number: CMS-10172 (OMB: 0938-New); Use: The 
Medicare Health Support Program (MHS) is authorized under Section 721 
of the Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (MMA). There are eight Medicare Health Support Organizations 
(MHSOs) that have signed cooperative agreements with the Centers for 
Medicare & Medicaid Services (CMS) to provide care support services to 
targeted Medicare fee-for-service (FFS) beneficiaries. The purposes of 
the MHS program are to improve the quality of healthcare provided to 
Medicare FFS beneficiaries with congestive heart failure and/or 
diabetes and to reduce the healthcare treatment cost to Medicare. MHS 
performance measures provide CMS with information to monitor the 
program operations and identify positive or negative program effects, 
provide MHSOs with feedback, and serve as the basis for MHS performance 
guarantees. To meet these requirements, CMS has developed a performance 
monitoring system for MHS. This system includes measures of clinical 
performance that require the collection of clinical data from the 
medical records of a sample of Medicare beneficiaries. Medical record 
abstraction will be performed in two phases: the first, a pilot test, 
will take place after approximately six months of program operations, 
and the second, the full study. CMS will obtain active informed consent 
from the affected beneficiaries prior to reviewing medical records; 
Frequency: Reporting--Other: Only Once; Affected Public: Individuals or 
Households and Business or other for-profit; Number of Respondents: 
26,643; Total Annual Responses: 26,643; Total Annual Hours: 12,416.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare--
Determining Third Party Liability (TPL) State Plan Preprint and 
Supporting Regulations in 42 CFR 433.138; Form Number: CMS-R-0107 
(OMB: 0938-0502); Use: Medicaid beneficiaries frequently have 
third party resources which are legally obligated to pay medical claims 
before Medicaid pays. Section 42 CFR 433.138 requires State Medicaid 
agencies to take specific steps to identify third party resources and 
determine their legal liability to pay for services under the plan. The 
collection of TPL information results in significant program savings to 
the extent that liable third parties can be identified and payments can 
be made for services that would otherwise be paid for by the Medicaid 
program. The State Medicaid agencies are the primary users of the 
collected data. Whenever States identify third party resources, 
pertinent information is entered into the State's Medicaid Management 
Information System (MMIS). This enables the State to advise the 
provider to bill the third party and to seek reimbursement in 
situations where Medicaid TPL claims have been paid; Frequency: 
Recordkeeping--On occasion; Affected Public: Individuals or Households 
and Federal, State, Local and Tribal Government; Number of Respondents: 
2,700,000; Total Annual Responses: 2,700,000; Total Annual Hours: 
472,259.
    3. Type of Information Collection Request: Extension of a currently

[[Page 61292]]

approved collection; Title of Information Collection: Request for 
Retirement Benefit Information (BBA `97); Form Number: CMS-R-285 
(OMB: 0938-0769); Use: The Request for Retirement Benefit 
Information form is used to obtain retirement benefit information from 
beneficiaries that purchase Medicare Part A coverage. The Social 
Security Administration (SSA) will use this information to determine if 
a beneficiary meets the requirements to qualify for a Medicare Part A 
premium reduction.; Frequency: Reporting--On occasion; Affected Public: 
State, Local or Tribal Government; Number of Respondents: 1500; Total 
Annual Responses: 1500; Total Annual Hours: 375.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS'l 
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.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received at the address below, 
no later than 5 p.m. on December 20, 2005. CMS, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development, 
Attention: Bonnie L Harkless, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: October 13, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-20962 Filed 10-20-05; 8:45 am]
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