[Federal Register Volume 70, Number 250 (Friday, December 30, 2005)]
[Notices]
[Pages 77400-77401]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-24567]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10157, CMS-10172, CMS-R-0107 and CMS-R-285]


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: Extension of a currently 
approved collection; Title of Information Collection: CMS Real-time 
Eligibility Agreement and Access Request; Form Number: CMS-10157 
(OMB: 0938-0960); 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 eligibility transaction on a real-time basis to access 
Medicare beneficiary information provide certain assurances as a 
condition of receiving access to the Medicare database for the purpose 
of conducting eligibility verification. Health care providers, 
clearinghouses, and health plans that wish access to the Medicare 
database are required to complete this form. The information will be 
used to assure that those entities that access the Medicare database 
are aware of applicable provisions and penalties; Frequency: 
Recordkeeping and Reporting--One time; Affected Public: Business or 
other for-profit, Not-for-profit institutions; Number of Respondents: 
122,000; Total Annual Responses: 122,000; Total Annual Hours: 45,000.
    2. 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

[[Page 77401]]

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.
    3. 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.
    4. Type of Information Collection Request: Extension of a currently 
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 these paperwork collections referenced above, access CMS Web site 
address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 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 at (410) 786-1326.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB Desk 
Officer at the address below, no later than 5 p.m. on January 30, 2006.

OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, CMS 
Desk Officer, New Executive Office Building, Room 10235, Washington, DC 
20503.

    Dated: December 21, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-24567 Filed 12-29-05; 8:45 am]
BILLING CODE 4120-01-P