[Federal Register Volume 71, Number 198 (Friday, October 13, 2006)]
[Notices]
[Pages 60532-60533]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-17035]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-43, CMS-R-142, CMS-4040 & 4040-SP, CMS-10210, 
and CMS-R-284]


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: Extension of a currently 
approved collection; Title of Information Collection: Application for 
Hospital Insurance Benefits for individuals with End Stage Renal 
Disease; Use: 42 CFR 406.13 outlines the requirements for entitlement 
to Medicare Part A (hospital insurance [HI]) and Part B (supplementary 
medical insurance [SMI]) for individuals with End Stage Renal Disease 
(ESRD). 42 CFR 406.7 lists the CMS-43 form, Application for Hospital 
Insurance Benefits for Individuals with End Stage Renal Disease, as the 
application to be used by individuals applying for Medicare under the 
ESRD provisions of the Act. The form CMS-43 elicits the information 
that the Social Security Administration and the Centers for Medicare & 
Medicaid Services need to determine entitlement to Medicare based on 
the ESRD requirements of the law and regulations. Form Number: CMS-43 
(OMB: 0938-0800); Frequency: Reporting--Once; Affected Public: 
Individuals or households; Number of Respondents: 60,000; Total Annual 
Responses: 60,000; Total Annual Hours: 25,989.60.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Examination and 
Treatment for Emergency Medical Conditions and Women in Labor Act 
(EMTALA) and Supporting Regulations in 42 CFR 482.12, 488.18, 489.20, 
and 489.24; Use: As mandated by Congress, the information collection 
requirements found in supporting regulations in 42 CFR 482.12, 488.18, 
489.20, and 489.24, aim to prevent hospitals from inappropriately 
transferring individuals with emergency medical conditions. These 
requirements are supported by two other current statutes. Section 
1861(e)(9) of the Act permits the Secretary to impose on hospitals such 
other requirements as he finds necessary in the interests of the health 
and safety of individuals who are furnished services in the 
institution. It is under this authority that the Secretary has 
obligated hospitals that participate in Medicare to report when they 
receive patients that have been inappropriately transferred. Under 
section 1866(b)(2)(A) and (B) of the Social Security Act (the Act), the 
Secretary may terminate the provider agreement of a hospital that is 
not complying substantially with the statute and regulations under 
title XVIII or that no longer substantially meets the provisions of 
section 1861 of the Act. Form Number: CMS-R-142 (OMB: 0938-
0667); Frequency: Recordkeeping and Reporting--On occasion; Affected 
Public: Individuals or households, Business or other for-profit, Not-
for-profit, State, Local or Tribal Governments, Federal Government; 
Number of Respondents: 5,600; Total Annual Responses: 5,600; Total 
Annual Hours: 1.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Enrollment in Supplementary Medical Insurance; Use: 42 CFR 407.10 lists 
the alternative requirements for enrollment in Part B for any 
individual who is not entitled to hospital insurance under Part A but 
has attained age 65 and is either a citizen of the United States (U.S.) 
or an alien lawfully admitted for permanent residence who has lived in 
the U.S. continually for 5 years. 42 CFR 407.11 lists the CMS-4040 
form, Request for Enrollment in Supplementary Medical Insurance, as the 
application to be used by individuals not eligible for monthly benefits 
or free Part A. Form CMS-4040 elicits the information that the Social 
Security Administration and Centers for Medicare & Medicaid Services 
need to determine entitlement to Part B only. Form Number: CMS-4040, 
4040-SP (OMB: 0938-0245); Frequency: Reporting--Once; Affected 
Public: Individuals or households; Number of Respondents: 10,000; Total 
Annual Responses: 10,000; Total Annual Hours: 25,000.
    4. Type of Information Collection Request: New collection; Title of 
Information Collection: Hospital Reporting Initiative--Hospital Quality 
Measures (Surgical Care Improvement (SCIP) Measures/Mortality Measures; 
Use: The purpose of this information collection request is to collect 
data to produce valid, reliable, comparable and salient quality 
measures to provide a potent stimulus for clinicians and providers to 
improve the quality of care they provide. The reporting of Surgical 
Care Improvement (SCIP) measures is currently being collected from 
hospitals for activities associated with the Quality Improvement 
Organization (QIO) Program. Section 5001(a) of Public Law 109-171 of 
the Deficit Reduction Act sets out new requirements under the Reporting 
Hospital Quality Data for Annual Payment Update program. This program 
was initially established under section 501(b) of the MMA which offers 
monetary incentives for hospitals participating in the reporting of 
quality data. The Act requires that we expand the existing ``starter 
set'' of 10 quality measures that we have used since 2003. Although, 
this effort increases the volume of data currently reported into the 
QIO Clinical Data Warehouse; it however, does not place a substantial 
data collection burden on hospitals. A substantial percentage of 
hospitals are voluntarily submitting these SCIP measures currently. In 
contrast to the SCIP quality measures, no additional data collection 
from hospitals will be required from the mortality measures. All three 
mortality measures can be calculated based on Medicare inpatient and 
outpatient claims data that are already reported to the Medicare 
program for payment purposes. Form Number: CMS-10210 (OMB: 
0938-NEW); Frequency: Recordkeeping, Reporting, Third-Party 
Disclosure--Quarterly; Affected Public: Business or other for-profit, 
Not-for-profit; Number of Respondents: 3,700; Total Annual Responses: 
3,700; Total Annual Hours: 587,500.
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicaid 
Statistical Information System; Use: State data are reported by the 
Federally mandated electronic process, known as Medicaid Statistical 
Information System

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(MSIS). These data are the basis of actuarial forecasts for Medicaid 
service utilization and costs; of analysis and cost savings estimates 
required for legislative initiatives relating to Medicaid; and for 
responding to requests for information from CMS components, the 
Department, Congress and other customers. Form Number: CMS-R-284 
(OMB: 0938-0345); Frequency: Quarterly; Affected Public: 
State, Local or Tribal Government; Number of Respondents: 53; Total 
Annual Responses: 212; Total Annual Hours: 3,392.
    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/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 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 12, 2006.
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development--C, Attention: Bonnie L Harkless, 
Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: October 4, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E6-17035 Filed 10-12-06; 8:45 am]
BILLING CODE 4120-01-P