[Federal Register Volume 71, Number 246 (Friday, December 22, 2006)]
[Notices]
[Pages 77026-77027]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-21916]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-43, CMS-4040 & 4040-SP, CMS-10179, CMS-R-142, 
and CMS-10210]


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: 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 Social Security 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: Request for 
Enrollment in Supplementary Medical Insurance; Use: 42 CFR 407.10 list 
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 or an 
alien lawfully admitted for permanent residence who has lived in the 
United States 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.
    3. Type of Information Collection Request: New Collection; Title of 
Information Collection: Requests by Hospitals for an Alternative Cost-
to-Charge Ration Instead of the Statewide Average Cost-to-Charge Ratio; 
Use: Because of the extensive gaming of outlier payments, CMS 
implemented new regulations in Sec.  412.84(i)(2) of the Code of 
Federal Regulations for Inpatient Prospective Payment System (IPPS) 
hospitals and Sec. Sec.  412.525(a)(4)(ii) and 412.529(c)(5)(ii) of the 
Code of Federal Regulations for Long Term Care Hospitals (LTCH) to 
allow a hospital to contact its FI to request that its cost-to-charge 
ratio (CCR) (operating and/or capital CCR for IPPS hospitals or the 
total (combined operating and capital) CCR for LTCHs), otherwise 
applicable, be changed if the hospital presents substantial evidence 
that the ratios are inaccurate for IPPS hospitals. Any such requests 
would have to be approved by the CMS RO with jurisdiction over that FI. 
Form Number: CMS-10179 (OMB: 0938-NEW); Frequency: Reporting--
On occasion; Affected Public: Business or other for-profit and Not-for-
profit institutions and Federal government; Number of Respondents: 18; 
Total Annual Responses: 18; Total Annual Hours: 144.
    4. 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

[[Page 77027]]

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.
    5. 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 Pub. L. 109-171 of the 
Deficit Reduction Act (DRA) 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 Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003, which 
offers monetary incentives for hospitals participating in the reporting 
of quality data. The DRA 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.
    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.
    Written comments and recommendations for the proposed information 
collections must be mailed or faxed within 30 days of this notice 
directly to the OMB desk officer: OMB Human Resources and Housing 
Branch, Attention: Carolyn Lovett, New Executive Office Building, Room 
10235, Washington, DC 20503. Fax Number: (202) 395-6974.

    Dated: December 18, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
 [FR Doc. E6-21916 Filed 12-21-06; 8:45 am]
BILLING CODE 4120-01-P