[Federal Register Volume 72, Number 17 (Friday, January 26, 2007)]
[Notices]
[Pages 3852-3853]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-1124]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10003, CMS-901A and D, CMS-9044, and CMS-
10099]


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: Notice of Denial 
of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) 
and supporting regulations in 42 CFR 422.568; Use: Section 
1852(g)(1)(B) of the Statute requires Medicare Health organizations 
(Medicare Advantage, cost, and Health Care Prepayment Plans) to provide 
determinations to deny coverage (i.e., medical services or payment) in 
writing and include a

[[Page 3853]]

statement in understandable language of the reasons for the denial and 
a description of the reconsideration and appeals processes. These 
notices fulfill the regulatory requirement. Form Number: CMS-10003 
(OMB: 0938-0829); Frequency: Reporting: Yearly; Affected 
Public: Business or other for-profit and Not-for-profit institutions; 
Number of Respondents: 454; Total Annual Responses: 105,138; Total 
Annual Hours: 26285.
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: CMS Application 
for Federal Qualification (901A); CMS Medicare Agreement Application 
(901D) and Supporting Regulations in 42 CFR Section 417.143 and 422.6; 
Use: Prepaid health plans must meet certain regulatory requirements to 
be federally qualified health maintenance organizations or to enter 
into a contract with CMS to provide health benefits to Medicare 
beneficiaries. The application forms are used by CMS to collect 
information about a health plan to determine their compliance with 
federal regulations. Form Number: CMS-901A and D (OMB: 0938-
0470); Frequency: Reporting: Once; Affected Public: Business or other 
for-profit and Not-for-profit institutions; Number of Respondents: 55; 
Total Annual Responses: 55; Total Annual Hours: 2,200.
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare ESRD 
Exceptions; Use: This information is collected in accordance with 
section 2145 of the Omnibus Budget Reconciliation Act of 1981 and 
section 623 of the Medicare Prescription Drug Improvement and 
Modernization Act of 2003. End Stage Renal Disease (ESRD) facilities 
can file for an exception to its composite payment rate. CMS uses the 
information submitted to determine whether an ESRD facility qualifies 
for a rate increase and the amount of the increase. Form Number: CMS-
9044 (OMB: 0938-0296); Frequency: Reporting: Occasionally; 
Affected Public: Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 10; Total Annual Responses: 10; 
Total Annual Hours: 400.
    4. Type of Information Collection Request: Extension of a currently 
approved information collection; Title of Information Collection: 
Review of National Coverage Determinations and Local Coverage 
Determinations and Supporting Regulations in 42 CFR 426.400 and 42 CFR 
426.500; Use: Section 522 of the Benefits Improvement and Protection 
Act (BIPA) of 2000 requires the implementation of a process for the 
appeal of National Coverage Determinations (NCDs) and Local Coverage 
Determinations (LCDs). Sections 426.400 and 426.500, state that an 
aggrieved party may initiate a review of an LCD or NCD, respectively, 
by filing a written complaint. These sections also identify the 
information required in the complaint to qualify as an aggrieved party 
as defined in Sec.  426.110, as well as the process and information 
needed for an aggrieved party to withdraw a complaint. The required 
documentation includes a copy of the written authorization to represent 
the beneficiary, if the beneficiary has a representative, and a copy of 
a written statement from the treating physician that the beneficiary 
needs a service that is the subject of the LCD. Form Number: CMS-10099 
(OMB: 0938-0911); Frequency: Reporting--On occasion; Affected 
Public: Individuals or Households; Number of Respondents: 1,040; Total 
Annual Responses: 1,040; Total Annual Hours: 4,160.
    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 March 27, 2007. 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: January 19, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E7-1124 Filed 1-25-07; 8:45 am]
BILLING CODE 4120-01-P