[Federal Register Volume 73, Number 207 (Friday, October 24, 2008)]
[Notices]
[Pages 63478-63479]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-25204]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-10, CMS-4040 and 4040SP, CMS-10130A and 
10130B, and CMS-R-257]


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: BPD-718: Advance 
Directives (Medicare and Medicaid); Use: Steps have been taken, at both 
the Federal and State level, to afford greater opportunity for the 
individual to participate in decisions made concerning the medical 
treatment to be received by an adult patient in the event that the 
patient is unable to communicate to others a preference about medical 
treatment. The individual may make his preference known through the use 
of an advance directive, which is a written instruction prepared in 
advance, such as a living will or durable power of attorney. This 
information is documented in a prominent part of the individual's 
medical record. Advance directives as described in the Patient Self-
Determination Act have increased the individual's control over 
decisions concerning medical treatment. The advance directives 
requirement was enacted because Congress wanted individuals to know 
that they have a right to make health care decisions and to refuse 
treatment even when they are unable to communicate. Sections 4206 of 
OBRA '90 defined an advance directive as a written instruction 
recognized under State law relating to the provision of health care 
when an individual is incapacitated (those persons unable to 
communicate their wishes regarding medical treatment).
    All States have enacted legislation defining a patient's right to 
make decisions regarding medical care, including the right to accept or 
refuse medical or surgical treatment and the right to formulate advance 
directives. Participating hospitals, skilled nursing facilities/nursing 
facilities, home health agencies, providers of home health care, 
hospices, religious nonmedical health care institutions, and prepaid or 
eligible organizations (including Health Care Prepayment Plans (HCPPs) 
and Medicare Advantage Organizations (MAOs) such as Coordinated Care 
Plans, Demonstration Projects, Chronic Care Demonstration Projects, 
Program of All Inclusive Care for the Elderly, Private Fee for Service, 
and Medical Savings Accounts) must provide written information, at 
explicit time frames, to all adult individuals about: (a) The right to 
accept or refuse medical or surgical treatments; (b) the right to 
formulate an advance directive; (c) a description of applicable State 
law (provided by the State); and (d) the provider's or organization's 
policies and procedures for implementing an advance directive. Form 
Number: CMS-R-10 (OMB 0938-0610); Frequency: Yearly; Affected 
Public: Business or other for-profits; Number of Respondents: 35,484; 
Total Annual Responses: 19,870,000; Total Annual Hours: 927,550.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of

[[Page 63479]]

Information Collection: Request for Enrollment in Supplementary Medical 
Insurance; Use: Section 1836 of the Social Security Act and 42 CFR 
407.10 provide the eligibility requirements for enrollment in 
Supplementary Medical Insurance (Part B) for individuals age 65 and 
older who are not entitled to premium-free Hospital Insurance (Part A). 
The form CMS-4040 is used to establish entitlement to Part B by 
individuals ineligible for Part A under Title XVIII of the Social 
Security Act. Form Number: CMS-4040 and 4040SP (OMB 0938-
0245); Frequency: Once; Affected Public: Individuals and households; 
Number of Respondents: 10,000; Total Annual Responses: 10,000; Total 
Annual Hours: 2,500.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Federal 
Reimbursement of Emergency Health Services Furnished to Undocumented 
Aliens, section 1011 of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (MMA): ``Section 1011 Provider Payment 
Determination'' and ``Request for section 1011 Hospital On-Call 
Payments to Physicians'' Forms; Use: Section 1011 of the MMA requires 
that the Secretary establish a process under which eligible providers 
(certain hospitals, physicians and ambulance providers) may request 
payment for (claim) their otherwise un-reimbursed costs of providing 
eligible services. The Secretary must make quarterly payments directly 
to such providers. The Secretary must also implement measures to ensure 
that inappropriate, excessive, or fraudulent payments are not made 
under section 1011, including certification by providers of the 
accuracy of their requests for payment. The Section 1011 Provider 
Payment Determination and the Request for section 1011 Hospital On-Call 
Payments to Physicians forms have been established to address the 
statutory requirements. Form Number: CMS-10130A and 10130B 
(OMB 0938-0952); Frequency: Daily, Weekly, Monthly, Quarterly 
and Yearly; Affected Public: Business or Other For-Profits and Not-for-
Profit Institutions; Number of Respondents: 12,037; Total Annual 
Responses: 300,148; Total Annual Hours: 75,007.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare 
Advantage & Part D Disenrollment Requests Collected Through 1-800-
MEDICARE; Use: Section 4001 of the Balanced Budget Act of 1997 amended 
the Social Security Act to add section 1851(c)(1), through which 
Medicare Advantage elections are made and changed. Section 101 of the 
Medicare Prescription Drug, Improvement, and Modernization Act amended 
the Social Security Act to include section 1860D-1(b)(1), through which 
Medicare Prescription Drug Plan enrollments are made and changed. The 
disenrollment process offered at 1-800-MEDICARE provides beneficiaries 
with the option of submitting a disenrollment request to a neutral 
third party, who then processes the disenrollment action as a change of 
enrollment.
    The collection updates: 1. Continue to allow Medicare beneficiaries 
to disenroll from Medicare Advantage plans by calling CMS' toll-free 
call center; 2. Continue to allow Medicare beneficiaries enrolled in 
Medicare Prescription Drug (Part D) Plans to request disenrollment from 
Medicare Prescription Drug Plans, and 3. Retire the CMS-R-257 Medicare 
Advantage Disenrollment Form given limited (zero) requests for the 
paper form since 2005. The information collected in the disenrollment 
process will be used to update the Medicare beneficiary's Health 
Insurance Master Record System in order to disenroll the beneficiary 
from a Medicare Advantage managed care plan or a Medicare prescription 
drug plan on a timely basis. Form Number: CMS-R-257 (OMB 0938-
0741); Frequency: Occasionally; Affected Public: Individuals or 
households; Number of Respondents: 117,000; Total Annual Responses: 
117,000; Total Annual Hours: 19,539.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access the 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 by the OMB desk 
officer at the address below no later than 5 p.m. on November 24, 2008:
    OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer, New Executive Office Building, Room 10235, Washington, DC 
20503, Fax Number: (202) 395-6974.

    Dated: October 16, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
 [FR Doc. E8-25204 Filed 10-23-08; 8:45 am]
BILLING CODE 4120-01-P