[Federal Register Volume 74, Number 29 (Friday, February 13, 2009)]
[Notices]
[Pages 7233-7234]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-3156]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-285, CMS-10170, CMS-R-0074, CMS-R-107, CMS-
2786U, CMS-416 and CMS-10265]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services.
    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: Request For 
Retirement Benefit Information; Use: Section 1818 of the Social 
Security Act provides that former State and local government employees 
who are age 65 or older, that have been entitled to Premium Part A for 
at least 7 years, and did not have the premium paid for by a State or a 
political subdivision of a State, may have the Part A premium reduced 
to zero. This collection will assist in determining whether individuals 
currently paying a monthly premium for Medicare Part A coverage are 
eligible to have their premium reduced to zero. Form Number: CMS-R-285 
(OMB 0938-0769); Frequency: Monthly; Affected Public: State, 
Local or Tribal Governments; Number of Respondents: 1,500; Total Annual 
Responses: 1,500; Total Annual Hours: 375. (For policy questions 
regarding this collection contact: Denise Cox at 410-786-3195. For all 
other issues call 410-786-1326.)
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Retiree Drug 
Subsidy (RDS) Payment Request and Instructions; Use: Under section 
1860D-22 of the Social Security Act, plan sponsors (e.g., employers, 
unions) who offer prescription drug coverage meeting specified criteria 
to their qualified covered retirees are eligible to receive a 28% tax-
free subsidy for allowable drug costs. Plan sponsors must submit 
required prescription drug cost data and other information in order to 
receive the subsidy. Form Number: CMS-10170 (OMB 0938-0977); 
Frequency: Yearly; Affected Public: Business or other for-profits, not-
for-profit institutions, not-for-profit institutions and State, Local 
or Tribal Governments; Number of Respondents: 4,500; Total Annual 
Responses: 4,500; Total Annual Hours: 679,500. (For policy questions 
regarding this collection contact: David Mlawsky at 410-786-6851. For 
all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Income and 
Eligibility Verification System; Use: This collection is necessary to 
verify income and eligibility requirements for Medicaid beneficiaries, 
as required by Section 1137 of the Social Security Act. Form Number: 
CMS-R-74 (OMB 0938-0467); Frequency: Monthly; Affected Public: 
State, Local or Tribal Governments; Number of Respondents: 54; Total 
Annual Responses: 54; Total Annual Hours: 124,054. (For policy 
questions regarding this collection contact: Mel Schmerler at 410-786-
3414. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid-
Determining Third Party Liability (TPL) State Plan Preprint and 
Supporting Regulations in 42 CFR 433.138; Use: The information 
collected from Medicaid applicants and beneficiaries as well as from 
State and local agencies is necessary to determine the legal liability 
of third parties to pay for medical services in lieu of Medicaid 
payment. Form Number: CMS-R-107 (OMB 0938-0502); Frequency: On 
occasion; Affected Public: Individuals or households and State, Local 
or Tribal Government; Number of Respondents: 2,900,000; Total Annual 
Responses: 2,900,000; Total Annual Hours: 510,968. (For policy 
questions regarding this collection contact Gwendolyn Talvert at 410-
786-5928. For all other issues call 410-786-1326.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Fire Safety 
Survey Reports; Use: The Life Safety Code (LSC) is a compilation of 
fire safety requirements for new and existing buildings and is updated 
and published every 3 years by the National Fire Protection Association 
(NFPA), a private, non-profit organization dedicated to reducing loss 
of life due to fire. The Medicare regulations have historically 
incorporated by reference these requirements along with Secretarial 
waiver authority. The statutory basis for incorporating NFPA's LSC for 
our providers is under the Secretary's general rulemaking authority at 
Sections 1102 and 1871 of the Social Security Act. These forms are used 
by the State Agencies to record data collected to determine compliance 
with standards specified in 416.44(b) for ambulatory surgical centers 
(ASCs), and 494.60(e) for End-Stage Renal Disease (ESRD) facilities. 
The Medicare Health Insurance Program is authorized by Title XVIII of 
the Social Security Act. The CMS-2786U form is being revised to include 
ESRD information. Form Number: 2786U (OMB 0938-0242); 
Frequency: Weekly; Affected Public: Individuals or households and 
State, Local or Tribal Government; Number of Respondents: 54; Total 
Annual Responses: 2,442; Total Annual Hours: 4,884. (For policy 
questions regarding this collection contact JoAnn Perry at 410-786-
3336. For all other issues call 410-786-1326.)
    6. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Annual Early and 
Periodic Screening, Diagnostic and Treatment (EPSDT) Report; Use: 
States are required to submit an annual report on the provision of 
EPSDT services pursuant to section 1902(a)(43)(D) of the Social 
Security Act. These reports provide CMS with data necessary to assess 
the effectiveness of State EPSDT programs, to determine a State's 
results in achieving its participation goal and to respond to 
inquiries. This collection is being submitted as a revision based on 
minor changes made to the form and instructions. CMS has added three 
additional lines of data to the form (lines 12d, 12e and 12f). This 
information is currently being collected; however, CMS expanded the 
lines to obtain a better understanding for the utilization of dental 
services. CMS believes there will be no additional burden for the 
changes made to the form. The changes were necessary to

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accommodate a need for more specific dental data and to preliminary 
notify States of a change in CPT codes. A clarification was also made 
to line 14 of the instructions. Form Number: CMS-416 (OMB 
0938-0354); Frequency: Yearly; Affected Public: State, Local or Tribal 
Governments; Number of Respondents: 56; Total Annual Responses: 56; 
Total Annual Hours: 1,568. (For policy questions regarding this 
collection contact Cindy Ruff at 410-786-5916. For all other issues 
call 410-786-1326.)
    7. Type of Information Collection Request: New collection; Title of 
Information Collection: Mandatory Insurer Reporting Requirements of 
Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (MMSEA) 
(Pub. L.110-173); Use: Section 111 of the Medicare, Medicaid and SCHIP 
Extension Act of 2007 (Pub. L. 110-173) amends the Medicare Secondary 
Payer (MSP) provisions of the Social Security Act (42 U.S.C. 1395y(b)) 
to provide for mandatory reporting by group health plan arrangements 
and by liability insurance (including self-insurance), no-fault 
insurance, and workers' compensation laws and plans. The law provides 
that, not withstanding any other provision of law, the Secretary of 
Health and Human Services may implement this provision by program 
instruction or otherwise. The Secretary has elected not to implement 
the provision through rulemaking and will implement by publishing 
instructions on a publicly available Web site and submitting an 
information collection request to OMB for review and approval of the 
associated information collection requirements.
    Effective January 1, 2009, as required by the MMSEA, an entity 
serving as an insurer or third party administrator for a group health 
plan and, in the case of a group health plan that is self-insured and 
self-administered, a plan administrator or fiduciary must: (1) Secure 
from the plan sponsor and plan participants such information as the 
Secretary may specify to identify situations where the group health 
plan is a primary plan to Medicare; and (2) report such information to 
the Secretary in the form and manner (including frequency) specified by 
the Secretary.
    Effective July 1, 2009, as required by the MMSEA, ``applicable 
plans,'' must: (1) Determine whether a claimant is entitled to Medicare 
benefits; and, if so, (2) report the identity of such claimant and 
provide such other information as the Secretary may require to properly 
coordinate Medicare benefits with respect to such insurance 
arrangements in the form and manner (including frequency) as the 
Secretary may specify after the claim is resolved through a settlement, 
judgment, award or other payment (regardless of whether or not there is 
a determination or admission of liability). Applicable plan refers to 
the following laws, plans or other arrangements, including the 
fiduciary or administrator for such law, plan or arrangement: (1) 
Liability insurance (including self-insurance); (2) No-fault insurance; 
and (3) Workers' compensation laws or plans.
    As indicated, the Secretary has elected to implement this provision 
by publishing instructions at a Web site established for such purpose. 
The Web site is (http://www.cms.hhs.gov/MandatoryInsRep/). CMS shall 
use this Web site to publish preliminary guidance as well as the final 
instructions. The Web site also advises interested parties how to 
comment on the preliminary guidance. Form Number: CMS-10265 
(OMB 0938-New); Frequency: Yearly; Affected Public: Business 
or other for-profits, not-for-profit institutions and State, Local or 
Tribal Governments; Number of Respondents: 290,404; Total Annual 
Responses: 6,920,504; Total Annual Hours: 2,120,478. (For policy 
questions regarding this collection contact John Albert at 410-786-
7457. For all other issues call 410-786-1326.)
    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 by the OMB desk 
officer at the address below, no later than 5 p.m. on March 16, 2009: 
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: February 6, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-3156 Filed 2-12-09; 8:45 am]
BILLING CODE 4120-01-P