[Federal Register Volume 74, Number 166 (Friday, August 28, 2009)]
[Notices]
[Pages 44368-44369]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-20839]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10080, CMS-R-70, CMS-R-38 and CMS-846-849, 
854, 10125, 10126, 10269]


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: Revision of a currently 
approved collection; Title of Information Collection: Publication Usage 
Survey; Use: The Publication Usage survey was developed to gather 
information from people who request or access Medicare publications, to 
ensure comprehension, usability, and use of the publications. CMS is 
seeking understanding about whether publications have been effective in 
informing members of the Medicare audience regarding policy and 
benefits. Included in the survey are questions regarding the 
satisfaction of publication users with specific publications and 
whether the information they received informed them about the Medicare 
program. Information gathered in this survey will be used only for 
purposes of targeting and improving communications with Medicare 
beneficiaries, caregivers, partners, and community organizations. Form 
Number: CMS-10080 (OMB: 0938-0892); Frequency: Reporting--On 
occasion; Affected Public: Individuals or Households; Number of 
Respondents: 3,800; Total Annual Responses: 3,800; Total Annual Hours: 
950. (For policy questions regarding this collection contact Renee 
Clarke at 410-786-0006. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements in HSQ-110, Acquisition, Protection and 
Disclosure of Peer review Organization Information and Supporting 
Regulations in 42 CFR, Sections 480.104, 480.105, 480.116, and 480.134; 
Use: The Peer Review Improvement Act of 1982 authorizes quality 
improvement organizations (QIOs), formally known as peer review 
organizations (PROs), to acquire information necessary to fulfill their 
duties and functions and places limits on disclosure of the 
information. The QIOs are required to provide notices to the affected 
parties when disclosing information about them. These requirements 
serve to protect the rights of the affected parties. The information 
provided in these notices is used by the patients, practitioners and 
providers to: obtain access to the data maintained and collected on 
them by the QIOs; add additional data or make changes to existing QIO 
data; and reflect in the QIO's record the reasons for the QIO's 
disagreeing with an individual's or provider's request for amendment.: 
Form Number: CMS-R-70 (OMB: 0938-0426); Frequency: Reporting--
On occasion; Affected Public: Business or other for-profits; Number of 
Respondents: 362; Total Annual Responses: 3729; Total Annual Hours: 
60,919. (For policy questions regarding this collection contact Tom 
Kessler at 410-786-1991. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Conditions of 
Certification for Rural Health Clinics and Supporting Regulations in 42 
CFR 491.9, 491.10, 491.11; Use: The Rural Health Clinic (RHC) 
conditions of certification are based on criteria prescribed in law and 
are designed to ensure that each facility has a properly trained staff 
to provide appropriate care and to assure a safe physical environment 
for patients. The Centers for Medicare and Medicaid Services (CMS) uses 
these conditions of participation to certify RHCs wishing to 
participate in the Medicare program. These requirements are similar in 
intent to standards developed by industry organizations such as the 
Joint Commission on Accreditation of Hospitals, and the National League 
of Nursing/American Public Association

[[Page 44369]]

and merely reflect accepted standards of management and care to which 
rural health clinics must adhere. Form Number: CMS-R-38 (OMB: 
0938-0334); Frequency: Recordkeeping and Reporting--Annually and upon 
initial application for Medicare approval; Affected Public: Business or 
other for-profits; Number of Respondents: 3,937; Total Annual 
Responses: 3,937; Total Annual Hours: 18,932. (For policy questions 
regarding this collection contact Mary Collins at 410-786-3189. For all 
other issues call 410-786-1326.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Durable Medical 
Equipment Medicare Administrative Contractors (MAC), Certificates of 
Medical Necessity; Use: The certificate of medical necessity (CMN) 
collects information required to help determine the medical necessity 
of certain items. CMS requires CMNs where there may be a vulnerability 
to the Medicare program. Each initial claim for these items must have 
an associated CMN for the beneficiary. Suppliers (those who bill for 
the items) complete the administrative information (e.g., patient's 
name and address, items ordered, etc.) on each CMN. The 1994 Amendments 
to the Social Security Act require that the supplier also provide a 
narrative description of the items ordered and all related accessories, 
their charge for each of these items, and the Medicare fee schedule 
allowance (where applicable). The supplier then sends the CMN to the 
treating physician or other clinicians (e.g., physician assistant, LPN, 
etc.) who completes questions pertaining to the beneficiary's medical 
condition and signs the CMN. The physician or other clinician returns 
the CMN to the supplier who has the option to maintain a copy and then 
submits the CMN (paper or electronic) to CMS, along with a claim for 
reimbursement.
    Due to a technical oversight on the part of CMS, an important 
question on CMN Form 10269 was omitted from the last OMB submission 
that would allow claims with an apnea-hypopnea index (AHI) or 
respiratory disturbance index (RDI) greater than or equal to 5 without 
symptoms for Criterion 2 be paid for by the Medicare program. The 
omission of the following question ``Does the patient have documented 
evidence of at least one of the following: Excessive daytime 
sleepiness, impaired cognition, mood disorders, insomnia, hypertension, 
ischemic heart disease or history of stroke'' could cause improper 
payment of claims without regards as to whether the patient has signs 
or symptoms in support of meeting the applicable coverage criteria for 
PAP devices. We are resubmitting this information collection request to 
have the revised CMN Form 10269 approved. None of the other CMN forms 
have changed. Form Number: CMS-846-849, 854, 10125, 10126, 10269 
(OMB 0938-0679); Frequency: Occasionally; Affected Public: 
Business or other for-profit and Not-for-profit institutions; Number of 
Respondents: 59,200; Total Annual Responses: 6,480,000; Total Annual 
Hours: 1,296,000. (For policy questions regarding this collection 
contact Doris Jackson at 410-786-4459. 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 September 28, 
2009.

OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, e-mail: [email protected].

    Dated: August 21, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-20839 Filed 8-27-09; 8:45 am]
BILLING CODE 4120-01-P