[Federal Register Volume 75, Number 223 (Friday, November 19, 2010)]
[Notices]
[Pages 70926-70927]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-29074]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10207, CMS-R-131, CMS-10215, CMS-724, CMS-
10227, and CMS-10244]


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: Physician Self-
Referral Exceptions for Electronic Prescribing and Electronic Health 
Records; Form Number: CMS-10207 (OMB: 0938-1009); Use: Section 
101 of the Medicare Prescription Drug, Improvement, and Modernization 
Act of 2003 (MMA) directed the Secretary to create an exception to the 
physician self-referral prohibition in section 1877 of the Social 
Security Act for certain arrangements in which a physician receives 
compensation in the form of items or services (not including cash or 
cash equivalents) (``nonmonetary remuneration'') that is necessary and 
used solely to receive and transmit electronic prescription 
information. Also, CMS created a separate regulatory exception for 
certain arrangements involving the provision of nonmonetary 
remuneration in the form of electronic health records software or 
information technology and training services necessary and used 
predominantly to create, maintain, transmit, or receive electronic 
health records.
    The conditions for both exceptions require that arrangements for 
the items and services provided must be set forth in a written 
agreement, be signed by the parties involved, specify the items or 
services being provided and the cost of those items or services, and 
cover all of the electronic prescribing and/or electronic health 
records technology to be provided by the donating entity. CMS would use 
the collected information for enforcement purposes; specifically, if we 
were investigating the financial relationships between the donors and 
the physicians to determine whether the provisions in the exceptions 
were met. Frequency: Occasionally; Affected Public: Private Sector: 
Business or other for-profits and Not-for-profit institutions; Number 
of Respondents: 9,796; Total Annual Responses: 38,959; Total Annual 
Hours: 12,451.5. . (For policy questions regarding this collection 
contact Kristin Bohl at 410-

[[Page 70927]]

786-8680. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Advance 
Beneficiary Notice of Noncoverage (ABN); Form Number: CMS-R-131 
(OMB: 0938-0566); Use: Under section 1879 of the Social 
Security Act, a physician, provider, practitioner, or supplier of items 
or services participating in the Medicare program, or taking a claim on 
assignment, may bill a Medicare beneficiary for items or services 
usually covered under Medicare, but denied in an individual case under 
one of the several statutory exclusions, if they inform the 
beneficiary, prior to furnishing the service, that Medicare is likely 
to deny payment. Sections 42 CFR 411.404(b) and (c), and 411.408(d)(2) 
and (f), require written notice be provided to inform beneficiaries in 
advance of potential liability for payment. Frequency: Once; Affected 
Public: Reporting: Weekly, Monthly, Yearly, Biennially and 
Occasionally; Number of Respondents: 1,326,282; Total Annual Responses: 
43,725,850; Total Annual Hours: 5,099,309. (For policy questions 
regarding this collection contact Evelyn Blaemire at 410-786-1803. For 
all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Payment 
for Prescription Drugs--Physicians and Hospital Outpatient Departments 
Collecting and Submitting Drug Identifying Information to State 
Medicaid Programs; Use: Section 6002 of the Deficit Reduction Act (DRA) 
of 2005 added provisions under section 1927 of the Social Security Act 
to require physicians in their offices and hospital outpatient settings 
or other entities (e.g., non-profit facilities) to collect and submit 
the drug National Drug Code (NDC) numbers on Medicaid claims to their 
State in order for Federal Financial Participation to be available for 
these drugs. Form Number: CMS-10215 (OMB: 0938-1026); 
Frequency: Weekly; Affected Public: Private Sector: Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
20,000; Total Annual Responses: 3,910,000; Total Annual Hours: 15,836. 
(For policy questions regarding this collection contact Bernadette 
Leeds at 410-786-9463. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare/Medicaid 
Psychiatric Hospital Survey Data; Use: The CMS-724 form is used to 
collect data that is not collected elsewhere and assists CMS in program 
planning and evaluation and in maintaining an accurate database on 
providers participating in the psychiatric hospital program. Form 
Number: CMS-724 (OMB: 0938-0378); Frequency: Annually; 
Affected Public: Private Sector: Business or other for-profits and Not-
for-profit institutions; Number of Respondents: 500; Total Annual 
Responses: 150; Total Annual Hours: 75. (For policy questions regarding 
this collection contact Kelley Leonette at 410-786-6664. For all other 
issues call 410-786-1326.)
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: PACE State Plan 
Amendment Pre-print; Use: The Balanced Budget Act of 1997 created 
section 1934 of the Social Security Act that established the Program 
for the All-Inclusive Care for the Elderly (PACE). The legislation 
established the PACE program as a Medicaid State plan option serving 
the frail and elderly in the home and community. Pursuant to the notice 
given in 64 FR 66271 (November 24, 1999), if a State elects to offer 
PACE as an optional Medicaid benefit, it must complete a State Plan 
Amendment described as Enclosures 3, 4, 5, 6 and 7. The 
information collected is used by CMS to affirm that the State elects to 
offer PACE an optional State plan service and the specifications of 
eligibility, payment and enrollment for the program. Form Number: CMS-
10227 (OMB: 0938-1027); Frequency: Once; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 36; Total 
Annual Responses: 12; Total Annual Hours: 240. (For policy questions 
regarding this collection contact Angela Taube at 410-786-2638. For all 
other issues call 410-786-1326.)
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid State 
Program Integrity Assessment (SPIA); Use: Under the provisions of the 
Deficit Reduction Act (DRA) of 2005, the Congress directed CMS to 
establish the Medicaid Integrity Program (MIP), CMS' first national 
strategy to combat Medicaid fraud, waste, and abuse. CMS has two broad 
responsibilities under the MIP: (1) Reviewing the actions of 
individuals or entities providing services or furnishing items under 
Medicaid; conducting audits of claims submitted for payment; 
identifying overpayments; and educating providers and others on payment 
integrity and quality of care; and (2) Providing effective support and 
assistance to States to combat Medicaid fraud, waste, and abuse.
    In order to fulfill the second of these requirements, CMS developed 
SPIA. CMS uses SPIA to collect data on State Medicaid program integrity 
activities, develop reports for each State based on these data, 
determine areas to provide States with technical support and 
assistance, and develop measures to assess States' performance. Form 
Number: CMS-10244 (OMB: 0938-1033); Frequency: Annually; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 1,400. 
(For policy questions regarding this collection contact Mary Jo Cook at 
410-786-3231. 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:[sol][sol]www.cms.hhs.gov[sol]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 December 20, 
2010. OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer. Fax Number: (202) 395-6974. E-mail: [email protected].

    Dated: November 12, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-29074 Filed 11-18-10; 8:45 am]
BILLING CODE 4120-01-P