[Federal Register Volume 77, Number 126 (Friday, June 29, 2012)]
[Notices]
[Pages 38836-38837]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-16002]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-437A and 437B and CMS-10406]


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: Revision of a currently 
approved collection. Title of Information Collection: State Agency 
Sheets for Verifying Exclusions from the Inpatient Prospective Payment 
System and Supporting Regulations in 42 CFR 412.20-412.29. Use: For 
first time verification requests for exclusion from the Inpatient 
Prospective Payment System (IPPS), a hospital/unit must notify the 
Regional Office (RO) servicing the State in which it is located that it 
believes it meets the criteria for exclusion from the IPPS. Currently, 
all new inpatient rehabilitation facilities (IRFs) must provide written 
certification that the inpatient population it intends to serve will 
meet the requirements of the IPPS exclusion criteria for IRFs. They 
must also complete the Form CMS-437A if they are a rehabilitation unit 
or complete Form CMS-437B if they are a rehabilitation hospital. This 
information is submitted to the State Agency (SA) no later than 5 
months before the date the hospital/unit would become subject to IRF-
PPS.
    CMS proposes to continue to use the Criteria Worksheets (Forms CMS-
437A and CMS-437B) for verifying first-time exclusions from the IPPS, 
for complaint surveys, for its annual 5 percent validation sample, and 
for facility self-attestation. These forms are related to the survey 
and certification and Medicare approval of the IPPS-excluded 
rehabilitation units and rehabilitation hospitals.
    For rehabilitation hospitals and rehabilitation units already 
excluded from the IPPS, annual onsite re-verification surveys by the SA 
are not required. These hospitals and units will be provided with a 
copy of the appropriate CMS-437 Worksheet at least 5-months prior to 
the beginning of its cost reporting period, so that the hospital/unit 
official may complete and sign an attestation statement and complete 
and return the appropriate CMS-437A or CMS-437B at least 5 months prior 
to the beginning of its cost reporting period. Fiscal Intermediaries 
will continue to verify, on an annual basis, compliance with the 60 
percent rule (42 CFR 412.29(b)(2)) for rehabilitation hospitals and 
rehabilitation units through a sample of medical records and the SA 
will verify the medical director requirement.
    The SA will maintain the documents unless instructed otherwise by 
the RO. The SA will notify the RO at least 60 days prior to the end of 
the rehabilitation hospital's/unit's cost reporting period of the IRF's 
compliance or non-compliance with the payment requirements. The 
information collected on these forms, along with other information 
submitted by the IRF is necessary for determining exclusion from the 
IPPS. Hospitals and units that have already been excluded need not 
reapply for exclusion. These facilities will automatically be 
reevaluated yearly to determine whether they continue to meet the 
exclusion criteria.
    Both forms have been revised since the publication of the 60-day 
Federal Register notice on April 4, 2012 (77 FR 20404). Burden 
estimates have not changed.
    Form Number: CMS-437A and CMS-437B (OCN 0938-0986). Frequency: 
Yearly. Affected Public: Private Sector (Business or other for-
profits). Number of Respondents: 1,164. Total Annual Responses: 1,164. 
Total Annual Hours: 291. (For policy questions regarding this 
collection contact Georgia Johnson at 410-786-6859. For all other 
issues call 410-786-1326.)
    2. Type of Information Collection Request: New collection. Title of 
Information Collection: Probable Fraud Measurement Pilot; Use: The 
Centers for Medicare & Medicaid Services (CMS) is seeking Office of 
Management and Budget (OMB) approval of the collections required for a 
probable fraud measurement pilot. The probable fraud measurement pilot 
would establish a baseline estimate of probable fraud in payments for 
home health care services in the fee-for-service Medicare program. CMS 
and its agents will collect information from home health agencies, the 
referring physicians and Medicare beneficiaries selected in a national 
random sample of home health claims. The pilot will rely on the 
information collected along with a summary of the service history of 
the HHA, the referring provider, and the beneficiary to estimate the 
percentage of total payments that are associated with probable fraud 
and the percentage of all claims that are associated with probable 
fraud for Medicare fee-for-service home health. CMS is requesting an 
exemption from the Paperwork Reduction Act under 5 CFR 1320.14A. 
However, CMS is providing information related to the purpose and need 
for this data collection in Supporting Statement Part A.
    Form Number: CMS-10406 (OCN: 0938--New). Frequency: Yearly; 
Affected Public: Individual and Private Sector--Business or other for-
profits; Number of Respondents: 6,000; Total Annual Responses: 6,000; 
Total Annual Hours: 10,500. (For policy questions regarding this 
collection contact Kelly Gent at 410-786-0918. 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 
email

[[Page 38837]]

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 July 30, 2012.

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

    Dated: June 26, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-16002 Filed 6-28-12; 8:45 am]
BILLING CODE 4120-01-P