[Federal Register Volume 78, Number 86 (Friday, May 3, 2013)]
[Notices]
[Pages 26034-26035]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-10530]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-276, CMS-339, and CMS-R-282]


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: Reinstatement with 
change of a previously approved collection; Title: Prepaid Health Plan 
Cost Report; Use: Health Maintenance Organizations and Competitive 
Medical Plans contracting with the Secretary under section 1876 of the 
Social Security Act are required to submit a budget and enrollment 
forecast, semi-annual interim report, interim final cost report, and a 
final certified cost report in accordance with 42 CFR 417.572 through 
417.576. Health Care Prepayment Plans contracting with the Secretary 
under section 1833 of the Social Security Act are required to submit a 
budget and enrollment forecast, semi-annual interim report, and final 
cost report in accordance with 42 CFR 417.808 and 417.810. CMS is 
requesting approval for the reinstatement with change of form CMS-276. 
The Cost Report outlines the provisions for implementing sections 
1876(h) and 1833(a)(1)(A) of the Act. The purposes of the revisions are 
to implement certain changes associated with the Affordable Care Act, 
clarify instructions, and update outdated issues within the Cost Report 
and the Budget Report. Form Number: CMS-276 (OCN 0938-0165); Frequency: 
Yearly; Affected Public: Private Sector--Business or other for-profits 
and not-for-profit institutions; Number of Respondents: 77; Total 
Annual Responses: 106; Total Annual Hours: 4,372. (For policy questions 
regarding this collection contact Temeshia Johnson at 410-786-8692. For 
all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Medicare Provider Cost Report Reimbursement Questionnaire; 
Use: The purpose of form CMS-339 is to assist the provider in preparing 
an acceptable cost report and to minimize subsequent contact between 
the provider and its Medicare Administrative Contractor (MAC). The form 
provides the basic data necessary to support the information in the 
cost report.
    Exhibit 1 of form CMS-339 contains a series of reimbursement-
oriented questions which serve to update information on the operations 
of the provider. It is arranged topically regarding financial 
activities such as independent audits, provider organization and 
operation, etc. The MAC is responsible for the settlement of the 
Medicare cost report and must determine the reasonableness and the 
accuracy of the reimbursement claimed. This process includes performing 
both a desk review of the cost report and an analysis leading to a 
decision to settle the cost report with or without further audit. The 
form provides essential information to enable the MAC to make the audit 
or no audit decision, scope of the audit if one is necessary, and to 
update the provider documentation (i.e., documentation to support the 
financial profile of the provider). If the information is not 
collected, the MAC will have to go onsite to each provider to get this 
information. Consequently, it is far less burdensome and extremely cost 
effective to capture this information through the form CMS-339.
    Exhibit 2 of form CMS-339 is a listing of bad debts pertaining to 
uncollectible Medicare deductible and coinsurance amounts. Preparation 
of the listing is a convenient way for providers to supply the MAC with 
information needed to determine the allowability of the bad debts for 
reimbursement. Some items required to determine allowability that are 
included on this exhibit are patient's

[[Page 26035]]

name, dates of service, date first bill sent to beneficiary, and date 
the collection effort ceased. Supplying the MAC with this information 
may be all that is required for the MAC to determine whether or not the 
bad debt is allowable. This too may eliminate a visit to the provider 
to gather this needed data. Form Number: CMS-339 (OCN 0938-0301); 
Frequency: Yearly; Affected Public: Private Sector--Business or other 
for-profits and not-for-profit institutions; Number of Respondents: 
23,391; Total Annual Responses: 23,391; Total Annual Hours: 75,625. 
(For policy questions regarding this collection contact Christine 
Dobrzycki at 410-786-3389. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension. Title of 
Information Collection: Medicare Advantage Appeals and Grievance Data 
Disclosure Requirements (42 CFR 422.111). Use: Section 1852(c)(2)(C) of 
the Social Security Act and 42 CFR 422.111(c)(3) require that Medicare 
Advantage (MA) organizations and demonstrations disclose information 
pertaining to the number of disputes, and their disposition in the 
aggregate, with the categories of grievances and appeals to any 
individual eligible to elect an MA organization who requests this 
information. MA organizations and demonstrations remain under a 
requirement to collect and provide this information to individuals 
eligible to elect an MA organization, we continue to need the same 
format and form for reporting. Form Number: CMS-R-282 (OCN 0938-0778). 
Frequency: Annually and semi-annually. Affected Public: Private Sector 
(business or other for-profit and not-for-profit institutions). Number 
of Respondents: 51,370. Total Annual Responses: 52,260. Total Annual 
Hours: 5,414. (For policy questions regarding this collection contact 
Stephanie Simons at 206-615-2420. 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 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 June 3, 2013. 
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, Email: [email protected].

    Dated: April 30, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-10530 Filed 5-2-13; 8:45 am]
BILLING CODE 4120-01-P