[Federal Register Volume 78, Number 134 (Friday, July 12, 2013)]
[Notices]
[Pages 41931-41932]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-16740]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-2746, CMS-2728, CMS-R-39, CMS-10170, CMS-
10156 and CMS-10485]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (the PRA), federal agencies are required to publish notice 
in the Federal Register concerning each proposed collection of 
information (including each proposed extension or reinstatement of an 
existing collection of information) and to allow 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates 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 functions; (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.

DATES: Comments must be received by September 10, 2013.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number (OCN). To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) that are accepting comments.
    2. By regular mail. You may mail written comments to the following 
address:
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number ------, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326

SUPPLEMENTARY INFORMATION: 

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-2746 End Stage Renal Disease Death Notification
CMS-2728 End Stage Renal Disease Medical Evidence Report Medicare 
Entitlement and/or Patient Registration
CMS-R-39 Home Health Conditions of Participation (CoP) and Supporting 
Regulations
CMS-10170 Retiree Drug Subsidy (RDS) Payment Request and Instructions
CMS-10156 Retiree Drug Subsidy (RDS) Application and Instructions
CMS-10485 Evaluation of the Multi-Payer Advanced Primary Care Practice 
(MAPCP) Demonstration: Provider Survey

    Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-
3520), federal agencies must obtain approval from the Office of 
Management and Budget (OMB) for each collection of information they 
conduct or sponsor. The term ``collection of information'' is defined 
in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests 
or requirements that members of the public submit reports, keep 
records, or provide information to a third party. Section 3506(c)(2)(A) 
of the PRA requires federal agencies to publish a 60-day notice in the 
Federal Register concerning each proposed collection of information, 
including each proposed extension or reinstatement of an existing 
collection of information, before submitting the collection to OMB for 
approval. To comply with this requirement, CMS is publishing this 
notice.

Information Collections

    1. Type of Information Collection Request: Revision of a previously 
approved collection; Title of Information Collection: End Stage Renal 
Disease Death Notification; Use: The End Stage Renal Disease (ESRD) 
Death Notification (CMS-2746) is completed by all Medicare-approved 
ESRD facilities upon the death of an ESRD patient. Its primary purpose 
is to collect fact of death and cause of death of ESRD patients. 
Certain other identifying information (e.g., name, Medicare claim 
number, and date of birth) is required for matching purposes. Federal 
regulations require that the ESRD Networks examine the mortality rates 
of every Medicare-approved facility within its area of responsibility. 
The death form provides the necessary data to assist the ESRD Networks 
in making decisions that result in improved patient care and in cost-
effective distribution of ESRD resources. The data is used by the ESRD 
Networks to verify facility deaths and to monitor facility performance. 
Form Number: CMS-2746 (OCN: 0938-0448); Frequency: On occasion; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 5,964; Total Annual Responses: 
75,000; Total Annual Hours: 37,500. (For policy questions regarding 
this collection contact Michelle Tucker at 410-786-0736.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: End Stage Renal 
Disease Medical Evidence Report Medicare Entitlement and/or Patient 
Registration; Use: The End Stage Renal Disease (ESRD) Medical Evidence 
Report is completed for all ESRD patients either by the first treatment 
facility or by a Medicare-approved ESRD facility when it is determined 
by a physician that the patient's condition has reached that stage of 
renal impairment that a regular course of kidney dialysis or a kidney 
transplant is necessary to maintain life. The data reported on the CMS-
2728 is used by the federal government, ESRD Networks, treatment 
facilities, researchers and others to monitor and assess the quality 
and type of care provided to end stage renal disease beneficiaries. The 
data collection captures the specific medical information required to 
determine the Medicare medical eligibility of End Stage Renal Disease 
claimants. Form

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Number: CMS-2728 (OCN: 0938-0046); Frequency: Occasionally; 
Affected Public: Individuals or households; Number of Respondents: 
130,000; Total Annual Responses: 130,000; Total Annual Hours: 97,500. 
(For policy questions regarding this collection contact Michelle Tucker 
at 410-786-0736.)
    3. Type of Information Collection Request: Reinstatement with 
change of a currently approved collection; Title of Information 
Collection: Home Health Conditions of Participation (CoP) and 
Supporting Regulations; Use: The information collection requirements 
contained in this request are part of the requirements classified as 
the conditions of participation (CoPs) which are based on criteria 
prescribed in law and are standards designed to ensure that each 
facility has properly trained staff to provide the appropriate safe 
physical environment for patients. These particular standards reflect 
comparable standards developed by industry organizations such as the 
Joint Commission on Accreditation of Healthcare Organizations, and the 
Community Health Accreditation Program. The primary users of this 
information will be state agency surveyors, the regional home health 
intermediaries, CMS and home health agencies (HHAs) for the purpose of 
ensuring compliance with Medicare CoPs as well as ensuring the quality 
of care provided by HHA patients. Form Numbers: CMS-R-39 (OCN: 0938-
0365); Frequency: Occasionally; Affected Public: Business or for-
profits, not-for-profit institutions, and State, Local or Tribal 
governments; Number of Respondents: 13,577; Total Annual Responses: 
20,202,576; Total Annual Hours: 6,422,694. (For policy questions 
regarding this collection contact Danielle Shearer at 410-786-6617.)
    4. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Retiree Drug Subsidy (RDS) Payment Request and 
Instructions; Use: Under section 1860D-22 of the Social Security Act 
and implementing regulations at 42 CFR part 423 subpart R, 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 percent 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. Subpart R 
stipulates that plan sponsors may elect to submit RDS payment requests 
on a monthly, quarterly, interim annual, or annual basis; once 
selected, the payment frequency may not be changed during the plan 
year. Form Number: CMS-10170 (OCN: 0938-0977); Frequency: Occasionally; 
Affected Public: Private sector (business or other for-profits and not-
for-profit institutions); Number of Respondents: 4,500; Total Annual 
Responses: 4,500; Total Annual Hours: 679,500. (For policy questions 
regarding this collection contact John W. Campbell at 410-786-0542.)
    5. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Retiree Drug Subsidy (RDS) Applications and Instructions; 
Use: Under the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 and implementing regulations at 42 CFR part 
423, subpart R plan sponsors (e.g., employers, unions) who offer 
prescription drug coverage to their qualified covered retirees are 
eligible to receive a 28 percent tax-free subsidy for allowable drug 
costs. In order to qualify, plan sponsors must submit a complete 
application with a list of retirees for whom it intends to collect the 
subsidy. Once CMS reviews and analyzes the information on the 
application and the retiree list, notification will be sent to the plan 
sponsor about its eligibility to participate in the RDS program. Form 
Number: CMS-10156 (OCN: 0938-0957); Frequency: Yearly and monthly; 
Affected Public: Private sector (business or other for-profits and not-
for-profit institutions); Number of Respondents: 4,500; Total Annual 
Responses: 4,500; Total Annual Hours: 288,000. (For policy questions 
regarding this collection contact John W. Campbell at 410-786-0542.)
    6. Type of Information Collection Request: New Collection (Request 
for a new OMB control number); Title of Information Collection: 
Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) 
Demonstration: Provider Survey; Use: On September 16, 2009, the 
Department of Health and Human Services announced the establishment of 
the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration, 
under which Medicare joined Medicaid and private insurers as a payer 
participant in state-sponsored patient-centered medical home (PCMH) 
initiatives. We selected eight states to participate in this 
demonstration: Maine, Vermont, Rhode Island, New York, Pennsylvania, 
North Carolina, Michigan, and Minnesota.
    We are proposing to conduct this provider survey to understand how 
participating practices' structures and functions vary, particularly 
with respect to their adoption of different components of the PCMH 
model of care. Researchers evaluating the MAPCP Demonstration plan to 
combine these survey data with claims data to conduct statistical 
analyses that identify which particular medical home care processes are 
associated with the largest gains in health care quality and reductions 
in health care cost trends. Form Number: CMS-10485 (OCN: 0938-NEW); 
Frequency: Annually; Affected Public: Individuals and households; 
Number of Respondents: 5,799; Total Annual Responses: 5,799; Total 
Annual Hours: 1,450. (For policy questions regarding this collection 
contact Suzanne Wensky at 410-786-0226.)

    Dated: July 9, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-16740 Filed 7-11-13; 8:45 am]
BILLING CODE 4120-01-P