[Federal Register Volume 79, Number 65 (Friday, April 4, 2014)]
[Notices]
[Pages 18913-18914]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-07577]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10421]
Emergency Clearance: Public Information Collection Requirements
Submitted to the Office of Management and Budget (OMB)
AGENCY: Centers for Medicare & Medicaid Services, HHS.
In compliance with 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 a summary of
this proposed information collection for public comment. Interested
persons are invited to send comments regarding this collection's
proposed 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.
In compliance with section 3506(c)(2)(A) of the Paperwork Reduction
Act of 1995, we have also submitted to the Office of Management and
Budget (OMB) the proposed information collection for their emergency
review. While the information collection request (ICR) is necessary to
ensure compliance with an initiative of the Administration, we are
requesting emergency review of the ICR
[[Page 18914]]
for the Medicare Fee-for-Service Recovery Audit Prepayment Review
Demonstration and Prior Authorization Demonstration be processed under
the emergency clearance process associated with 5 CFR 1320.13(a)(2)(i)
and 5 CFR 1320.13(a)(2)(ii). However, the revisions contained in this
request only pertain to the Prior Authorization of Power Mobility
Device (PMD) Demonstration.
The approval of the revisions to this ICR is essential to prevent
improper payments for PMDs that do not meet Medicare coverage
requirements. We believe that this demonstration prevents public harm
by protecting the Medicare Trust Fund from improper payments made for
PMDs that do not comply with Medicare policy and by ensuring that a
beneficiary's medical condition warrants the medical equipment ordered.
Reductions in improper payments will help ensure the sustainability of
the Medicare Trust Fund and protect beneficiaries who depend upon the
Medicare program. In absence of this expanded demonstration, a
significant number of claims will not be reviewed to ensure compliance
with Sec. 1862(a)(l)(A) of the Act which provides that Medicare may
only make payment for services which are reasonable and necessary for
the diagnosis or treatment of illness or injury or to improve the
functioning of a malformed body member.
1. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Fee-for-Service
Recovery Audit Prepayment Review Demonstration and Prior Authorization
Demonstration; Use: On July 23, 2012, the Office of Management and
Budget approved the collections required for two demonstrations of
prepayment review and prior authorization. The first demonstration
allows Medicare Recovery Auditors to review claims on a pre-payment
basis in certain States. The second demonstration established a prior
authorization program for Power Mobility Device claims in certain
States.
For the Recovery Audit Prepayment Review Demonstration, CMS and its
agents request additional documentation, including medical records, to
support submitted claims. As discussed in more detail in Chapter 3 of
the Program Integrity Manual, additional documentation includes any
medical documentation, beyond what is included on the face of the claim
that supports the item or service that is billed. For Medicare to
consider coverage and payment for any item or service, the information
submitted by the provider or supplier (e.g., claims) must be supported
by the documentation in the patient's medical records. When conducting
complex medical review, the contractor specifies documentation they
require in accordance with Medicare's rules and policies. In addition,
providers and suppliers may supply additional documentation not
explicitly listed by the contractor. This supporting information may be
requested by CMS and its agents on a routine basis in instances where
diagnoses on a claim do not clearly indicate medical necessity, or if
there is a suspicion of fraud.
For the Prior Authorization of Power Mobility Devices (PMDs)
Demonstration, we are piloting prior authorization for PMDs. Prior
authorization will allow the applicable documentation that supports a
claim to be submitted before the item is delivered. For prior
authorization, relevant documentation for review is submitted before
the item is delivered or the service is rendered. CMS will conduct this
demonstration in California, Florida, Illinois, Michigan, New York,
North Carolina and Texas based on beneficiary address as reported to
the Social Security Administration and recorded in the Common Working
File (CWF). For the demonstration, a prior authorization request can be
completed by the (ordering) physician or treating practitioner and
submitted to the appropriate DME MAC for an initial decision. The
supplier may also submit the request on behalf of the physician or
treating practitioner. The physician, treating practitioner or supplier
who submits the request on behalf of the physician or treating
practitioner, is referred to as the ``submitter.'' Under this
demonstration, the submitter will submit to the DME MAC a request for
prior authorization and all relevant documentation to support Medicare
coverage of the PMD item.
With this emergency Federal Register notice, we are announcing our
plans to expand the demonstration from the seven aforementioned States
to 12 new States, bringing the total number of participating States to
19; however, the original demonstration requirements will remain the
same in all 19 States. The new States include Pennsylvania, Ohio,
Louisiana, Missouri, Maryland, New Jersey, Indiana, Kentucky, Georgia,
Tennessee, Washington, and Arizona.
Form Number: CMS-10421 (OCN: 0938-1169); Frequency: Occasionally;
Affected Public: State, Local or Tribal Governments; Number of
Respondents: 333,750; Total Annual Responses: 333,750; Total Annual
Hours: 170,060. (For policy questions regarding this collection contact
Daniel Schwartz at 410-786-4197. For all other issues call 410-786-
1326.)
We are requesting OMB review and approval of this collection by
April 18, 2014, with a 180-day approval period. Written comments and
recommendations will be considered from the public if received by the
date and address noted below.
Copies of the supporting statement and any related forms can be
found at: http://www.cms.hhs.gov/PaperworkReductionActof1995 or can be
obtained by emailing your request, including your address, phone
number, OMB number, and CMS document identifier, to:
[email protected], or by calling the Reports Clearance Office at:
410-786-1326.
When commenting on this proposed information collection, please
reference the CMS document identifier and the OMB control number (OCN).
To be assured consideration, comments and recommendations must be
received in one of the following ways by April 18, 2014:
1. Electronically. You may submit 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) 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 (CMS-10421),
Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850
and,
OMB Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, New Executive Office Building, Room 10235, Washington, DC
20503, Fax Number: 202-395-6974.
Dated: April 1, 2014.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2014-07577 Filed 4-3-14; 8:45 am]
BILLING CODE 4120-01-P