[Federal Register Volume 79, Number 65 (Friday, April 4, 2014)]
[Pages 18913-18914]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-07577]



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 
    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-
    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: 
    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 

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 
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]