[Federal Register Volume 80, Number 216 (Monday, November 9, 2015)]
[Notices]
[Pages 69228-69229]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-28448]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-906 and CMS-1771]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

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 (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 a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the 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 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 on the collection(s) of information must be received by 
the OMB desk officer by December 9, 2015.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 OR, Email: 
[email protected].
    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: 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 (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-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 that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: The Fiscal 
Soundness Reporting Requirements; Use: The CMS is assigned 
responsibility for overseeing all Medicare Advantage Organizations 
(MAOs), Prescription Drug Plan (PDP) sponsors and PACE organizations 
on-going financial performance. Specifically, CMS needs the requested 
collection of information to establish that contracting entities within 
those programs maintain fiscally sound organizations and thereby remain 
a going concern. All contracting organizations must submit annual 
independently audited financial statements one time per year. The MAOs 
with a negative net worth and/or a net loss and the amount of that loss 
is greater than one-half of the organization's total net worth must 
file three quarterly financial statements. Currently, there are 
approximately 71 MAOs filing quarterly financial statements. Part D 
organizations must also file 3 quarterly financial statements. The PACE 
organizations are required to file 4 quarterly financial statements for 
the first three years in the program as well as PACE organizations with 
a negative net worth and/or a net loss and the amount of that loss is 
greater than one-half of the organization's total net worth. Form 
Number: CMS-906 (OMB control number: 0938-0469); Frequency: Annually; 
Affected Public: Business or other for-profits; Number of Respondents: 
815; Total Annual Responses: 1,518; Total Annual Hours: 506. (For 
policy questions regarding this collection contact Geralyn Glenn at 
410-786-0973.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Emergency and Foreign Hospital Services; Use: Section 1866 
of the Social Security Act states that any provider of services shall 
be qualified to participate in the Medicare program and shall be 
eligible for payments under Medicare if it files an agreement with the 
Secretary to meet the conditions outlined in this section of the Act. 
Section 1814 (d)(1) of

[[Page 69229]]

the Social Security Act and 42 CFR 424.100, allows payment of Medicare 
benefits for a Medicare beneficiary to a nonparticipating hospital that 
does not have an agreement in effect with the Centers for Medicare and 
Medicaid Services. These payments can be made if such services were 
emergency services and if CMS would be required to make the payment if 
the hospital had an agreement in effect and met the conditions of 
payment. This form is used in connection with claims for emergency 
hospital services provided by hospitals that do not have an agreement 
in effect under section 1866 of the Social Security Act. As specified 
in 42 CFR 424.103(b), before a non-participating hospital may be paid 
for emergency services rendered to a Medicare beneficiary, a statement 
must be submitted that is sufficiently comprehensive to support that an 
emergency existed. Form CMS-1771 contains a series of questions 
relating to the medical necessity of the emergency. The attending 
physician must attest that the hospitalization was required under the 
regulatory emergency definition and give clinical documentation to 
support the claim. A photocopy of the beneficiary's hospital records 
may be used in lieu of the CMS-1771 if the records contain all the 
information required by the form. Form Number: CMS-1771 (OMB control 
number: 0938-0023); Frequency: Annually; Affected Public: Private 
sector (Business or other for-profits and Not-for-profit institutions); 
Number of Respondents: 100; Total Annual Responses: 200; Total Annual 
Hours: 50. (For policy questions regarding this collection contact 
Shauntari Cheely at 410-786-1818.)

    Dated: November 4, 2015.
William N. Parham, III
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-28448 Filed 11-6-15; 8:45 am]
BILLING CODE 4120-01-P