[Federal Register Volume 81, Number 48 (Friday, March 11, 2016)]
[Notices]
[Pages 12903-12904]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-05472]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-359/360, CMS-10003, and CMS-10280]


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: The 
necessity and utility of the proposed information collection for the 
proper performance of the agency's functions; the accuracy of the 
estimated burden; ways to enhance the quality, utility, and clarity of 
the information to be collected; and 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 April 11, 2016.

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 information collection; Title of Information Collection: 
Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and 
Survey Forms and Supporting Regulations; Use: The form CMS-359 is used 
as the application for health care providers seeking to participate in 
the Medicare program as a Comprehensive Outpatient Rehabilitation 
Facility (CORF). This form initiates the process for facilities to 
become certified as a CORF and it provides the CMS Regional Office 
State Survey Agency staff identifying information regarding the 
applicant that is stored in the Automated Survey Processing Environment 
(ASPEN) system.
    The form CMS-360 is a survey tool used by the State Survey Agencies 
to record information in order to determine a provider's compliance 
with the CORF Conditions of Participation (CoPs) and to report this 
information to the Federal government. The form includes basic 
information on the CoP requirements, check boxes to indicate the level 
of compliance, and a section for recording notes. We have the 
responsibility and authority for certification decisions which are 
based on provider compliance with the CoPs and this form supports this 
process. Form Number: CMS-359/360 (OMB control number: 0938-0267); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profits); Number of Respondents: 50; Number of Responses: 50; 
Total Annual Hours: 123. (For questions regarding this collection 
contact James Cowher (410) 786-1948.)
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Notice of Denial 
of Medical Coverage (or Payment); Use: Medicare health plans, including

[[Page 12904]]

Medicare Advantage plans, cost plans, and Health Care Prepayment Plans, 
are required to issue the CMS-10003 form when a request for either a 
medical service or payment is denied in whole or in part. The notice 
explains why the plan denied the service or payment and informs 
Medicare enrollees of their appeal rights. The notice is also used, as 
appropriate, to explain Medicaid appeal rights to full dual eligible 
individuals enrolled in a Medicare health plan that is also managing 
the individual's Medicaid benefits. The PRA package has been revised 
subsequent to the publication of the 60-day Federal Register notice 
(October 16, 2015; 80 FR 62534). Form Number: CMS-10003 (OMB control 
number: 0938-0829). Frequency: Occasionally; Affected Public: Private 
sector (Business or other for-profit and Not-for-profit institutions); 
Number of Respondents: 730; Total Annual Responses: 33,574,293; Total 
Annual Hours: 5,593,477. (For policy questions regarding this 
collection contact Staci Paige at 410-786-2045.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Home Health 
Change of Care Notice (HHCCN); Use: The Home Health Change of Care 
Notice (HHCCN) is used to notify original Medicare beneficiaries 
receiving home health care benefits of plan of care changes. Home 
health agencies (HHAs) must provide the HHCCN whenever they reduce or 
terminate a beneficiary's home health services due to physician/
provider orders or limitation of the HHA in providing the specific 
service. Notification is required for covered and non-covered services 
listed in the plan of care. This iteration contains non-substantive 
changes which add language informing beneficiaries of their rights 
under Section 504 of the Rehabilitation Act of 1973 by alerting the 
beneficiary to CMS' nondiscrimination practices and the availability of 
alternate forms of this notice if needed. There are no substantive 
changes. Form Number: CMS-10280 (OMB control number: 0938-0829); 
Frequency: Occasionally; Affected Public: Private sector (Business or 
other for-profits and Not-for-profit institutions); Number of 
Respondents: 12,459; Total Annual Responses: 13,764,434; Total Annual 
Hours: 917,262. (For policy questions regarding this collection contact 
Evelyn Blaemire at 410-786-1803).

    Dated: March 7, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2016-05472 Filed 3-10-16; 8:45 am]
BILLING CODE 4120-01-P