[Federal Register Volume 83, Number 105 (Thursday, May 31, 2018)]
[Notices]
[Pages 25012-25013]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11492]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers CMS-10599]


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 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 must be received by July 30, 2018.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. 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' website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    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: William Parham at (410) 786-4669.

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-10599 Pre-Claim Review Demonstration for Home Health Services

    Under the 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 Collection

    1. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Pre-Claim Review 
Demonstration for Home Health Services; Use: Section 402(a)(1)(J) of 
the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J)) 
authorizes the Secretary to ``develop or demonstrate improved methods 
for the investigation and prosecution of fraud in the provision of care 
or services under the health programs established by the Social 
Security Act (the Act).'' Pursuant to this authority, the CMS seeks to 
develop and implement a Medicare demonstration project, which CMS 
believes will help assist in developing improved procedures for the 
identification, investigation, and prosecution of Medicare fraud 
occurring among Home Health Agencies (HHA) providing services to 
Medicare beneficiaries.
    This revised demonstration would help assist in developing improved 
procedures for the identification, investigation, and prosecution of 
potential Medicare fraud. The demonstration would help make sure that 
payments for home health services are appropriate through either pre-
claim or postpayment review, thereby working towards the prevention and 
identification of potential fraud, waste, and abuse; the protection of 
Medicare Trust Funds from improper payments; and the reduction of 
Medicare appeals. CMS proposes initially implementing the demonstration 
in Illinois, Ohio, North Carolina, Florida, and Texas with the option 
to expand to other states in the Palmetto/JM jurisdiction. Under this 
demonstration, CMS proposes to offer choices for providers to 
demonstrate their compliance with CMS' home health policies. Providers 
in the demonstration states may participate in either 100 percent pre-
claim review or 100 percent postpayment review. These providers will 
continue to be subject to a review method until the HHA reaches the 
target affirmation or claim approval rate. Once a HHA reaches the 
target pre-claim review affirmation or post-payment review claim 
approval rate, it may choose to be relieved from claim reviews, except 
for a spot check of their claims to ensure continued compliance. 
Providers who do not wish to participate in either 100 percent pre-
claim or postpayment reviews have the option to furnish home health 
services and submit the associated claim for payment without undergoing 
such reviews; however, they will receive a 25 percent payment reduction 
on all claims

[[Page 25013]]

submitted for home health services and may be eligible for review by 
the Recovery Audit Contractors.
    The information required under this collection is required by 
Medicare contractors to determine proper payment or if there is a 
suspicion of fraud. Under the pre-claim review option, HHA will send 
the pre-claim review request along with all required documentation to 
the Medicare contractor for review prior to submitting the final claim 
for payment. If a claim is submitted without a pre-claim review 
decision one file, the Medicare contractor will request the information 
from the HHA to determine if payment is appropriate. For the 
postpayment review option, the Medicare contractor will also request 
the information from the HHA provider who submitted the claim for 
payment from the Medicare program to determine if payment was 
appropriate. Form Number: CMS-10599 (OMB control number: 0938-1311); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profits and Not-for-profits); Number of Respondents: 941,287; 
Total Annual Responses: 1,330,980; Total Annual Hours: 670,375. (For 
questions regarding this collection contact Jennifer McMullen (410) 
786-7635).

    Dated: May 23, 2018.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2018-11492 Filed 5-29-18; 4:15 pm]
 BILLING CODE 4120-01-P