[Federal Register Volume 84, Number 36 (Friday, February 22, 2019)]
[Notices]
[Pages 5690-5691]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-03015]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-855R, CMS-2746, CMS-2728, and CMS-10065/
10066]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

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 April 23, 2019.

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 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 N. 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-855R Reassignment of Medicare Benefits
CMS-2746 End Stage Renal Disease Death Notification
CMS-2728 End Stage Renal Disease Medical Evidence Report Medicare 
Entitlement and/or Patient Registration
CMS-10065/10066 Hospital Notices: IM/DND

    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: Extension; Title of 
Information Collection: Reassignment of Medicare Benefits; Use: The 
reassignment application is submitted at the time the provider/supplier 
first reassigns of his/her Medicare benefits to a group practice, as 
well as any subsequent reassignments, changes to current reassignment 
information or terminations of established reassignments as requested 
by the provider/supplier or group. The application is used by the 
Medicare Administrative Contractor (MAC) to collect data to assure the 
applicant has the necessary information that allows the MAC to 
correctly establish, change, or terminate the reassignment.
    The collection and verification of reassignment information defends 
and protects our beneficiaries from illegitimate providers/suppliers. 
These procedures also protect the Medicare Trust Fund against fraud. It 
gathers information that allow Medicare contractors to ensure that the 
provider/supplier is not sanctioned from the Medicare and/or Medicaid 
program(s), or debarred, or excluded from any other Federal agency or 
program. The data (e.g., Social Security Numbers, Employer 
Identification Numbers) collected also ensures that the applicant has 
the necessary credentials to provide the health care services for which 
they intend to bill Medicare through the reassignment. This is sole 
instrument implemented for this purpose. Form Number: CMS-855R (OMB 
control number: 0938-1179); Frequency: Occasionally; Affected Public: 
Private Sector (Businesses or other for-profits, Not-for-profit 
institutions); Number of Respondents: 357,628; Number of Responses: 
357,628; Total Annual Hours: 89,407. For policy questions regarding 
this collection, contact Kimberly McPhillips at 410-786-5374.
    2. Type of Information Collection Request: Reinstatement of 
previously approved collection; Title of Information Collection: End 
Stage Renal Disease Death Notification; Use: The ESRD Death 
Notification form (CMS-2746) is completed by all Medicare-approved ESRD 
facilities upon death of an ESRD patient. Its primary purpose is to 
collect fact of death and cause of death of ESRD patients. The ESRD 
Program Management and Medical Information System (PMMIS) has the 
responsibility of collecting, maintaining and disseminating, on a 
national basis, uniform data pertaining to ESRD patients and their 
treatment of care. All renal facilities approved to participate

[[Page 5691]]

in the ESRD program are required by Pub. L. 95-292 to supply data to 
this system. Form Number: CMS-2746 (OMB control number: 0938 -0448); 
Frequency: Yearly; Affected Public: Private Sector (Business or other 
for-profits, Not-for-Profit Institutions); Number of Respondents: 
7,311; Total Annual Responses: 92,023; Total Annual Hours: 46,011.50. 
(For policy questions regarding this collection contact Gequinicia Polk 
at 410-786-2305.)
    3. Type of Information Collection Request: Reinstatement of 
previously approved collection; Title of Information Collection: End 
Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or 
Patient Registration; Use: The primary purpose of this form is to have 
a physician medically determine that a patient has end stage renal 
disease for purposes of filing for Medicare benefits. The End Stage 
Renal Disease (ESRD) Medical Evidence (CMS-2728) is completed for all 
ESRD patients either by the first treatment facility or by a Medicare-
approved ESRD facility when it is determined by a physician that the 
patient's condition has reached that stage of renal impairment that a 
regular course of kidney dialysis or a kidney transplant is necessary 
to maintain life. The data reported on the CMS-2728 is to monitor and 
assess the quality and type of care provided to end stage renal disease 
beneficiaries. Collection of these data are also necessary for the 
maintenance of a single, nationwide kidney disease registry for 
dialysis, transplant, and prospective transplant patients. Form Number: 
CMS-2728 (OMB control number: 0938-0046); Frequency: Yearly; Affected 
Public: Private Sector (Business or other for-profits, Not-for-Profit 
Institutions); Number of Respondents: 7,311; Total Annual Responses: 
138,000; Total Annual Hours: 103,500. (For policy questions regarding 
this collection contact Gequinicia Polk at 410-786-2305.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Hospital Notices: 
IM/DND; Use The purpose of the IM is to inform beneficiaries and 
enrollees of their rights as hospital inpatients and how to request a 
discharge appeal by a Quality Improvement Organization (QIO) and how to 
file a request. For all Medicare beneficiaries, hospitals must deliver 
valid, written notice of a beneficiary's rights as a hospital 
inpatient, including discharge appeal rights. The hospital must use a 
standardized notice, as specified by CMS. This is satisfied by IM 
delivery.
    Consistent with 42 CFR 405.1205 for Original Medicare and 422.620 
for Medicare health plans, hospitals must provide the initial IM within 
2 calendar days of admission. A follow-up copy of the signed IM is 
given no more than 2 calendar days before discharge. The follow-up copy 
is not required if the first IM is provided within 2 calendar days of 
discharge. In accordance with 42 CFR 405.1206 for Original Medicare and 
422.622 for Medicare health plans, if a beneficiary/enrollee appeals 
the discharge decision, the beneficiary/enrollee and the QIO must 
receive a detailed explanation of the reasons services should end. This 
detailed explanation is provided to the beneficiary/enrollee using the 
DND, the second notice included in this renewal package. Form Number: 
CMS-10065/10066 (OMB control number: 0938-1019); Frequency: Yearly; 
Affected Public: Private Sector (Business or other for-profits, Not-
for-Profit Institutions); Number of Respondents: 6,123; Total Annual 
Responses: 17,742,803; Total Annual Hours: 2,990,720. (For policy 
questions regarding this collection contact Janet Miller at 410-786-
1799.)

    Dated: February 15, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-03015 Filed 2-21-19; 8:45 am]
 BILLING CODE 4120-01-P