[Federal Register Volume 85, Number 36 (Monday, February 24, 2020)]
[Notices]
[Pages 10443-10444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-03537]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-199, CMS-10180 and CMS-1771]


Agency Information Collection Activities: Submission for OMB 
Review; 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 (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 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 March 25, 2020.

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: 
OIRA_[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' website address at website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    1. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    2. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

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: Reinstatement without 
change of a currently approved collection; Title of Information 
Collection: Medicaid Report on Payables and Receivables; Use: Section 
1903(b)(d)(1) of the Social Security Act requires the Secretary to 
estimate the amount each State should be paid at the beginning of each 
quarter. This amount is to be based on a report filed by the State. 
Section 1903(b)(d)(2)(A) of the Social Security Act authorizes the 
Secretary to pay the amount estimated, reduced or increased to the 
extent of any overpayment or underpayment for any prior quarter. 
Section 3515 of CFO Act requires government agencies to produce 
auditable financial statements in accordance with Office of Management 
and Budget guidelines on Form and Content. The Government Management 
and Reform Act of 1994 requires that all offices, bureaus and 
associated activities of the 24 CFO Act agencies must be covered in an 
agency. Form Number: CMS-R-199 (OMB control number: 0938-0697); 
Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 56; Total Annual Responses: 56; 
Total Annual Hours: 504. (For policy questions regarding this 
collection

[[Page 10444]]

contact Beverly Boher at (410) 786-7806.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Children's Health 
Insurance Program (CHIP) Report on Payables and Receivables; Use: 
Section 2105 of the Social Security Act (Title XXI) requires the 
Secretary to estimate the amount each State should be paid at the 
beginning of each quarter. This amount is based on a report filed by 
the State. Section 2105 of the Social Security Act authorizes the 
Secretary to pay the amount estimated, reduced or increased to the 
extent of any overpayment or underpayment for any prior quarter. 
Section 3515 of the CFO Act requires government agencies to produce 
auditable financial statements in accordance with Office of Management 
and Budget guidelines on Form and Content. The Government Management 
and Reform Act of 1994 requires that all offices, bureaus and 
associated activities of the 24 CFO Act agencies must be covered in an 
agency-wide, audited financial statement. Collection of CHIP data and 
the calculation of the CHIP Incurred But Not Reported (IBNR) estimate 
are pertinent to CMS' financial audit. The CHIP Report on Payables and 
Receivables will provide the information needed to calculate the CHIP 
IBNR. Failure to collect this information could result in non-
compliance with the law. Form Number: CMS-10180 (OMB control number: 
0938-0988); Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 56; Total Annual Responses: 56; 
Total Annual Hours: 504. (For policy questions regarding this 
collection contact Beverly Boher at (410) 786-7806.)
    3. Type of Information Collection Request: Reinstatement without 
change of a currently approved collection; Title of Information 
Collection: Emergency and Foreign Hospital Services and Supporting 
Regulation in 42 CFR Section 424.103; 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 
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. 42 CFR 424.103 
(b) requires that 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 (42 CFR 424.101 attached) 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: Yearly; 
Affected Public: Private Sector; Business or other for-profits, 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: February 18, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2020-03537 Filed 2-21-20; 8:45 am]
BILLING CODE 4120-01-P