[Federal Register Volume 85, Number 241 (Tuesday, December 15, 2020)]
[Notices]
[Pages 81208-81209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-27579]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10765]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
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 February 16, 2021.

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.

[[Page 81209]]

    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. 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-10765 Review Choice Demonstration for Inpatient Rehabilitation 
Facility (IRF) 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: New collection (Request 
for a new OMB control number); Title of Information Collection: Review 
Choice Demonstration for Inpatient Rehabilitation Facility (IRF) 
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 IRFs providing 
services to Medicare beneficiaries.
    This demonstration will assist in developing improved procedures 
for the identification, investigation, and prosecution of potential 
Medicare fraud. The demonstration will ensure that payments for IRF 
services are appropriate through either pre-claim or postpayment 
review, thereby working towards the prevention and identification of 
potential fraud, waste, and abuse, as well as protecting the Medicare 
Trust Funds from improper payments while reducing Medicare appeals. CMS 
proposes implementing the demonstration in Alabama, then expand to 
Pennsylvania, Texas, and California. After the initial four states, CMS 
will expand the demonstration to include the IRFs in any state that 
bill to Medicare Administrative Contractor (MAC) jurisdictions JJ, JL, 
JH, and JE. Under this demonstration, CMS proposes to offer choices for 
providers to demonstrate their compliance with CMS' IRF 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 the selected review method 
until the IRF reaches the target affirmation or claim approval rate (90 
percent, based on a minimum of 10 pre-claim requests or claims 
submitted). Once an IRF reaches the target pre-claim review affirmation 
or postpayment review claim approval rate, it may choose to be relieved 
from claim reviews under the demonstration, except for a spot check of 
five percent of their claims to ensure continued compliance.
    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 choice, IRFs 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 on file, the Medicare contractor will request the information 
from the IRF to determine if payment is appropriate. For the 
postpayment review option, the Medicare contractor will also request 
the information from the IRF provider who submitted the claim for 
payment from the Medicare program to determine if payment was 
appropriate. Form Number: CMS-10765 (OMB Control Number: 0938-NEW); 
Frequency: Occasionally; Affected Public: Private Sector (Business or 
other for-profits and Not-for-profits); Number of Respondents: 526; 
Number of Responses: 179,910; Total Annual Hours: 89,955. (For 
questions regarding this collection contact Jaclyn Gray (410) 786-
3744.)

    Dated: December 10, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2020-27579 Filed 12-14-20; 8:45 am]
BILLING CODE 4120-01-P