[Federal Register Volume 86, Number 69 (Tuesday, April 13, 2021)]
[Notices]
[Pages 19267-19269]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-07478]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-718-721, CMS-724, CMS-2088-17 and CMS-1763]
Agency Information Collection Activities: Submission for OMB
Review; 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 (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 May 13, 2021.
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ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
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.
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: Revision of a currently
approved collection; Title of Information Collection: Business Proposal
Forms for Quality Improvement Organizations (QIOs); Use: The submission
of proposal information by current quality improvement associations
(QIOs) and other bidders, on the appropriate forms, will satisfy our
need for meaningful, consistent, and verifiable data with which to
evaluate contract proposals. We use the data collected on the forms
associated with this information collection request to negotiate QIO
contracts. We will be able to compare the costs reported by the QIOs on
the cost reports to the proposed costs noted on the business proposal
forms. Subsequent contract and modification negotiations will be based
on historic cost data. The business proposal forms will be one element
of the historical cost data from which we can analyze future proposed
costs. In addition, the business proposal format will standardize the
cost proposing and pricing process among all QIOs. With well-defined
cost centers and line items, proposals can be compared among QIOs for
reasonableness and appropriateness. Form Number: CMS-718-721 (OMB
control number: 0938-0579); Frequency: Annually; Affected Public:
Business or other for-profits and Not-for-profit institutions; Number
of Respondents: 58; Total Annual Responses: 58; Total Annual Hours:
2,320. (For policy questions regarding this collection contact Benjamin
Bernstein at 410-786-6570.)
2. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Medicare/Medicaid Psychiatric Hospital Survey Data and
Supporting Regulations; Use: The CMS-724 form is used to collect data
that assists us in program planning and evaluation and in maintaining
an accurate database on providers participating in the psychiatric
hospital program. Specifically, we use the information collected on
this form in evaluating the Medicare psychiatric hospital program. The
form is also used for audit purposes; determining patient population
and characteristics of the hospital; and survey term composition. Form
Number: CMS-724 (OMB control number: 0938-0378); Frequency: Annually;
Affected Public: Business or other for-profits and Not-for-profit
institutions; Number of Respondents: 19; Total Annual Responses: 191;
Total Annual Hours: 96. (For policy questions regarding this collection
contact Caroline Gallaher at 410-786-8705.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Community Mental
Health Center Cost Report Use: CMS requires the Form CMS-2088-17 to
determine a provider's reasonable cost incurred in furnishing medical
services to Medicare beneficiaries and reimbursement due to or from a
provider. In addition, CMHCs may receive reimbursement through the cost
report for Medicare reimbursable bad debts. CMS uses the Form CMS-2088-
17 for rate setting; payment refinement activities, including market
basket analysis; Medicare Trust Fund projections; and to support
program operations. The primary function of the cost report is to
determine provider reimbursement for services rendered to Medicare
beneficiaries. Each CMHC submits the cost report to its contractor for
reimbursement determination.
Section 1874A of the Act describes the functions of the contractor.
CMHCs must follow the principles of cost reimbursement, which require
they maintain sufficient financial records and statistical data for
proper determination of costs. The S series of worksheets collects the
provider's location, CBSA, date of certification, operations, and
unduplicated census days. The A series of worksheets collects the
provider's trial balance of expenses for overhead costs, direct patient
care services, and non-revenue generating cost centers. The B series of
worksheets allocates the overhead costs to the direct patient care and
non-revenue generating cost centers using functional statistical bases.
The Worksheet C computes the apportionment of costs between Medicare
beneficiaries and other patients. The D series of worksheets are
Medicare specific and calculate the reimbursement settlement for
services rendered to Medicare beneficiaries. The Worksheet F collects
the provider's revenues and expenses data from the provider's income
statement. Form Number: CMS-2088-17 (OMB control number: 0938-0378);
Frequency: Annually; Affected Public: Private Sector, Business or other
for-profits, Not-for-profits institutions; Number of Respondents: 184;
Total Annual Responses: 184; Total Annual Hours: 16,560. (For policy
questions regarding this collection contact Jill Keplinger at 410-786-
4550.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Termination of Premium-Hospital and or Supplementary Medical Insurance;
Use: Form CMS-1763 provides the necessary information to process the
enrollee's request for termination of Part B and/or premium Part A
coverage.
Sections 1818(c)(5), 1818A(c)(2)(B) and 1838(b)(1) of the Act and
corresponding regulations at 42 CFR 406.28(a) and 407.27(c) require
that a Medicare enrollee wishing to voluntarily terminate Part B and/or
premium Part A coverage file a written request with CMS or SSA. The
statute and regulations also specify when coverage ends based upon the
date the request for termination is filed.
Form CMS-1763 collects the information necessary to process
Medicare enrollment terminations. The Request for Termination of
Premium
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Hospital and/or Supplementary Medical Insurance (Form CMS-1763)
provides a standardized means to satisfy the requirements of law, as
well as allow both agencies to protect the individual from an
inappropriate decision. Form Number: CMS-1763 (OMB control number:
0938-0025); Frequency: Annually; Affected Public: State, Local, or
Tribal Governments; Number of Respondents: 114,215; Total Annual
Responses: 114,215; Total Annual Hours: 19,074. (For policy questions
regarding this collection contact Carla Patterson at 410-786-1000.)
Dated: April 7, 2021.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2021-07478 Filed 4-12-21; 8:45 am]
BILLING CODE 4120-01-P