[Federal Register Volume 89, Number 82 (Friday, April 26, 2024)]
[Notices]
[Pages 32433-32434]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-09040]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1500/1490S and CMS-R-234]


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 (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 June 25, 2024.

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, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

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-1500/1490 Health Insurance Common Claims Form and Supporting 
Regulations at 42 CFR part 424, subpart C
CMS-R-234 Subpart D--Private Contracts and Supporting Regulations in 42 
CFR 405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 
415.110, and 424.24

    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 without change 
of a currently approved collection; Title of Information Collection: 
Health Insurance Common Claims Form and Supporting Regulations at 42 
CFR part 424, subpart C; Use: The CMS-1500 and the CMS-1490S forms are 
used to deliver information to CMS for CMS to reimburse for provided 
services. Medicare Administrative Contractors use the data collected on 
the CMS-1500 and the CMS-1490S to determine the proper amount of 
reimbursement for Part B medical and other health services (as listed 
in section 1861(s) of the Social Security Act) provided by physicians 
and suppliers to beneficiaries. The CMS-1500 is submitted by 
physicians/suppliers for all Part B Medicare. Serving as a common claim 
form, the CMS-1500 can be used by other third-party payers (commercial 
and nonprofit health insurers) and other Federal programs (e.g., 
TRICARE, RRB, and Medicaid). Form Number: CMS-1500/1490S (OMB control 
number: 0938-1197); Frequency: Occasionally; Affected Public: Private 
Sector: Business or other for-profit and not-for-profit institutions; 
Number of Respondents: 2,507,992; Total Annual Responses: 994,038,623; 
Total Annual Hours: 17,328,912. (For policy questions regarding this 
collection contact Sadaf Ali-Simpson at 667-414-0004.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Subpart D-Private Contracts and Supporting Regulations in 
42 CFR 405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 
415.110, and 424.24; Use: Section 4507 of the Balanced Budget Act of 
1997 (BBA 1997) amended section 1802 of the Social Security Act (the 
Act) to permit certain physicians and practitioners to opt-out of 
Medicare and to provide--through private contracts--services that 
Medicare would otherwise cover. Under such contracts, the mandatory 
claims submission and limiting charge rules of section 1848(g) of the 
Act would not apply. CMS-R-234 allows certain physicians and 
practitioners to opt out of Medicare and furnish covered services to 
Medicare beneficiaries through private contracts. Physicians and 
practitioners use this information collection to comply with the 
applicable regulations. Physicians and practitioners entering private 
contracts with beneficiaries must file an affidavit with Medicare in 
which they agree to opt-out of Medicare for 2 years and to meet certain 
other criteria. In general, the applicable regulations require that 
during that 2-year period, physicians and practitioners who have filed 
affidavits opting out of Medicare must sign private contracts with all 
Medicare beneficiaries to whom they furnish services that Medicare 
would otherwise cover (except those who need emergency or urgently 
needed care). In addition, Medicare Administrative Contractors (MACs) 
use this information to determine if benefits should be paid or 
continued. Form Number: CMS-R-234 (OMB control number: 0938-0730);

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Frequency: Occasionally; Affected Public: Business or other for-profit 
and not-for-profit institutions; Number of Respondents; 78,258; Total 
Annual Responses; 78,258; Total Annual Hours: 22,780. (For policy 
questions regarding this collection contact Frank Whelan at 410-786-
1302.)

William N. Parham, III
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-09040 Filed 4-25-24; 8:45 am]
BILLING CODE 4120-01-P