[Federal Register Volume 90, Number 112 (Thursday, June 12, 2025)]
[Notices]
[Pages 24803-24804]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-10650]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-417, CMS-10465 and CMS-10106]
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 August 11, 2025.
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-417--Hospice Request for Certification in the Medicare Program
CMS-10465--Minimum Essential Coverage
CMS-10106--Medicare Authorization to Disclose Personal Health
Information
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
[[Page 24804]]
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 Collections
1. Type of Information Collection Request: Reinstatement without
change of a previously approved collection; Title of Information
Collection: Hospice Request for Certification in the Medicare Program;
Use: This is a request to reinstate the CMS-417 form, which was
approved under OMB control number 0938-0313 and the current approval
expired on 11/30/2024. We have made several changes to the CMS-417 form
that make it easier to read, understand and complete. For example, we
made the data fields larger to provide more space in which to provide
responses. We have also reformatted the data fields and available
responses to make them easier to understand and complete. In addition,
we have added a new data field to collect the title of the person
signing the CMS-417 form. We believe it is important to collect this
information to ensure that the person completing and signing the form
has the proper authority to do so. Finally, we made the instruction
more comprehensive. We have submitted a change crosswalk that provides
a detailed explanation of all the changes made to the CMS-417 form.
The CMS-417 form is an identification and screening form used to
initiate the certification process for new hospices. The CMS-417 form
is also completed by existing hospices at the time of their
recertification surveys, to update their certification information. The
form collects data that is used to determine if the provider has
sufficient personnel to participate in the Medicare program. If a
hospice provider meets these preliminary staffing requirements, a
survey is scheduled to determine if the provider complies with the
conditions of participation (CoPs) required by the Medicare program.
The data provided by the hospice on the CMS-417 form serve as a basis
for the survey inspection. The facility is only required to complete
certain items on the certification forms as indicated by the
instructions included with the form. Form Number: CMS-417 (OMB Control
number: 0938-0313); Frequency: Annually; Affected Public: Private
Sector--Business or other for-profits; Number of Respondents: 3,418;
Total Annual Responses: 3,418; Total Annual Hours: 2,564. (For policy
questions regarding this collection contact Caroline Gallaher at 410-
786-8705.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Minimum Essential
Coverage; Use: The final rule titled ``Patient Protection and
Affordable Care Act; Exchange Functions: Eligibility for Exemptions;
Miscellaneous Minimum Essential Coverage Provisions,'' published July
1, 2013 (78 FR 39494) designates certain types of health coverage as
minimum essential coverage. Other types of coverage, not statutorily
designated and not designated as minimum essential coverage in
regulation, may be recognized by the Secretary of Health and Human
Services (HHS) as minimum essential coverage if certain substantive and
procedural requirements are met. To be recognized as minimum essential
coverage, the coverage must offer substantially the same consumer
protections as those enumerated in Title I of the Affordable Care Act
relating to non-grandfathered, individual health insurance coverage to
ensure consumers are receiving adequate coverage. The final rule
requires sponsors of other coverage that seek to have such coverage
recognized as minimum essential coverage to adhere to certain
procedures. Sponsoring organizations must submit to HHS certain
information about their coverage and an attestation that the plan
substantially complies with the provisions of Title I of the Affordable
Care Act applicable to non-grandfathered individual health insurance
coverage. Sponsors must also provide notice to enrollees informing them
that the plan has been recognized as minimum essential coverage. Form
Number: CMS-10465 (OMB Control number: 0938-1189); Frequency:
Occasionally; Affected Public: Private Sectors; State, Local or Tribal
Governments; Number of Respondents: 10; Total Annual Responses: 10;
Total Annual Hours: 53. (For policy questions regarding this collection
contact Russell Tipps at 301-492-4371.)
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare
Authorization to Disclose Personal Health Information; Use: The
Medicare Authorization to Disclose Personal Health Information will be
used by Medicare beneficiaries to authorize Medicare to disclose their
protected health information to a third party. Medicare beneficiaries
can submit the Medicare Authorization to Disclose Personal Health
Information electronically at Medicare.gov. Beneficiaries may also
submit the Medicare Authorization to Disclose Personal Health
Information by mailing a complete and valid authorization form to
Medicare. Beneficiaries can submit the Medicare Authorization to
Disclose Personal Health Information verbally over the phone by calling
1-800-Medicare. Form Number: CMS-10106 (OMB Control number: 0938-0930);
Frequency: Occasionally; Affected Public: Individuals or Households;
Number of Respondents: 1,000,000; Total Annual Responses: 1,00,000;
Total Annual Hours: 250,000. (For policy questions regarding this
collection contact Samuel Jenkins at 410-786-3261.)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-10650 Filed 6-11-25; 8:45 am]
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