[Federal Register Volume 90, Number 167 (Tuesday, September 2, 2025)]
[Notices]
[Pages 42411-42413]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-16789]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10775, CMS-10417, CMS-10524, CMS-10501, CMS-
10465 and CMS-417]
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 October 2, 2025.
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, 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 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: Extension of a currently
approved collection; Title of Information Collection: Medicare Severity
Diagnosis Related Groups Reclassification Request (MS-DRGs); Use:
Section 1886(d)(4) of the Act establishes a classification system,
referred to as DRGs, for inpatient discharges and adjusts payments
under the IPPS based on appropriate weighting factors assigned to each
MS-DRG. Section 1886(d)(4)(C)(i) of the Act specifies adjustments to
the classification and weighting factors shall occur ``at least
annually to reflect changes in treatment patterns, technology, and
other factors which may change the relative use of hospital
resources.''
The requests are evaluated in the Division of Coding and DRGs
(DCDRG) by the DRG and Coding Team and the clinical advisors (medical
officers) in both the Technology, Coding and Pricing Group (TCPG) and
the Hospital and Ambulatory Policy Group (HAPG), along with the CMS
contractor(s). This team participates via conference calls in the
review of MedPAR claims data to analyze and perform clinical review of
the requested changes. Based on the examination of claims data and
clinical judgment, the team provides recommendations to CMS and HHS
leadership for proposed changes. Per the statue, proposed MS-DRG
changes and payment adjustments must go through notice and comment
rulemaking giving the opportunity for the public to comment. Finalized
MS-DRG changes are effective with discharges on and after October 1,
consistent with the beginning of the fiscal year. CMS makes the updated
MS-DRG Grouper software and related materials that reflects the changes
available to the public for free via download at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.
When an application is submitted in MEARIS\TM\, the DRG and Coding
Team in DCDRG will have instant access to the application request and
accompanying materials to facilitate a more-timely review of the
request, including the ability to efficiently inform other team members
involved in the process that information is available for their review
and input. Form Number: CMS-10775 (OMB control number 0938-1431);
Frequency: Occasionally; Affected Public: Private Sector, Business or
other for-profits, Not-for-profits institutions; Number of Respondents:
50; Total Annual Responses: 50; Total Annual Hours: 48,000. (For policy
questions regarding this collection contact Marilu Hue at 410-786-
4510.)
2. Type of Information Collection Request: Extension of a currently
approved collection: Title of
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Information Collection: Medicare Fee-for-Service Prepayment Review of
Medical Records; Use: The Medical Review program is designed to prevent
improper payments in the Medicare FFS program. Whenever possible,
Medicare Administrative Contractors (MACs) are encouraged to automate
this process; however, it may require the evaluation of medical records
and related documents to determine whether Medicare claims are billed
in compliance with coverage, coding, payment, and billing policies.
Addressing improper payments in the Medicare fee-for-service (FFS)
program and promoting compliance with Medicare coverage and coding
rules is a top priority for the CMS. Preventing Medicare improper
payments requires the active involvement of every component of CMS and
effective coordination with its partners including various Medicare
contractors and providers. The information required under this
collection is requested by Medicare contractors to determine proper
payment, or if there is a suspicion of fraud. Medicare contractors
request the information from providers/suppliers submitting claims for
payment when data analysis indicates aberrant billing patterns or other
information which may present a vulnerability to the Medicare program.
Form Number: CMS-10417 (OMB control number: 0938-0969); Frequency:
Occasionally; Affected Public: Private Sector, State, Business, and
Not-for Profits; Number of Respondents: 489,871; Number of Responses:
489,871; Total Annual Hours: 244,936. (For questions regarding this
collection, contact Olufemi Shodeke at 410-786-1649.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Program;
Prior Authorization Process for Certain Durable Medical Equipment,
Prosthetic, Orthotics, and Supplies (DMEPOS); Use: Section 1834(a)(15)
of the Social Security Act (the Act) authorizes the Secretary to
develop and periodically update a list of DMEPOS that the Secretary
determines, on the basis of prior payment experience, are frequently
subject to unnecessary utilization and to develop a prior authorization
process for these items. Pursuant to this authority, CMS published
final rules CMS-6050-F and CMS-1713-F.
The information required under this collection is used to determine
proper payment and coverage for DMEPOS items. The information requested
includes all documents and information that demonstrate the DMEPOS item
requested is reasonable and necessary for the beneficiary and meets
applicable Medicare requirements. The documentation will be reviewed by
trained registered nurses, therapists, or physician reviewers to
determine if item(s) or service requested meets all applicable Medicare
coverage, coding and payment rules. Form Number: CMS-10524 (OMB control
number: 0938-1293); Frequency: Occasionally; Affected Public: Private
Sector (Business or other for-profits, Not-for-Profit Institutions);
Number of Respondents:; Total Annual Responses: 190,344; Total Annual
Hours: 95,172. (For policy questions regarding this collection contact
Emily Calvert at (410) 786-4277.)
4. Type of Information Collection Request: Revision of currently
approved collection; Title: Healthcare Fraud Prevention Partnership
(HFPP) Data Sharing and Information Exchange; Use: Section 1128C(a)(2)
of the Social Security Act (42 U.S.C. 1320a-7c(a)(2)) authorizes the
Secretary and the Attorney General to consult, and arrange for the
sharing of data with, representatives of health plans for purposes of
establishing a Fraud and Abuse Control Program as specified in Section
1128(C)(a)(1) of the Social Security Act. The result of this authority
has been the establishment of the HFPP. The HFPP was officially
established by a Charter in the fall of 2012 and signed by HHS
Secretary Sibelius and U.S. Attorney General Holder. In December 2020,
President Trump signed into law H.R.133--Consolidated Appropriations
Act, 2021, which amended Section 1128C(a) of the Social Security Act
(42 U.S.C. 1320a-7c(a)) providing explicit statutory authority for the
Healthcare Fraud Prevention Partnership including the potential
expansion of the public-private partnership analyses.
Data sharing within the HFPP primarily focuses on conducting
studies for the purpose of combatting fraud, waste, and abuse. These
studies are intended to target specific vulnerabilities within the
payment systems in both the public and private healthcare sectors. The
HFPP and its committees design and develop studies in coordination with
the TTP. The core function of the TTP is to manage and execute the HFPP
studies within the HFPP. Form Number: CMS-10501 (OMB control number:
0938-1251); Frequency: Occasionally; Affected Public: Private sector
(Business or other for-profits); Number of Respondents: 28; Number of
Responses: 28; Total Annual Hours: 120. (For questions regarding this
collection, contact Maricruz Bonfante at (410-786-5086).
5. 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.)
6. Type of Information Collection Request: Reinstatement with
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
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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.)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-16789 Filed 8-29-25; 8:45 am]
BILLING CODE 4120-01-P