[Federal Register: December 1, 2003 (Volume 68, Number 230)]
[Notices]               
[Page 67192-67193]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01de03-81]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-3070, CMS-10095, and CMS-10096]

 
Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

    Agency: Centers for Medicare and Medicaid Services, HHS. In 
compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid 
Services (CMS) (formerly known as the Health Care Financing 
Administration (HCFA), Department of Health and Human Services, is 
publishing the following summary of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
burden estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the agency's functions; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    1. Type of Information Collection Request: Extension of a 
previously approved collection.
    Title of Information Collection: Intermediate Care Facility for the 
Mentally Retarded or Persons with Related Conditions ICF/MR Survey 
Report Form (3070G-I) and Supporting Regulations at 42 CFR 442.30, 
483.410, 483.420, 483.440, 483.450, and 483.460.
    Form No.: CMS-3070 (0938-0062).
    Use: The survey forms are needed to ensure provider compliance. In 
order to participate in the Medicaid program as an ICF/MR, a provider 
must meet Federal standards. The survey report form is used to record 
providers' level of compliance with the individual standard and report 
it to the Federal government. The collection includes the information 
collection requirements that ICF/MRs must meet.
    Frequency: Annually.
    Affected Public: Business or other for-profit, Not-for-profit 
institutions.
    Number of Respondents: 6,763.
    Total Annual Responses: 177,721,815.
    Total Annual Hours: 6,841,538.
    2. Type of Information Collection Request: New Collection.
    Title of Information Collection: ``Detailed Explanation of Non-
Coverage'' 42 CFR 422.626(e)(1), and ``Important Message of Non-
Coverage'' 42 CFR 625(b)(1).
    Form No.: CMS-10095 (OMB 0938-NEW).
    Use: Pursuant of 42 CFR 422.624(b)(1), providers in skilled nursing 
facilities, home health agencies, and comprehensive outpatient 
rehabilitation facilities must deliver to M+C enrollees a 2-day advance 
notice of termination of services. Per requirements at 42 CFR 
422.626(e)(1), M+C organizations must deliver detailed notices to the 
QIO and enrollees upon request for appeal of the termination of 
services. These notices fulfill the regulatory requirement.
    Frequency: Other: distribution.
    Affected Public: Business or other-for-profit, Not-for-profit 
institutions, Federal Government, and Individuals or Households.
    Number of Respondents: 22,247.
    Total Annual Responses: 612,000.
    Total Annual Hours: 68,000.
    3. Type of Information Collection Request: New Collection.
    Title of Information Collection: Medicare Health Survey (MHS).
    Form No.: CMS-10096 (OMB 0938-NEW).
    Use: The Centers for Medicare and Medicaid Services has developed a 
survey, the Medicare Health Survey, that is similar to the Health 
Outcomes Survey (HOS). The main purpose of the MHS is to collect 
information that may be used to adjust Medicare payment. This approach 
has been tested for PACE (as mandated by BBA) and other organizations 
that serve frail populations and frailty adjusted payments will be made 
to PACE and certain demonstrations starting in 2004. CMS is currently 
investigating the feasibility of applying frailty adjustment to the M+C 
program in the future. To

[[Page 67193]]

conduct the necessary research, CMS needs functional impairment 
information for a national sample of FFS beneficiaries. The information 
will be used for two purposes; to develop appropriate adjustments to 
the ratebook for levels of functional impairment, and to recalibrate 
the frailty payment model using FFS data. Adjusting the ratebook is 
necessary to ensure accurate payment while recalibration of the frailty 
model based on the MHS will properly align the calibration of the model 
and the data collection method, thereby avoiding payment error 
associated with the mode of administration issues.
    Frequency: Annually.
    Affected Public: Individuals or Households.
    Number of Respondents: 50,000.
    Total Annual Responses: 40,000.
    Total Annual Hours: 6,667.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS Web 
site address at http://cms.hhs.gov/regulations/pra/default.asp, or E-
mail your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@hcfa.gov, or call the Reports 
Clearance Office on (410) 786-1326. Written comments and 
recommendations for the proposed information collections must be mailed 
within 30 days of this notice directly to the OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Brenda Aguilar, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: November 20, 2003.
Melissa Musotto,
Acting Paperwork Reduction Act Team Leader, CMS Reports Clearance 
Officer, Office of Strategic Operations and Strategic Affairs, Division 
of Regulations Development and Issuances.
[FR Doc. 03-29821 Filed 11-28-03; 8:45 am]

BILLING CODE 4120-03-P