[Federal Register Volume 84, Number 208 (Monday, October 28, 2019)]
[Notices]
[Pages 57734-57735]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-23504]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-3427 and CMS-484, 846, 854, 847, 848, 849,
10125, and 10126]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid 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 (the 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 December 27, 2019.
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.
[[Page 57735]]
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.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to [email protected].
3. Call the Reports Clearance Office at (410) 786-1326.
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-3427 End Stage Renal Disease Application and Survey and
Certification Report
CMS-484, 846, 854, 847, 848, 849, 10125, and 10126 Durable Medical
Equipment Medicare Administrative
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: Reinstatement with
change of a previously approved collection; Title of Information
Collection: End Stage Renal Disease Application and Survey and
Certification Report; Use: Part I of this form is a facility
identification and screening measurement used to initiate the
certification and recertification of ESRD facilities. Part II is
completed by the Medicare/Medicaid State survey agency to determine
facility compliance with ESRD conditions for coverage. Form Number:
CMS-3427 (OMB control number: 0938-0360); Frequency: Every three years;
Affected Public: Private sector (Business or other for-profit and Not-
for profit institutions); Number of Respondents: 7,493; Total Annual
Responses: 2,473; Total Annual Hours: 824. (For policy questions
regarding this collection contact Jennifer Milby at 410-786-8828).
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Durable Medical Equipment Medicare Administrative Contractor
Certificate of Medical Necessity and Supporting Documentation
Requirements; Use: The certificates of medical necessity (CMNs) collect
information required to help determine the medical necessity of certain
items. CMS requires CMNs where there may be a vulnerability to the
Medicare program. Each initial claim for these items must have an
associated CMN for the beneficiary. Suppliers (those who bill for the
items) complete the administrative information (e.g., patient's name
and address, items ordered, etc.) on each CMN. The 1994 Amendments to
the Social Security Act require that the supplier also provide a
narrative description of the items ordered and all related accessories,
their charge for each of these items, and the Medicare fee schedule
allowance (where applicable). The supplier then sends the CMN to the
treating physician or other clinicians (e.g., physician assistant, LPN,
etc.) who completes questions pertaining to the beneficiary's medical
condition and signs the CMN. The physician or other clinician returns
the CMN to the supplier who has the option to maintain a copy and then
submits the CMN electronically to CMS, along with a claim for
reimbursement. Form Numbers: CMS-484, 846, 847, 848, 849, 10125, 10126
(OMB control number: 0938-0679); Frequency: Occasionally; Affected
Public: Individuals or Households; Number of Respondents: 1,335,658;
Total Annual Responses: 1,335,658; Total Annual Hours: 267,132. (For
policy questions regarding this collection contact Melissa Singer at
410-786-0365.)
Dated: October 23, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2019-23504 Filed 10-25-19; 8:45 am]
BILLING CODE 4120-01-P