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 ).

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 Collections

1. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title of Information Collection: Organ Procurement Organization (OPO) Request for Designation as an OPO, Health Insurance Benefits Agreement, and Supporting Regulations; Use: We are requesting reinstatement without change of the OMB approval for the ( printed page 61407) CMS-576 and CMS-576A forms. A Centers for Medicare & Medicaid Services (CMS) approved (OPO) is an organization that is certified by CMS and responsible for facilitating the procurement, recovery, and distribution of human organs for transplantation. They must abide by CMS regulations and undergo regular inspections to ensure compliance with performance standards.

Organizations seeking initial designation from CMS as a qualified and approved OPO, as per §§ 371(a) and 1138 of the Social Security Act (“the Act”) must complete and submit the CMS-576 form, titled “Organ Procurement Organization (OPO) Request for Designation as An OPO Under § 1138 Of the Social Security Act.” After designation as an OPO, the organization must sign a “Health Insurance Benefits Agreement” (CMS-576A form) in order to be reimbursed by Medicare for their services.

The CMS-576A form requires OPOs to agree to comply with current CMS regulations. This includes an agreement to maintain compliance with the requirements of titles XVIII and XIX of the Act, § 1138 of the Act, applicable regulations including the conditions set forth in Part 486, subpart G, title 42 of the Code of Federal Regulations, those conditions of the Organ Procurement and Transplantation Network established under § 372 of the Public Health Service Act that have been approved by the Secretary, and to report promptly to CMS. Form Number: CMS-576 and 576A (OMB Control Number: 0938-0512); Frequency: Occasionally; Affected Public: Private Sector (Business or other for-profit and Not-for-profit institutions); Number of Respondents: 16; Total Annual Responses: 16; Total Annual Hours: 32. (For policy questions regarding this collection contact Caroline Gallaher at 410-786-8705.)

2. Type of Information Collection Request: Extension of currently approved; Title of Information Collection: Home Health Agency Cost Report; Use: The Form CMS-1728-20 cost report is used to determine a provider's reasonable cost incurred in furnishing medical services to Medicare beneficiaries and reimbursement due to or from a provider. The Form CMS-1728-20 cost report is also used for annual rate setting and payment refinement activities, including developing a home health market basket. Additionally, the Medicare Payment Advisory Commission (MedPAC) uses the home health cost report data to calculate Medicare margins, to formulate recommendations to Congress regarding the HHA PPS, and to conduct additional analysis of the HHA PPS.

The primary function of the cost report is to implement the principles of cost reimbursement which require that HHAs maintain sufficient financial records and statistical data for proper determination of costs payable under the program. The S series of worksheets collects the provider's location, CBSA, date of certification, operations, and unduplicated census days. The A series of worksheets collects the provider's trial balance of expenses for overhead costs, direct patient care services by level of care, and non-revenue generating cost centers. The B series of worksheets allocates the overhead costs to the revenue and non-revenue generating cost centers using functional statistical bases. The C series of worksheets computes the average cost per visit for HHA services. The D series of worksheets are Medicare specific and are used to determine reimbursement due to the provider or program. The F series of worksheets collect data from a provider's balance sheet and income statement. Form Number: CMS-1728-20 (OMB control number: 0938-0022); Frequency: Yearly; Affected Public: Private Sector—Business or other for-profits, Not-for-profit institutions; Number of Respondents: 12,240; Total Annual Responses: 12,240; Total Annual Hours: 2,421,900. (For policy questions regarding this collection contact LuAnn Piccione at (410) 786-5423.)

91 FR 61406