ATTENDING PHYSISIANS PARENTERAL/ENTERAL NUTRITION CERTIFICATION OF MEDICAL NECESSITY

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
114059	ATTENDING PHYSISIANS PARENTERAL/ENTERAL NUTRITION CERTIFICATION OF MEDICAL NECESSITY Form	Migrated

ICR Details

OMB Control No: 0938-0603	ICR Reference No: 199202-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: ATTENDING PHYSISIANS PARENTERAL/ENTERAL NUTRITION CERTIFICATION OF MEDICAL NECESSITY
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/22/1992
	Date Received in OIRA: 02/24/1992
Terms of Clearance: Approved for use through 12/93 with the understanding that the followi flexibility will be provided: 1) suppliers may complete the "beneficia identification" section in the forms; 2) health care professionals supervised by the attending physician may complete all sections of the forms with the exception of the physician certification at the bottom; and 3) physicians may use office letterhead to submit at a minimum, the data required by the forms. In addition, prior to use in the fiel HCFA will revise question D.1. of the parenteral nutritional therapy form and the instructions to ensure that the question applies only to the most appropriate patients and medical conditions. OMB is concerne that this question on laboratory test utilization may in certain instances encourage physicians to order unnecessary tests to ensure Medicare reimbursement. HCFA should submit a draft revised version of this form and instructions to OMB at least two weeks prior to printing to demonstrate compliance with these conditions of approval. Finally, the next submission for OMB approval will include an analysis of the practical utility and cost effectiveness of the data collected on this form. This analysis should be done for each data element and combina tions of data elements used to make coverage decisions. The analysis should evaluate public and private information burden: 1) throughout t claims process; and 2) imposed by the standard form (electronic format versus letterhead submittal and any differences in claims actions.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/1993	12/31/1993
Responses	492,000	0	0
Time Burden (Hours)	128,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE CERTIFICATION FOR MEDICAL NECESSITY FOR PARENTERAL AND ENTERAL NUTRITION IS NEEDED TO PROTECT THE MEDICARE PROGRAM FROM PAYING FOR UNNECESSARY SERVICES BY STANDARDIZING THE INFORMATION COLLECTED TO DETERMINE COVERAGE. ATTENDING PHYSICIANS OR THEIR EMPLOYEES, UPON DIRECTION, WILL COMPLETE THE FORMS, WHICH WILL BE USED BY CARRIERS IN THE PROCESSING OF CLAIMS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
ATTENDING PHYSISIANS PARENTERAL/ENTERAL NUTRITION CERTIFICATION OF MEDICAL NECESSITY	HCFA-191, 195

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	492,000	0	0	492,000	0	0
Annual Time Burden (Hours)	128,400	0	0	128,400	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/24/1992

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