Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)

Forms and Documents

Document Name	Status
Crosswalk Document 7.2010.docx Supplementary Document	2010-11-19
CMS-10207 Supporting Statement-8.2010 final clean.doc Supporting Statement A	2010-11-19

IC Document Collections

IC ID	Document Title	Status
45541	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)	Removed
45540	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donor and Representative Negotiation(CMS-10207)	Modified
45539	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donation of Technology	Modified
45538	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records - Preparing Model Agreements	Modified
181366	Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)	Removed

ICR Details

OMB Control No: 0938-1009	ICR Reference No: 201012-0938-005
Status: Historical Inactive	Previous ICR Reference No: 200707-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 04/05/2011
	Date Received in OIRA: 12/06/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	04/30/2011
Responses	54,730	0	54,730
Time Burden (Hours)	17,545	0	17,545
Cost Burden (Dollars)	0	0	0

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Abstract: As required by section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS created an exception to the physician self-referral prohibition for certain arrangements in which a physician receives non-monetary remuneration in the form of items or services that is necessary and used solely to receive and transmit electronic prescription information. Also, CMS created a regulatory exception for certain arrangements involving the provision of non-monetary remuneration in the form of electronic health records software or information technology and training services necessary and used predominantly to create, maintain, transmit, and receive electronic health records.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 55330	09/10/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 70926	11/19/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donor and Representative Negotiation(CMS-10207)
Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)
Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records (CMS-1303-F)
Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records - Preparing Model Agreements
Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records-Donation of Technology

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

Burden Increase Due to:

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

Burden Reduction Due to: Using Information Technology

Short Statement: The annual burden hours decreased due to fewer providers drafting original agreements and the decrease in the annual number of responses is due to a reduced number of providers adopting this technology because many already have.

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 12/06/2010

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