Pre-Claim Review Demonstration For Home Health Services (CMS-10599)

Forms and Documents

Document Name	Status
Responses for the HH PRA Comments - Final.docx Supplementary Document	2016-07-29
CMS-10599.Supporting Statement Part A 8-2-16 (CLEAN).docx Supporting Statement A	2016-08-02
CMS-10599 - Responses for the HH PRA comments1.pdf Supplementary Document	2016-06-22

IC Document Collections

IC ID	Document Title	Status
222826	HH Demo - Home Health Agency Education (Michigan and Massachusetts) Instruction	New
222825	HH Demo for Mailed Requests (Michigan and Massachusetts) Instruction	New
222824	HH Demo Fax and Electronic Submissions and Resubmissions (Michigan and Massachusetts) Instruction	New
222823	HH Demo - Home Health Agency Education (Illinois, Florida, Texas) Instruction	New
222819	HH Demo for Mailed Requests (Illinois, Florida, Texas) Instruction	New
222818	HH Demo Fax and Electronic Submissions and Resubmissions (Illinois, Florida, Texas)	New

ICR Details

OMB Control No: 0938-1311	ICR Reference No: 201606-0938-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Pre-Claim Review Demonstration For Home Health Services (CMS-10599)
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 with change	Conclusion Date: 08/03/2016
	Date Received in OIRA: 06/24/2016
Terms of Clearance: We ask that the agency continue to review other collections to determine if there is a corresponding decrease in burden as a result of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved
Responses	2,955,403	0	0
Time Burden (Hours)	1,492,710	0	0
Cost Burden (Dollars)	737,355	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for the Pre-Claim Review Demonstration for Home Health Services. This demonstration would help assure that payments for home health services are appropriate before the claims are paid, thereby preventing fraud, waste, and abuse. CMS proposes performing prior authorization before processing claims for home health services in: Florida, Texas, Illinois, Michigan, and Massachusetts.

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Authorizing Statute(s): PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act

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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:
	81 FR 6275	02/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 40308	06/21/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
HH Demo Fax and Electronic Submissions and Resubmissions (Illinois, Florida, Texas)
HH Demo for Mailed Requests (Illinois, Florida, Texas)
HH Demo - Home Health Agency Education (Illinois, Florida, Texas)
HH Demo Fax and Electronic Submissions and Resubmissions (Michigan and Massachusetts)
HH Demo for Mailed Requests (Michigan and Massachusetts)
HH Demo - Home Health Agency Education (Michigan and Massachusetts)

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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	2,955,403	0	2,955,403	0	0	0
Annual Time Burden (Hours)	1,492,710	0	1,492,710	0	0	0
Annual Cost Burden (Dollars)	737,355	0	737,355	0	0	0

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: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $152,050,000

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: 06/24/2016

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