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Federal forms, ICRs, and supporting documents

Information Collection Request

Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detaile (CMS-10066)

ICR 201607-0938-010 · OMB 0938-1019 · Historical Active

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Supporting Statement A
2016-07-18
IC Document Collections
IC ID
Document
Title
Status
179807 Modified
ICR Details
0938-1019 201607-0938-010
Historical Active 201305-0938-015
HHS/CMS
Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges Detaile (CMS-10066)
Extension without change of a currently approved collection   No
Regular
Approved without change 10/12/2016
Retrieve Notice of Action (NOA) 07/20/2016
  Inventory as of this Action Requested Previously Approved
10/31/2019 36 Months From Approved 10/31/2016
22,515 0 12,852
22,515 0 12,852
0 0 0
Based on a settlement agreement of the Weichardt vs. Leavitt class action suit, CMS-4105-F sets forth new requirements for how hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge rights. Pursuant to sections 405.1206 and 422.622, hospitals and Medicare Advantage plans must deliver to beneficiaries and enrollees, who are appealing inpatient hospital discharges, a detailed notice providing the reasons for the discharge decision. Notice is required both for original Medicare beneficiaries and for beneficiaries enrolled in Medicare Advantage plans and other Medicare health plans subject to the MA regulations.
Statute at Large: 18 Stat. 1154 Name of Statute: null
  
None
Not associated with rulemaking
  80 FR 74112 11/27/2015
81 FR 38189 06/13/2016
No
  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 22,515 12,852 0 0 9,663 0
Annual Time Burden (Hours) 22,515 12,852 0 0 9,663 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The number of Medicare inpatient hospitals has decreased by 27 facilities. Since our 2013 PRA submission, the number of Medicare hospital discharges have increased by 2.4 million, from 12.4 million to 14.8 million; thus, the increase in discharge appeal requests by 9,663 is likely due to program growth and increased utilization of inpatient hospitalizations. This increase in the number of appeals requests results in a 9,663 hour increase in the annual hour burden (22,515 current hour burden estimate – 12,852 hour burden estimate in 2013).
$0
No
No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/20/2016