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

Forms and Documents

Document Name	Status
CMS-10599 - Appendix 2 - Review Choice Demonstration HHS Design - 30-day.docx Supplementary Document	2018-10-09
CMS-10599 - Appendix 1 - Responses for the HH RCD PRA Comments.docx Supplementary Document	2018-10-09
CMS-10599 - Supporting Statement Clean.docx Supporting Statement A	2018-10-09

IC Document Collections

IC ID	Document Title	Status
222826	HH Demo - Home Health Agency Education (16 States) Instruction	Modified
222825	HH Demo for Mailed Requests (16 States) Instruction	Modified
222824	HH Demo Fax and Electronic Submissions and Resubmissions (16 States) Instruction	Modified
222823	HH Demo - Home Health Agency Education (Illinois, Florida, Texas) Instruction	Removed
222819	HH Demo for Mailed Requests (Illinois, Florida, Texas) Instruction	Removed
222818	HH Demo Fax and Electronic Submissions and Resubmissions (Illinois, Florida, Texas)	Removed

ICR Details

OMB Control No: 0938-1311	ICR Reference No: 201810-0938-001
Status: Active	Previous ICR Reference No: 201606-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Pre-Claim Review Demonstration For Home Health Services (CMS-10599)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/26/2019
	Date Received in OIRA: 10/10/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved	08/31/2019
Responses	2,205,437	0	2,955,403
Time Burden (Hours)	1,135,772	0	1,492,710
Cost Burden (Dollars)	3,653,695	0	737,355

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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:
	83 FR 25012	05/31/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 48818	09/27/2018
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
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 (16 States)
HH Demo for Mailed Requests (16 States)
HH Demo - Home Health Agency Education (16 States)
HH Demo Fax and Electronic Submissions and Resubmissions (Illinois, Florida, Texas)

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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	2,205,437	2,955,403	0	0	-749,966	0
Annual Time Burden (Hours)	1,135,772	1,492,710	0	0	-356,938	0
Annual Cost Burden (Dollars)	3,653,695	737,355	0	0	2,916,340	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: The overall burden has decreased as a result of the proposed new review options that will allow for greater flexibility for the providers and different states being included (from 1,492,170 to 1,135,772 based on all 16 states being included in the demonstration).

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Annual Cost to Federal Government: $780,400,000

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 10/10/2018

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