[Federal Register Volume 62, Number 165 (Tuesday, August 26, 1997)]
[Notices]
[Pages 45263-45264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22588]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-484, HCFA-R-200]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Health Care Financing Administration, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Health Care Financing
Administration (HCFA), Department of Health and Human Services, is
publishing the following summary of proposed collections for public
comment. Interested persons are invited to send comments regarding this
burden estimate or any other aspect of this collection of information,
including any of the following subjects: (1) The necessity and utility
of the proposed information collection for the proper performance of
the agency's functions;
[[Page 45264]]
(2) the accuracy of the estimated burden; (3) ways to enhance the
quality, utility, and clarity of the information to be collected; and
(4) the use of automated collection techniques or other forms of
information technology to minimize the information collection burden.
1. Type of Information Collection Request: Extension of a currently
approved collection without change; Title of Information Collection:
Attending Physician's Certification of Medical Necessity for Home
Oxygen Therapy and Supporting Regulations 42 CFR 410.38 and 42 CFR
424.5; Form Number: HCFA-484 (OMB approval # 0938-0534); Use: To
determine oxygen is reasonable and necessary pursuant to Medicare
Statute, Medicare claims for home oxygen therapy must be supported by
the treating physician's statement and other information including
estimate length of need (# of months), diagnosis codes (ICD-9) and:
1. Results and date of the most recent arterial blood gas
PO2 and/or oxygen saturation tests.
2. The most recent arterial blood gas PO2 and/or oxygen
saturation test performed EITHER with the patient in a chronic stable
state as an outpatient, OR within two days prior to discharge from an
inpatient facility to home.
3. The most recent arterial blood gas PO2 and/or oxygen
saturation test performed at rest, during exercise, or during sleep.
4. Name and address of the physician/provider performing the most
recent arterial blood gas PO2 and/or oxygen saturation test.
5. If ordering portable oxygen, information regarding the patient's
mobility within the home.
6. Identification of the highest oxygen flow rate (in liters per
minute) prescribed.
7. If the prescribed liters per minute (LPM), as identified in item
6, are greater than 4 LPM, provide the results and date of the most
recent arterial blood gas PO2 and/or oxygen saturation test
taken on 4 LPM.
If the PO2=56-59, or the oxygen saturation=89%, then
evidence of the beneficiary meeting at least one of the following
criteria must be provided.
8. The patient having dependent edema due to congestive heart
failure.
9. The patient having cor pulmonale or pulmonary hypertension, as
documented by P pulmonale on an EKG or by an echocardiogram, gated
blood pool scan or direct pulmonary artery pressure measurement.
10. The patient having a hematocrit greater than 56%.
Form HCFA-484 obtains all pertinent information and promotes
national consistency in coverage determinations; Frequency: Other (as
needed); Affected Public: Individuals/households, business or other for
profit, and not for profit institutions; Number of Respondents:
300,000; Total Annual Responses: 300,000; Total Annual Hours Requested:
50,000.
2. Type of Information Request: Extension of a currently approved
collection without change; Title of Information Collection: HEDIS 3.0
(Health Plan Data and Information Set), including the Health of Seniors
and Consumer Assessment of Health Plans Study (CAHPS) surveys and
supporting regulations 42 CFR 417.470, and 42 CFR 417.126; Form Number:
HCFA-R-200 (OMB approval #0938-0701); Use: HEDIS and CAHPS will be used
for 3 purposes: (1) To provide summary comparative data to the Medicare
beneficiary to assist them in choosing among health plans; (2) to
provide information to health plans for internal quality improvement
activity; and (3) to provide HCFA, as purchaser, information useful for
monitoring quality of and access to care provided by the plans;
Frequency: Annually; Affected Public: Individuals or Households, non-
profit and for profit HMOs which contract with HCFA to provide managed
health care to Medicare beneficiaries; Number of Respondents: 293,834;
Total Annual Responses: 293,834 Total Annual Hours Requested: 181,520.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, E-mail your
request, including your address and phone number, to
Paperwork@hcfa.gov, or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information
collections must be mailed within 60 days of this notice directly to
the HCFA Paperwork Clearance Officer designated at the following
address: HCFA, Office of Information Services, Information Technology
Investment Management Group, Division of HCFA Enterprise Standards,
Attention: John P. Burke III, Room C2-26-17, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: August 19, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services,
Information Technology Investment Management Group, Division of HCFA
Enterprise Standards.
[FR Doc. 97-22588 Filed 8-25-97; 8:45 am]
BILLING CODE 4120-03-P
