View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1293
ICR Reference No:
201512-0938-014
Status:
Historical Active
Previous ICR Reference No:
201509-0938-004
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicare Program: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CMS-10524)
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 without change
Conclusion Date:
02/24/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/30/2015
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2019
36 Months From Approved
Responses
157,500
0
0
Time Burden (Hours)
78,750
0
0
Cost Burden (Dollars)
1,537,500
0
0
Abstract:
A revision is being made to ยง414.234 to require, as a condition for payment, submission of a prior authorization request to receive a provisional prior authorization decision for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). A claim with a provisional affirmative prior authorization submitted for processing will be paid as long as all other requirements are met. A claim with a non-affirmative decision or without a decision and submitted for processing will be denied.
Authorizing Statute(s):
US Code:
42 USC 1395m
Name of Law: Social Security Act
Citations for New Statutory Requirements:
US Code: 42 USC 1395m Name of Law: Social Security Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AR85
Final or interim final rulemaking
80 FR 81674
12/30/2015
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Submitting a Prior Authorization Request and Mailing Medical Records
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
157,500
0
0
157,500
0
0
Annual Time Burden (Hours)
78,750
0
0
78,750
0
0
Annual Cost Burden (Dollars)
1,537,500
0
0
1,537,500
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new information collection request.
Annual Cost to Federal Government:
$7,875,000
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
Agency Contact:
William Parham 410 786-4669 william.parham@cms.hhs.gov
Common Form ICR:
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:
(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:
12/30/2015
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