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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:
0938-1368
ICR Reference No:
202004-0938-006
Status:
Historical Active
Previous ICR Reference No:
201909-0938-012
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CCSQ
Title:
Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)
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:
07/14/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/23/2020
Terms of Clearance:
OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2023
36 Months From Approved
Responses
151,451
0
0
Time Burden (Hours)
73,242
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for establishing a new prior authorization process and requirements for certain outpatient department (OPD) services. This process will be under the authority of §1833(t)(2)(F) which authorizes the Secretary to develop a method for controlling unnecessary increases in the volume of covered OPD services. It will establish criteria for identifying a list of outpatient department services requiring prior authorization and will focus on five groups of OPD services – Blepharoplasty, Botulinum Toxin Injections, Panniculectomy, Rhinoplasty, Vein Ablation, and their related services. CMS recently completed an analysis of the volume of covered OPD services furnished and recognized significant increases in the utilization volume of these services. CMS believes a prior authorization process for OPD services would ensure beneficiaries receive medically necessary care while protecting the Medicare Trust Funds from improper payments and unnecessary utilization
Authorizing Statute(s):
US Code:
42 USC 1895I
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AT74
Final or interim final rulemaking
84 FR 61142
11/12/2019
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 39398
08/09/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 61142
11/08/2019
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
Proposed Prior Authorization Proces
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
151,451
0
0
151,451
0
0
Annual Time Burden (Hours)
73,242
0
0
73,242
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The annualized burden hours have decreased from 108,044 stated in the proposed rule to 73,242 hours in the final rule. The annualized burden cost has decreased from $3,851,504 stated in the proposed rule to $2,604,167 in the final rule. In the proposed rule, the hour/cost burden was calculated using historical claims data, which included all claims lines billed on the claim and inaccurately inflated the burden. For the final rule, CMS used historical data to calculate at the revenue line level, which allowed for a more specific estimate as it ensures that only the claim lines that included the selected codes are included in the estimate. Additionally, based on the comments received on our proposal, CMS included two additional HCPCS codes to the list of codes that require prior authorization. Coupled with the change in methodology in our claim line calculations, these changes resulted in a net decrease in burden hours and costs.
Annual Cost to Federal Government:
$6,200,000
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?
No
Agency Contact:
Denise King 410 786-1013 Denise.King@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:
04/23/2020
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