Approved for use
through 1/93 under the condition that HCFA fully responds to the
previous clearance conditions dated 6/90. In particular, HCFA
should reestimate the burden based upon the average response time
for data retrieval and completion of the Form. In its supporting
statement, HCFA argues that the burden estimate should reflect best
practices on the part of the physician, physician staff, and
hospital discharge staff. OMB, however, argues that the burden
should reflect the ACTUAL burden in the field, not what HCFA
believes the burden should be under optimal records management. In
addition, HCFA should clarify that at a minimum, RNs in a hospital
setting may complete this Form, and should consider allowing
qualified health professionals to complete this Form in all
provider settings. Finally HCFA should explain in more detail its
efforts to reevaluate the 3 month recertification requirements and
alternative recertification frequencies dependent upon patient
diagnosis, history of program abuse etc. Failure to comprehensively
address these issues in the next package's Supporting Statement and
timely resubmit it for OMB review shall result in a Disapproval
Action.
Inventory as of this Action
Requested
Previously Approved
01/31/1993
01/31/1993
600,000
0
0
15,000
0
0
0
0
0
S CERTIFICATION' MEDICARE CLAIMS FOR
HOME OXYGEN THERAPY MUST BE SUPPORTED BY THE ATTENDING PHYSICIAN'S
STATEMENT INCLUDING THE DIAGNOSIS, PRESCRIPTION DETAILS, AND THE
RESULTS OF TESTING TO ESTABLISH THE EXTENT OF HYPOXEMIA. FORM
HCFA-484 OBTAINS ALL PERTINENT INFORMATION AND SO PROMOTES NATIONAL
CONSISTENCY IN COVERAGE DETERMINATIONS.
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.
ATTENDING PHYSICIAN'S CERTIFICATION OF MEDICAL NECESSITY FOR HOME OXYGEN THERAPY