Pursuant to 42 CFR 422.624(b)(1), providers in skilled nursing facilities, home health agencies and comprehensive outpatient rehabilitation facilities must deliver to MA enrollees a 2-day advance notice of termination of services. Per requirements at 42 CFR 422.626(e)(1), MA organizations must deliver detailed notices to the QIO and enrollees upon request for appeal of the termination of services. These notices fulfill the regulatory requirement.
42 CFR 417.600(b) provides that cost plans must follow these same fast track appeal notification procedures for their enrollees in SNFs HHAs and CORFs.
PL:
Pub.L. 108 - 173 234
Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
US Code:
42 USC 1395-21
Name of Law: Implementation of Medicare Advantage Program
During the initial certification of the NOMNC and DENC notices, we had no ability to determine the impact of the fast track notification process on MA organizations and providers. Although we now have actual data regarding the use of the process, we still do not know the number of providers required to deliver the NOMNC on behalf of MA organizations. Since CMS holds the MA organization liable and responsible for delivery of all notices, and compliance with the regulations governing the fast track appeal process, we decided to account for that burden only in this package. The change in burden numbers then, is due to reliance on actual appeals data gathered since implementation of the fast track process from MA organizations only. Additionally, the change in burden is due to the increase in the hourly rate for individuals responsible for collecting and formatting the appeals information (from 2003 wages to 2006 wages) in MA organizations.
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman
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:
(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.
Form CMS-10095 DENC "Detailed Explanation of Non-Coverage and Notice of Medicare Non-Coverage" and Supporting Regulations in 42 CFR 422.626(e)(1) and 42 CFR 422.624(b)(1)
CMS-10095 suppstateMA Expedited appealsfinal121906.doc
"Detailed Explanation of Non-Coverage and Notice of Medicare Non-Coverage" and Supporting Regulations in 42 CFR 422.626(e)(1) and 42 CFR 422.624(b)(1)