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)