Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare

Forms and Documents

Document Name	Status
Form CMS-R-193 SP Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare Form	Modified
Statement of Changes to the Important Message from Medicare.doc Justification for No Material/Nonsubstantive Change	2007-06-28

IC Document Collections

IC ID	Document Title	Status
8309	Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare Form	Modified

ICR Details

OMB Control No: 0938-0692	ICR Reference No: 200706-0938-007
Status: Historical Active	Previous ICR Reference No: 200704-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2007
	Date Received in OIRA: 06/28/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	05/31/2010	05/31/2010
Responses	13,000,000	0	13,000,000
Time Burden (Hours)	3,250,000	0	3,250,000
Cost Burden (Dollars)	0	0	0

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Abstract: As a result of the Weichardt v. Leavitt class action lawsuit, CMS proposed that hospitals and Medicare Advantage plans deliver a new advance notice of discharge to Medicare beneficiaries who are receiving inpatient hospital services. In response to public comments, CMS set forth a final rule, CMS-4105-F, for how hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge rights. Notice is required both for original Medicare beneficiaries and for beneficiaries enrolled in Medicare Advantage plans and other Medicare health plans subject to the MA regulations. Under the final rule, hospitals will use a revised version of the Important Message from Medicare (IM), an existing statutorily required notice, to explain the discharge rights. Hospitals must issue the IM within two days of admission, and must obtain the signature of the beneficiary or his or her representative. Hospitals generally must also deliver a copy of the signed notice to each beneficiary not more than two days before the day of discharge. This notice fulfills the regulatory requirement.

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Authorizing Statute(s): Statute at Large: 18 Stat. 1866 Name of Statute: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AO41	Final or interim final rulemaking	71 FR 17052	04/05/2006

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 568	01/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 17169	04/06/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare	CMS-R-193 SP, CMS-R-193	MENSAJE IMPORTANTE DE MEDICARE SOBRE SUS DERECHOS ,   The Important Message From Medicare

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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	13,000,000	13,000,000	0	0	0	0
Annual Time Burden (Hours)	3,250,000	3,250,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/28/2007

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