Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24

ICR 201110-0938-007

OMB: 0938-0236

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2011-10-12
Supplementary Document
2011-10-12
Supplementary Document
2011-10-12
Supporting Statement A
2011-10-12
IC Document Collections
IC ID
Document
Title
Status
7893 Modified
ICR Details
0938-0236 201110-0938-007
Historical Active 201008-0938-022
HHS/CMS
Independent Renal Dialysis Facility Cost Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24
Revision of a currently approved collection   No
Regular
Approved without change 11/28/2011
Retrieve Notice of Action (NOA) 10/14/2011
  Inventory as of this Action Requested Previously Approved
11/30/2014 36 Months From Approved 10/31/2013
5,654 0 5,508
367,510 0 275,400
0 0 0
The Independent Renal Dialysis Facility Cost Report provides for the determination and allocation of costs to the components of the facility in order to establish a proper basis for Medicare payment.
PL: Pub.L. 110 - 275 153 Name of Law: Medicare Improvements for Patients and Providers Act
   US Code: 42 USC 1395g Name of Law: Payment of Providers of Services
  
PL: Pub.L. 110 - 275 153 Name of Law: Medicare Improvements for Patients and Providers Act
Not associated with rulemaking
  76 FR 18222 04/01/2011
76 FR 62414 10/07/2011
Yes
  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 5,654 5,508 0 0 146 0
Annual Time Burden (Hours) 367,510 275,400 55,445 27,175 9,490 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
The forms are revised in accordance with the End-Stage Renal Disease Prospective Payment System Final Rule published August 12, 2010 which implemented statutory requirements of the Medicare Improvements for Patients and Providers Act (MIPPA), enacted July 15, 2008. Additionally, the forms are revised to incorporate data previously reported on the Provider Cost Report Reimbursement Questionnaire, Form CMS-339. o On a per respondent basis, revisions to the MCR to implement ESRD PPS resulted in an increase in burden of 10 hours. o On a per respondent basis, incorporating the Form CMS-339 into the revised MCR resulted in an increase in burden of 5 hours for this information collection. (However, the overall burden to the provider decreased by 11 hours as a result of eliminating the paper Form CMS-339, for which the burden was estimated at 16 hours.) o The estimated number of respondents increased by 146 (from 5,508 as of 03/15/2010 to 5,654 as of 03/04/2011).
$44,715,900
No
No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]
  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.
10/14/2011
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