Rural Health Clinics (RHCs) Reporting of Healthcare Common Procedure Coding System (HCPCS) and Other Codes as Required for RHC Claims and Supporting Regulations (CMS-10568)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10568 - Supporting Statement A [rev 11-16-2015 by OSORA PRA].docx	Supporting Statement A	Uploaded 2015-11-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217367	Payment for RHC and FQHC Services (sec. 405.2462(g)(3))		Unchanged

ICR Details

OMB Control No: 0938-1287	ICR Reference No: 201511-0938-006
Status: Historical Active	Previous ICR Reference No: 201507-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Rural Health Clinics (RHCs) Reporting of Healthcare Common Procedure Coding System (HCPCS) and Other Codes as Required for RHC Claims and Supporting Regulations (CMS-10568)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/02/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/17/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved
Responses	8,964,208	0	0
Time Burden (Hours)	522,912	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS regulations require covered entities to report a standard medical code set for electronic health care transactions, although CMS program instructions have directed RHCs to submit HCPCS codes only for approved preventive health services. Under section 1862(a)(22) of the Social Security Act (the Act), payment under Medicare Part A and B shall only be made for claims submitted in electronic form, subject to exceptions under section 1862(h) of the Act. Section 1173(a)(1) of the Act authorized the Secretary to adopt standards and data elements for financial and administrative transactions exchanged electronically. The regulations at 45 CFR 162.1000, define level I and level II of the HCPCS coding as standard medical code sets for healthcare transactions. In the CY 2016 PFS proposed rule, CMS proposed that all RHCs, including RHCs exempt from electronic reporting under §424.32(d)(3), are required to submit HCPCS and other codes as required on claims for services furnished. The requirements for RHCs to submit HCPCS codes on RHC claims have been finalized in the CY 2016 PFS final rule with comment period.

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Authorizing Statute(s): US Code: 45 USC 162.1000 Name of Law: General Requirements
  

Citations for New Statutory Requirements: US Code: 45 USC 162.1000 Name of Law: General Requirements

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS40	Final or interim final rulemaking	80 FR 70886	11/16/2015

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 41685	07/15/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 70886	11/16/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Payment for RHC and FQHC Services (sec. 405.2462(g)(3))

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ICR Summary of Burden

table that charts list 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	8,964,208	0	8,964,208	0	0	0
Annual Time Burden (Hours)	522,912	0	522,912	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: This is a new collection.

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 11/17/2015

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