This information
collection request is approved as an extension, noting that CMS
intends to display the expiration date. The expiration date must be
displayed, along with the OMB control number, on all paper and
electronic versions of this collection.
Inventory as of this Action
Requested
Previously Approved
03/31/2020
36 Months From Approved
03/31/2017
63,601,300
0
52,967,771
7,420,364
0
6,177,101
0
0
0
The use of written notices to inform
beneficiaries of their liability under specific conditions has been
available since Title XVIII of the Social Security Act (the Act),
section 1879, Limitation On Liability, was enacted in 1972 (P.L.
92-603). Similar required notification and liability protections
are available under other sections of the Act: section 1834(a)(18)
refund requirements for certain items when unsolicited telephone
contacts are made, section 1834(j)(4) for the same types of items
when there is neither a required advance coverage determination nor
required supplier number; 1834(a)(15) also for advance
determinations for these items and section 1842(l) applicable to
physicians not accepting assignment. Implementing regulations are
found at 42 CFR 411.404(b) and (c), and 411.408(d)(2) and (f), on
written notice requirements. These statutory requirements apply
only to Original Medicare, not Medicare Advantage plans. Under
section 1879 of the Act, Medicare beneficiaries may be held
financially responsible for items or services usually covered under
Medicare, but denied in an individual case under specific statutory
exclusions, if the beneficiary is informed prior to furnishing the
issues or services that Medicare is likely to deny payment. When
required, the ABN is delivered by Part B paid physicians, providers
(including institutional providers like outpatient hospitals)
practitioners (such as chiropractors), and suppliers, as well as
hospice providers and Religious Non-medical Health Care
Institutions paid under Part A. Other Medicare institutional
providers paid under Part A use other approved notice for this
purpose.
Statute at
Large: 18
Stat. 1879 Name of Statute: null
We have also adjusted our
burden estimates based on an overall increase in respondents and
Medicare claims filed by the respondents. This iteration also
contains a number of nonsubstantive changes to the ABN.
$0
No
No
No
No
No
Uncollected
William Parham
4107864669
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-R-131 Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408
CMS-R-131 - Supporting Statement A [rev 04-26-2016 by OSORA PRA].doc
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408