Disclosure Requirement for the In-Office Ancillary Services Exception (CMS-10332)

ICR 201709-0938-003

OMB: 0938-1133

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2017-09-21
IC Document Collections
IC ID
Document
Title
Status
194232
Modified
194231
Modified
ICR Details
0938-1133 201709-0938-003
Active 201406-0938-005
HHS/CMS CMS-10332 (CM/CCPG/DTPC)
Disclosure Requirement for the In-Office Ancillary Services Exception (CMS-10332)
Extension without change of a currently approved collection   No
Regular
Approved without change 01/02/2018
Retrieve Notice of Action (NOA) 09/21/2017
  Inventory as of this Action Requested Previously Approved
01/31/2021 36 Months From Approved 01/31/2018
273,774 0 761,676
17,881 0 19,638
0 0 0

In order to implement section 6003 of the Affordable Care Act, CMS has proposed to amend 42 C.F.R. 411.355(b). Section 6003 establishes a new disclosure requirement for physicians who refer magnetic resonance imaging, computed tomography, and positron emission tomography (MRI, CT and PET) under the in-office ancillary services exception to the prohibition on physician self-referral (section 1877 of the Social Security Act). Under this new requirement physicians must inform patients in writing, at the time of the referral, that the patient may receive the imaging service from another supplier. The physician must also provide the patient with a list of other suppliers that from whom the patient may obtain the services. The proposed rule provides detail regarding what criteria must be included in the disclosure notifcation and supplier list in order to satisfy this new requirement.

PL: Pub.L. 111 - 148 6003 Name of Law: Disclosure requirements for in-office ancillary services exception
  
PL: Pub.L. 111 - 148 6003 Name of Law: Disclosure requirements for in-office ancillary services exception

Not associated with rulemaking

  82 FR 28852 06/26/2017
82 FR 43378 09/15/2017
No

2
IC Title Form No. Form Name
Development of Form
Disclosure Requirement

  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 273,774 761,676 0 0 -487,902 0
Annual Time Burden (Hours) 17,881 19,638 0 0 -1,757 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The burden estimates have been updated to reflect changes in the number of physicians, the number of disclosures, and the hourly wages of the personnel preparing and delivering the disclosure. However, we have made no changes to the information being collected.

$0
No
    No
    No
Yes
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.
09/21/2017


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