Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 (CMS-R-131)

ICR 201912-0938-015

OMB: 0938-0566

Federal Form Document

ICR Details
0938-0566 201912-0938-015
Active 201605-0938-006
HHS/CMS CM-CPC
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408 (CMS-R-131)
Revision of a currently approved collection   No
Regular
Approved with change 06/09/2020
Retrieve Notice of Action (NOA) 12/23/2019
  Inventory as of this Action Requested Previously Approved
06/30/2023 36 Months From Approved 06/30/2020
382,216,385 0 63,601,300
44,593,186 0 7,420,364
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
  
None

Not associated with rulemaking

  84 FR 43135 08/20/2019
84 FR 69380 12/18/2019
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 382,216,385 63,601,300 0 0 318,615,085 0
Annual Time Burden (Hours) 44,593,186 7,420,364 0 0 37,172,822 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
CMS is using the same data that was used for the last PRA submission, however, CMS is including the Part B claims which should have been included in the last approved package for accurate data. If this information was included, the collection responses would have been 369,994,251 and have calculated a 12,222,134 increase, with a corresponding annual hour burden increase of 1,425,957 hours (from 43,167,229 hours to 44,593,186 if Part B claims were included).

$0
No
    No
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [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.
12/23/2019


© 2024 OMB.report | Privacy Policy