OMB is approving
this information collection request for a period of three years
during which time the agency will request approval to extend or
revise the collection if the agency seeks to continue the
information collection activity beyond the period approved under
this action.
Inventory as of this Action
Requested
Previously Approved
07/31/2023
36 Months From Approved
151,451
0
0
73,242
0
0
0
0
0
The Centers for Medicare &
Medicaid Services (CMS) is requesting the Office of Management and
Budget (OMB) approval for establishing a new prior authorization
process and requirements for certain outpatient department (OPD)
services. This process will be under the authority of
§1833(t)(2)(F) which authorizes the Secretary to develop a method
for controlling unnecessary increases in the volume of covered OPD
services. It will establish criteria for identifying a list of
outpatient department services requiring prior authorization and
will focus on five groups of OPD services – Blepharoplasty,
Botulinum Toxin Injections, Panniculectomy, Rhinoplasty, Vein
Ablation, and their related services. CMS recently completed an
analysis of the volume of covered OPD services furnished and
recognized significant increases in the utilization volume of these
services. CMS believes a prior authorization process for OPD
services would ensure beneficiaries receive medically necessary
care while protecting the Medicare Trust Funds from improper
payments and unnecessary utilization
US Code:
42
USC 1895I Name of Law: Social Security Act
The annualized burden hours
have decreased from 108,044 stated in the proposed rule to 73,242
hours in the final rule. The annualized burden cost has decreased
from $3,851,504 stated in the proposed rule to $2,604,167 in the
final rule. In the proposed rule, the hour/cost burden was
calculated using historical claims data, which included all claims
lines billed on the claim and inaccurately inflated the burden. For
the final rule, CMS used historical data to calculate at the
revenue line level, which allowed for a more specific estimate as
it ensures that only the claim lines that included the selected
codes are included in the estimate. Additionally, based on the
comments received on our proposal, CMS included two additional
HCPCS codes to the list of codes that require prior authorization.
Coupled with the change in methodology in our claim line
calculations, these changes resulted in a net decrease in burden
hours and costs.
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.
CMS-10711 Prior Authorization Supporting Statement v2 (4-22-20).docx
Proposed Prior Authorization Proces