Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)

Forms and Documents

Document Name	Status
CMS-10711 Prior Authorization Supporting Statement 2-2-21.docx Supporting Statement A	2021-02-04

IC Document Collections

IC ID	Document Title	Status
237862	Proposed Prior Authorization Proces	Modified

ICR Details

OMB Control No: 0938-1368	ICR Reference No: 202102-0938-005
Status: Received in OIRA	Previous ICR Reference No: 202004-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI
Title: Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/04/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2023
Responses	151,451	151,451
Time Burden (Hours)	108,108	73,242
Cost Burden (Dollars)	0	0

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Abstract: 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

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Authorizing Statute(s): US Code: 42 USC 1895I Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU12	Final or interim final rulemaking	85 FR 85866	12/29/2020

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 48772	08/12/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 85866	12/29/2020
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Proposed Prior Authorization Proces

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ICR Summary of Burden

	Total Request	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	151,451	151,451	0	0	0	0
Annual Time Burden (Hours)	108,108	73,242	0	34,866	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The annualize burden hours and costs have increased due to the addition of the two new service categories. The annualized burden hours have increased from 73,242 hours stated in the CY 2020 OPPS/ASC final rule to 108,108 with the addition of the two new service categories. The annualized burden cost has increased from $ $2,604,167 for the initial five service categories to $3,839,146 with the inclusion of the two new service categories.

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Annual Cost to Federal Government: $9,300,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 02/04/2021

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