Pre-Claim Review Demonstration For Home Health Services (CMS-10599)

Forms and Documents

Document Name	Status
CMS-10599 - Responses for 60-day Comments.docx Supplementary Document	2022-05-09
CMS-10599 Renewal- Supporting StatementFinal.docx Supporting Statement A	2022-05-09

IC Document Collections

IC ID	Document Title	Status
222826	HH Demo - Home Health Agency Education (16 States) Instruction	Modified
222825	HH Demo for Mailed Requests (16 States) Instruction	Modified
222824	HH Demo Fax and Electronic Submissions and Resubmissions (16 States) Instruction	Modified

ICR Details

OMB Control No: 0938-1311	ICR Reference No: 202205-0938-011
Status: Received in OIRA	Previous ICR Reference No: 201810-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 10599
Title: Pre-Claim Review Demonstration For Home Health Services (CMS-10599)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/10/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,688,139	0
Time Burden (Hours)	1,357,224	0
Cost Burden (Dollars)	2,675,200	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for the Pre-Claim Review Demonstration for Home Health Services. This demonstration would help assure that payments for home health services are appropriate before the claims are paid, thereby preventing fraud, waste, and abuse. CMS proposes performing prior authorization before processing claims for home health services in: Florida, Texas, Illinois, Michigan, and Massachusetts.

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Authorizing Statute(s): PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 67473	11/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 26760	05/05/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
HH Demo - Home Health Agency Education (16 States)
HH Demo Fax and Electronic Submissions and Resubmissions (16 States)
HH Demo for Mailed Requests (16 States)

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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	2,688,139	0	0	0	482,702	2,205,437
Annual Time Burden (Hours)	1,357,224	0	0	1	221,451	1,135,772
Annual Cost Burden (Dollars)	2,675,200	0	0	0	-978,495	3,653,695

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: With the implementation of the Home Health Patient-Driven Groupings Model (PDGM), effective on January 1, 2020, claims are now submitted every 30 days instead of 60 days. Providers now submit two claims for each of the 30- day billing periods, where they previously submitted one for the whole 60-day episode of care. This has led to a significant increase in the number of claims submitted. While providers in Choice 1- Pre-Claim Review, may request more than one billing period at once to limit the number of reviews, providers may still request each billing period separately. In addition, there are more claims to review under the other review options. The overall burden has increased as a result of the change to submitting claims every 30 days instead of 60 days (from 1,132,772 to 1,357,224 for all 16 states).

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Annual Cost to Federal Government: $443,500,000

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: 05/10/2022

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