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

ICR 202205-0938-011

OMB: 0938-1311

Federal Form Document

Forms and Documents
Supplementary Document
Supporting Statement A
ICR Details
0938-1311 202205-0938-011
Received in OIRA 201810-0938-001
HHS/CMS CPI - 10599
Pre-Claim Review Demonstration For Home Health Services (CMS-10599)
Reinstatement with change of a previously approved collection   No
Regular 05/10/2022
  Requested Previously Approved
36 Months From Approved
2,688,139 0
1,357,224 0
2,675,200 0

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.

PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act
PL: Pub.L. 90 - 248 234 Name of Law: Social Security Act

Not associated with rulemaking

  86 FR 67473 11/26/2021
87 FR 26760 05/05/2022

  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
Miscellaneous Actions
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).

Jamaa Hill 301 492-4190


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.

© 2022 | Privacy Policy