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

ICR 202208-0938-001

OMB: 0938-1368

Federal Form Document

Forms and Documents
Supporting Statement A
ICR Details
0938-1368 202208-0938-001
Received in OIRA 202102-0938-005
Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)
Revision of a currently approved collection   No
Regular 08/02/2022
  Requested Previously Approved
36 Months From Approved 07/31/2024
564,010 151,451
289,926 108,108
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

0938-AU82 Proposed rulemaking 87 FR 44502 07/26/2022


  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 564,010 151,451 0 412,559 0 0
Annual Time Burden (Hours) 289,926 108,108 0 181,818 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Changing Regulations
The burden has increased to account for an increased number of respondents as well as the addition of a new service category to the prior authorization process.

William Parham 4107864669


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.

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