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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10711.Supporting Statement Part A.docx	Supporting Statement A	Uploaded 2022-12-01	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254983	Prior Authorization Process (One New Service Category - Facet Joint Interventions)		Modified
237862	Prior Authorization Process (Five Original Categories)		Modified

ICR Details

OMB Control No: 0938-1368	ICR Reference No: 202212-0938-002
Status: Historical Active	Previous ICR Reference No: 202208-0938-001
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
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/01/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/01/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved	07/31/2024
Responses	564,010	0	151,451
Time Burden (Hours)	269,413	0	108,108
Cost Burden (Dollars)	846,013	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 adding additional services to the established prior authorization process and requirements for certain outpatient department (OPD) services. This process is 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. CMS adds OPD services to the prior authorization process through the CY OPPS/ASC final rules. CMS' extensive data analysis of these additional OPD services demonstrated significant increases in the utilization volume. CMS believes a prior authorization process 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-AU82	Final or interim final rulemaking	87 FR 71748	11/23/2022

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Prior Authorization Process (Five Original Categories)
Prior Authorization Process (One New Service Category - Facet Joint Interventions)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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)	269,413	108,108	0	161,305	0	0
Annual Cost Burden (Dollars)	846,013	0	0	846,013	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: The annualized burden hours and costs have increased due to the addition of the new service category. The annualized burden hours have increased from 108,108 hours stated in the CY 2021 OPPS/ASC final rule for the current services to 269,413 with the addition of the new service category.

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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: 12/01/2022

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