Non-Substantial Justification Document

To: Jamie Wilson

Office of Information and Regulatory Affairs (OIRA)

Office of Management and Budget (OMB)

From: Janet Miller

Center for Medicare (CM)

Medicare Enrollment and Appeals Group (MEAG)

Date: December 19, 2022

Subject: Non-Substantive Change Request – Hospital Notices: IM/DND (OMB# 0938-1019; CMS-10065-10066)

This memo requests approval of a non-substantive change to the approved information collection, Hospital Notices: IM/DND (OMB# 0938-1019; CMS-10065-10066)

Background

The purpose of the Important Message from Medicare (IM) is to inform beneficiaries and enrollees of their rights as hospital inpatients and how to request a discharge appeal by a Quality Improvement Organization (QIO) and how to file a request. For all Medicare beneficiaries, hospitals must deliver valid, written notice of a beneficiary's rights as a hospital inpatient, including discharge appeal rights. The hospital must use a standardized notice, as specified by CMS. This is satisfied by IM delivery.

Consistent with 42 CFR 405.1205 for Original Medicare and 422.620 for Medicare health plans, hospitals must provide the initial IM within 2 calendar days of admission.  A follow-up copy of the signed IM is given no more than 2 calendar days before discharge. The follow-up copy is not required if the first IM is provided within 2 calendar days of discharge. In accordance with 42 CFR 405.1206 for Original Medicare and 422.622 for Medicare health plans, if a beneficiary/enrollee appeals the discharge decision, the beneficiary/enrollee and the QIO must receive a detailed explanation of the reason’s services should end.  This detailed explanation is provided to the beneficiary/enrollee using the Detailed Notice of Discharge (DND), the second notice included in this renewal package.

The collection was last approved by OMB on December 7, 2022 and expires on December 31, 2025.

Overview of Requested Changes

Subsequent to OMB’s approval, this Non-material/Non-substantive Change request includes the Spanish translation of the Medicare Outpatient Observation Notice. Otherwise, there are no program changes or burden adjustments.