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Federal Register / Vol. 86, No. 22 / Thursday, February 4, 2021 / Notices amended Title XI of the Social Security Act to create the Utilization and Quality Control Peer Review Organization PRO
program which replaces the Professional Standards Review Organization PSRO
program and streamlines peer review activities. The term PRO has been renamed Quality Improvement Organization QIO. This information DATES: Comments on the collections of collection describes the review information must be received by the functions to be performed by the QIO.
OMB desk officer by March 8, 2021.
It outlines relationships among QIOs, ADDRESSES: Written comments and providers, practitioners, beneficiaries, recommendations for the proposed intermediaries, and carriers. Form information collection should be sent Number: CMSR71 OMB control within 30 days of publication of this number: 09380445; Frequency: Yearly;
notice to www.reginfo.gov/public/do/
Affected Public: Business or other forPRAMain. Find this particular profit and Not-for-profit institutions;
information collection by selecting Number of Respondents: 6,939; Total Currently under 30-day ReviewOpen Annual Responses: 972,478; Total for Public Comments or by using the Annual Hours: 1,034,655. For policy search function.
questions regarding this collection To obtain copies of a supporting contact Kimberly Harris at 401837
statement and any related forms for the 1118.
proposed collections summarized in 2. Type of Information Collection this notice, you may make your request Request: Extension of a currently using the following:
approved collection; Titles of 1. Access CMS website address at Information Collection: ASC Forms for website address at https www.cms.gov/ Medicare Program Certification; Use:
Regulations-and-Guidance/Legislation/
The form CMS370 titled Health PaperworkReductionActof1995/PRAInsurance Benefits Agreement is used Listing.html for the purpose of establishing an ASCs eligibility for payment under Title XVIII
FOR FURTHER INFORMATION CONTACT:
of the Social Security Act the Act.
William Parham at 410 7864669.
This agreement, upon acceptance by the SUPPLEMENTARY INFORMATION: Under the Secretary of Health & Human Services, Paperwork Reduction Act of 1995 PRA shall be binding on the ASC and the 44 U.S.C. 35013520, federal agencies Secretary. The agreement may be must obtain approval from the Office of terminated by either party in accordance Management and Budget OMB for each with regulations. In the event of collection of information they conduct termination of this agreement, payment or sponsor. The term collection of will not be available for the ASCs information is defined in 44 U.S.C.
services furnished to Medicare 35023 and 5 CFR 1320.3c and beneficiaries on or after the effective includes agency requests or date of termination.
requirements that members of the public The CMS377 form is used by ASCs submit reports, keep records, or provide to initiate both the initial and renewal information to a third party. Section survey by the State Survey Agency, 3506c2A of the PRA 44 U.S.C.
which provides the certification 3506c2A requires federal agencies required for an ASC to participate in the to publish a 30-day notice in the Medicare program. An ASC must Federal Register concerning each complete the CMS377 form and send it proposed collection of information, to the appropriate State Survey Agency including each proposed extension or prior to their scheduled accreditation reinstatement of an existing collection renewal date. The CMS377 form of information, before submitting the provides the State Survey Agency with collection to OMB for approval. To information about the ASC facilitys comply with this requirement, CMS is characteristics, such as, determining the publishing this notice that summarizes size and the composition of the survey the following proposed collections of team on the basis of the number of ORs/
information for public comment:
procedure rooms and the types of 1. Type of Information Collection surgical procedures performed in the Request: Extension of a currently ASC. Form Numbers: CMS370 and approved collection; Title of CMS377 OMB control number: 0938
Information Collection: Quality 0266; Frequency: Occasionally;
Improvement Organization QIO
Affected Public: Private Sector Business or other for-profit and Not-forAssumption of Responsibilities and profit institutions; Number of Supporting Regulations; Use: The Peer Respondents: 1,567; Total Annual Review Improvement Act of 1982

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the agencys functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

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Responses: 1,567; Total Annual Hours:
1,012. For policy questions regarding this collection contact Caroline Gallaher at 4107868705.
3. Type of Information Collection Request: Reinstatement with change of a previously approved collection; Title of Information Collection: Home Health Agency Survey and Deficiencies Report;
Use: In order to participate in the Medicare Program as a Home Health Agency HHA provider, the HHA must meet federal standards. This form is used to record information and patients health and provider compliance with requirements and to report the information to the federal government.
Form Number: CMS1572 OMB control number: 09380355; Frequency: Yearly;
Affected Public: State, Local or Tribal Government; Number of Respondents:
3,833; Total Annual Responses: 3,833;
Total Annual Hours: 1,917. For policy questions regarding this collection contact Tara Lemons at 4107863030.
4. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Final Peer Review Organizations Sanction Regulations; Use: The Peer Review Improvement Act of 1982 amended Title XI of the Social Security Act the Act, creating the Utilization and Quality Control Peer Review Organization Program. Section 1156 of the Act imposes obligations on health care practitioners and others who furnish or order services or items under Medicare.
This section also provides for sanction actions, if the Secretary determines that the obligations as stated by this section are not met. Quality Improvement Organizations QIOs are responsible for identifying violations. The QIOs may allow practitioners or other entities, opportunities to submit relevant information before determining that a violation has occurred. The information collection requirements contained in this information collection request are used by the QIOs to collect the information necessary to make their decision. Form Number: CMSR65
OMB control number: 09380444;
Frequency: Occasionally; Affected Public: Private sectorBusiness or other for-profit and Not-for-profit institutions;
Number of Respondents: 18; Total Annual Responses: 18; Total Annual Hours: 4,716. For policy questions regarding this collection contact Kimberly Harris at 4018371118.

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