Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB)

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Form #HCFA-R-224]

Emergency Clearance: Public Information Collection Requirements

Submitted to the Office of Management and Budget (OMB)

In compliance with the requirement of section 3506(c)(2)(A) of the

Paperwork Reduction Act of 1995, the Health Care Financing

Administration (HCFA), Department of Health and Human Services (DHHS),

has submitted to the Office of Management and Budget (OMB) the

following request for Emergency review. We are requesting an emergency

review because the collection of this information is needed prior to

the expiration of the normal time limits under OMB's regulations at 5

CFR, part 1320. The Agency cannot reasonably comply with the normal

clearance procedures because of a statutory deadline imposed by section

1853(a)(3) of the Balanced Budget Act of 1997. Without this

information, HCFA would not be able to properly implement the

requirements set forth in the statute.

HCFA is requesting OMB review and approval of this collection by 5/

8/98, with a 180-day approval period. Written comments and

recommendations will be accepted from the public if received by the

individual designated below, by 5/6/98.

During this 180-day period HCFA will pursue OMB clearance of this

collection as stipulated by 5 CFR 1320.5.

Type of Information Collection Request: Extension of a currently

approved collection;

Title of Information Collection: Collection of Managed Care Data

Using the Uniform Institutional Providers Form (HCFA-1450/UB-92) and

Supporting Statute Section 1853(a)(3) of the Balanced Budget Act of

1997;

Form No.: HCFA-R-224;

Use: Section 1853(a)(3) of the Balanced Budget Act (BBA) requires

Medicare+Choice organizations, as well as eligible organizations with

risk-sharing contracts under section 1876, to submit encounter data.

Data regarding inpatient hospital services are required for periods

beginning on or after July 1, 1997. These data may be collected

starting January 1, 1998. Other data (as the Secretary deems necessary)

may be required beginning July 1, 1998.

The BBA also requires the Secretary to implement a risk adjustment

methodology that accounts for variation in per capita costs based on

health status. This payment method must be implemented no later than

January 1, 2000. The encounter data are necessary to implement a risk

adjustment methodology.

Hospital data from the period, July 1, 1997-June 30, 1998, will

serve as the basis for plan-level estimates of risk adjusted payments.

These estimates will be provided to plans by March, 1999. Encounter

data collected from subsequent time periods will serve as the basis for

actual payments to plans for CY 2000 and beyond.

In implementing the requirements of the BBA, hospitals will submit

data to the managed care plan for enrollees who have a hospital

discharge using the HCFA-1450 (UB-92), Uniform Institutional Provider

Claim Form. Encounter data for hospital discharges occurring on or

after July 1, 1997 are required. While submission from the hospital to

the plan is required, plans are provided with a start-up period during

which time an alternate submission route is permitted.

The six month start up period, beginning January 1, 1998 will

enable plans to accomplish the requirements of the BBA by the end of

the start-up period, or June 30, 1998. Special procedures have been

identified to ensure that hospital encounter data are submitted for

discharges occurring on or after July 1, 1997 and before June 30, 1998.

The special procedures for the start up period include the following:

1. In order to provide plans with an estimate of their Average

Payment Rate (APR) by March, 1999, HCFA must receive data on hospital

discharges that occurred on or after July 1, 1997 and before December

31, 1997, as well as encounter data on discharges that occur during the

start up period, or January 1, 1998 through June 30, 1998. Currently,

most plans do not have the capacity to submit data electronically to a

fiscal intermediary (FI), and the FIs are not capable of receiving

these data. Therefore, during this period only, unless an alternative

approach is approved by HCFA, hospitals must submit completed UB-92s

for the Plan's enrollees. These pseudo-claims must be submitted to the

hospital's regular fiscal intermediary. This is a current requirement

for hospitals, and they are expected to comply with this requirement

throughout this period. Plans must provide hospitals with the Medicare

identification number of all enrollees admitted who have Medicare

coverage.

If hospitals are unable to submit these data on behalf of the plan

during the start-up period, an alternate method of submitting the data

may be developed by HCFA. If such a method is developed, it would

require the plans to submit a subset of data elements that are found on

the UB-92. Possible data elements include the following: Plan Contract

Number; HIC (or Medicare Identification Number); enrollee's name;

enrollee's state and county of residence; enrollee's birthdate and

gender; Medicare Provider Number for the Hospital; claim from and thru

date; admission date; and principal and secondary diagnoses codes. HCFA

will specify the data elements, submission route, and format for these

data.

2. During the start up period, the plan is expected to establish an

electronic data linkage to a FI to be determined by HCFA. By June 30,

1998, the Plan is expected to have completed this

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linkage, including testing of the linkage, and to be capable of

transmitting hospital encounter data to an FI. All data submitted after

July 1, 1998 will be transmitted using this linkage. (See Attachment 1

for additional information on the transmission of data to HCFA.) Each

plan and/or contract will use a single FI.

HCFA will establish a series of interim deadlines to ensure that

plans are making sufficient progress toward accomplishing this linkage

no later than June 30, 1998. HCFA will assist plans in initiating

discussions with their FI.

After plans have established linkages to a FI, hospitals will

submit HCFA-1450 (UB-92) forms to the managed care plan. The HCFA-1450

(UB92) form is identical to the one used by hospitals in billing for

Medicare fee-for-service claims. After receiving the pseudo claim from

the hospital, the plan attaches the plan identifier, which is the HCFA

assigned managed care organization (MCO) Contract Number, and submits

the pseudo-claim electronically to the fiscal intermediary (FI). The

data processing flow by the FI is very similar to current claims

processing for the fee-for-service system, except that no payment is

authorized to the plan. Pseudo claims will flow though the FI to our

Common Working File (CWF) and will be retained by HCFA;

Frequency: On occasion;

Affected Public: Business or other for-profit, Not-for-profit

institutions, and Federal government;

Number of Respondents: 1.9 million;

Total Annual Responses: 1.9 million;

Total Annual Hours: 13,310.

To obtain copies of the supporting statement and any related forms

for the proposed paperwork collections referenced above, access HCFA's

Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail

your request, including your address, phone number, OMB number, and

HCFA document identifier, to P[email protected], or call the Reports

Clearance Office on (410) 786-1326.

Interested persons are invited to send comments regarding the

burden or any other aspect of these collections of information

requirements. However, as noted above, comments on these information

collection and recordkeeping requirements must be mailed and/or faxed

to the designee referenced below, by 5/6/98:

Office of Information and Regulatory Affairs, Office of Management and

Budget, Room 10235, New Executive Office Building, Washington, DC

20503, Fax Number: (202) 395-6974 or (202) 395-5167, Attn: Allison

Herron Eydt, HCFA Desk Officer.

Dated: April 9, 1998.

John P. Burke III,

HCFA Reports Clearance Officer, HCFA, Office of Information Services,

Information Technology Investment Management Group, Division of HCFA

Enterprise Standards.

[FR Doc. 98-10105 Filed 4-15-98; 8:45 am]

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