Agency Information Collection Activities: Submission for OMB Review; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-R-224]

Agency Information Collection Activities: Submission for OMB

Review; Comment Request

AGENCY: Health Care Financing Administration.

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, is

publishing the following summary of proposed collections for public

comment. Interested persons are invited to send comments regarding this

burden estimate or any other aspect of this collection of information,

including any of the following subjects: (1) The necessity and utility

of the proposed information collection for the proper performance of

the agency's functions; (2) the accuracy of the estimated burden; (3)

ways to enhance the quality, utility, and clarity of the information to

be collected; and (4) the use of automated collection techniques or

other forms of information technology to minimize the information

collection burden.

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 (OMB No. 0938-0711); 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 an alternate submission

route for the start-up year.

Special procedures have been identified to ensure that hospital

encounter data are submitted for discharges occurring between July 1,

1997 and June 30, 1998, the start-up year. HCFA has identified three

alternatives for the submission of hospital encounter data for

discharges during the start-up year, including the following:

Option 1: The Plan will have a hospital submit UB-92s or Medicare

Part A ANSI ASC X12 837 (ANSI 837) records using the traditional HMO

``No Pay'' bill method.

Option 2: The Plan can currently produce a complete UB-92/ANSI 837

and will hold the data until the fiscal intermediary (FI) can accept

it.

Option 3: The Plan will submit an abbreviated UB-92 data set via an

alternative route.

During the start up year, the plan is expected to establish an

electronic data linkage to a FI to be determined by

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HCFA. HCFA will assist Plans in initiating discussions with their FI.

By July 15, 1998, the Plan is expected to have completed this linkage,

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

hospital encounter data to a FI. Data for the start-up year must be

transmitted to the plan's FI by September, 18, 1998. All data with

discharge dates after July 1, 1998 will be transmitted using this

linkage. (See Appendix III 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 July 15, 1998.

After plans have established linkages to a FI, hospitals will

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

(UB-92) 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 through 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: 6,547.

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. Written comments and

recommendations for the proposed information collections must be mailed

within 30 days of this notice directly to the OMB desk officer: OMB

Human Resources and Housing Branch, Attention: Allison Eydt, New

Executive Office Building, Room 10235, Washington, D.C. 20503.

Dated: September 8, 1998.

John P. Burke III,

HCFA Reports Clearance Officer, HCFA Office of Information Services,

Security and Standards Group, Division of HCFA Enterprise Standards.

[FR Doc. 98-24881 Filed 9-16-98; 8:45 am]

BILLING CODE 4120-03-P