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

[Document Identifier HCFA-R-257]

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),

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 of the

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.

We are, however, requesting an emergency review of the information

collection referenced below. In compliance with the requirement of

section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, we have

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

requirements for emergency review. Due to the unanticipated event and

the fact that this collection of this information is needed before the

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

part 1320, we are requesting an emergency review.

With the creation of the Medicare+Choice program, as required by

the Balanced Budget Act of 1997 (Pub. L. 105-33), new provisions have

been implemented to coordinate Medicare beneficiaries' choices through

the Medicare+Choice organizations. Specifically, the provisions require

the establishment of procedures through which Medicare+Choice elections

are made and changed, including the form and manner in which such

elections are made and changed, as required by section 4001 of the

Balanced Budget Act (BBA) of 1997. This necessitated a need to create

an additional mechanism for beneficiaries make election to disenroll to

original Medicare. This also provided the opportunity to collect

information on beneficiary disenrollment behavior, as the BBA

provisions required the development of quality and performance

measures, specifically including collection of information regarding

disenrollment rates. Collection of disenrollment reason data will

promote active, informed selection by beneficiaries of options as well

as to conduct quality control studies. By allowing beneficiaries the

ability to request the disenrollment forms from the customer

teleservice representatives, HCFA will ultimately be providing the

beneficiary with more flexibility and options.

The purpose of this submission is to request approval of a

disenrollment form that beneficiaries will be able to obtain from the

Medicare+Choice toll-free number that is to be established (as required

by the BBA). Such a form allows the beneficiary to disenroll from a

Medicare+Choice organization to original (fee-for-service) Medicare and

allows HCFA to collect information for analysis of disenrollment rates

and reasons for disenrollment. The Medicare+Choice toll-free number

will be operational in November 1998 and a more expedient review is

needed in order for the form to be ready to provide to the

beneficiaries when the call center is operational.

HCFA is requesting OMB review and approval of this collection

within eleven working days, with a 180-day approval period. Written

comments and recommendations will be accepted from the public if

received by the individual designated below, within ten working days of

publication of this notice in the Federal Register.

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

collection as stipulated by 5 CFR 1320.

Type of Information Collection Request: New Collection.

Title of Information Collection: Medicare+Choice Disenrollment

Form.

Form Nos.: HCFA-R-257.

Use: The primary purpose of the new form is to receive and process

the beneficiary's request for disenrollment from a Medicare+Choice plan

and to return to original (fee-for-service) Medicare. The secondary

purpose of the new form is to obtain the reason for the disenrollment,

for analysis and reporting.

Frequency: As requested by beneficiary.

Affected Public: Individuals or households, Business or other for-

profit, Not-for-profit institutions, and Federal government.

Number of Respondents: 60,000 annually.

Total Annual Responses: 20,000 in first year, 60,000 thereafter.

Total Annual Hours: 3,960.

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 record keeping requirements must be mailed and/or faxed

to the designee referenced below, within ten working days of

[[Page 49702]]

publication of this collection in the Federal Register:

Health Care Financing Administration, Office of Information Services,

Security and Standards Group, Division of HCFA Enterprise Standards,

Room N2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, Fax

Number: (410) 786-0262, Attn: Louis Blank HCFA-R-257

and

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: September 10, 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. 98-24934 Filed 9-16-98; 8:45 am]

BILLING CODE 4120-03-P