OMB notes that
CMS states it plans to display the expiration date associated with
this collection. The expiration date and OMB control number must be
displayed on all paper and electronic versions of the
collection.
Inventory as of this Action
Requested
Previously Approved
03/31/2020
36 Months From Approved
03/31/2017
23,680,000
0
19,840,000
3,404,000
0
2,976,000
0
0
0
As a result of the Weichardt v.
Leavitt class action lawsuit and in response to public comments,
CMS set forth a final rule in November 2006, CMS-4105-F, for how
hospitals must notify Medicare beneficiaries who are hospital
inpatients about their hospital discharge rights. Notice is
required both for original Medicare beneficiaries and for
beneficiaries enrolled in Medicare Advantage plans and other
Medicare health plans subject to the MA regulations. Under the
final rule, hospitals use a revised version of the Important
Message from Medicare (IM), Form CMS-R-193 to explain discharge
rights. Hospitals must issue the IM within two days of admission,
and must obtain the signature of the beneficiary or his or her
representative. Hospitals must also deliver a copy of the signed
notice to each beneficiary not more than two days before the day of
discharge. This notice was approved in 2007 to fulfill the
regulatory requirement
Statute at
Large: 18
Stat. 1866 Name of Statute: null
The total annual hour burden
has increased by 428,000 hours due to the Medicare program’s
general growth and an increase in inpatient hospitalization claims.
Although the number of Medicare participating hospitals decreased
by 27 facilities since our last PRA submission, the number of
annual inpatient hospitalizations has increased by from 12.4
million in the previous submission to 14.8 million, an increase of
2.4 million. With this increase in inpatient hospitalizations, the
estimated annual number of responses has increased by 3.84 million
annually, from 19.84 million in 2013 to 23.68 million in this
submission.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-R-193 Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-R-193)
CMS-R-193 - Supporting Statement A CleanFINAL [rev July 2016].docx
Medicare and Medicare Advantage Programs; Notification Procedures for Hospital Discharges : Important Message From Medicare (CMS-R-193)