Paperwork Reduction Act (PRA) of 1995

  • PRA Listing

PRA Listing

PRAs that are available for comment and have not been released by the Department.

CMS Form Number Date Subject
CMS-10217 04/20/2007 Physician Survey for the 2006 Medicare Oncology Demonstration Program
CMS-R-39 05/30/2007 Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies and Supporting Regulations in 42 CFR 484.10, 484.12, 484.14, 484.16, 484.18, 484.36, 484.48, and 484.52
CMS-10407 08/17/2011 Summary of Benefits and Coverage Uniform Glossary
CMS-417 09/03/2010 Hospice Medicare Certification
CMS-10227 09/03/2010 PACE State Plan Amendment Pre-print
CMS-R-0053 08/20/2010 Imposition of Cost Sharing Charges Under Medicaid and Supporting Regulations Contained in 42 CFR Section 447.53
CMS-10244 09/10/2010 Medicaid State Program Integrity Assessment (SPIA)
CMS-10206 08/04/2006 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Accreditation Proposals from Independent Accrediting Bodies
CMS-10246 08/24/2007 COST AND RESOURCE UTILIZATION (CRU) DATA COLLECTION FOR THE MEDICARE POST ACUTE CARE PAYMENT REFORM DEMONSTRATION
CMS-10195 06/09/2006 Evaluation of the Medicare Recovery Audit Contractor Demonstration RAC Provider Satisfaction Survey
CMS-10116 04/27/2007 Medicare Program; Conditions for Payment of Power Mobility Devices, including Power Wheelchairs and Power-Operated Vehicles (CMS-3017-IFC)
CMS-10148 01/08/2007 HIPAA Administrative Simplification Non-Privacy Enforcement
CMS-10088 09/01/2006 Notification of FIs and CMS of co-located Medicare providers and Supporting Regulations in 42 CFR 22 and 412.533
CMS-10140 04/04/2005 Claims Error Rate Testing (CERT) / Electronic Records Exploratory Survey
CMS-10207 09/10/2010 Physician Self-Referral Exceptions for Electronic Prescribing and Electronic Health Records
CMS-10168 09/13/2006 Medicare Program: Complex Medical Review
CMS-10225 05/08/2007 Disclosures to Patients by Certain Hospitals & Critical Access Hospitals
CMS-10184 05/26/2006 Payment Error Rate Measurement of Eligibility in Medicaid and the State Children';s Health Insurance Program (SCHIP)
CMS-10201 08/16/2006 Evaluation of the Home Health Independence Demonstration: Survey of Home Health Agencies
CMS-255 02/23/2007 Municipal Health Services Cost Report Form and supporting Regulations 42CFR 405.2470
CMS-10247 08/24/2007 Sponsor application for CMS coverage under the Medicare Clinical Trial/Research Policy
CMS-10243 07/27/2007 Data Collection for Administering the Medicare Continuity Assessment Record and Evaluation (CARE)Instrument
CMS-10238 07/27/2007 Testing of Revised OASIS Instrument for Home Health Quality Measures and Data Analysis
CMS-588 04/28/2006 Electronic Funds Transfer Authorization Agreement
CMS-10233 05/23/2007 Regional Preferred Provider Organization (RPPO) Reconciliation Cost Report
CMS-460 03/15/2007 Medicare Participating Physician or Supplier Agreement
CMS-R-137 08/19/2005 Internal Revenue Service/Social Security Administration/Centers for Medicare and Medicaid Services Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206
CMS-R-50 04/14/2008 Medical Records Review Under the Prospective Payment System (PPS) and Supporting Regulations in 42 CFR 412.40- 412.52
CMS-R-305 2012-05-31 External Quality Review Protocols
CMS-10279 03/20/2009 Ambulatory Surgical Center Conditions for Coverage
CMS-10314 08/20/2010 Medicare Savings Program Protection from Medicaid Estate Recovery - State Plan Preprint Under Title 19
CMS-10260 03/11/2011 Medicare Advantage and Prescription Drug Program: Final Marketing Provisions CFR 422.111(a)(3) and 423.128 (a)(3)
CMS-10115 03/11/2011 FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS (SECTION 1011) PROVIDER ENROLLMENT APPLICATION
CMS-10343 09/10/2010 State Plan Preprint for Medicaid Recovery Audit Contractors (RACs)
CMS-R-5 03/20/2009 Physician Certification/Recertification in Skilled Nursing Facilities (SNFs) Manual Instructions
CMS-10133 03/20/2009 Competitive Acquisition Program for Medicare Part B Drugs: Vendor Application and Bid Form
CMS-10009 10/03/2008 HIPAA Nondiscrimination Provisions and Supporting Regulations in 45 CFR 146.121 (f)(2)(v)(A)
CMS-10001 10/03/2008 Health Insurance Portability and Accountability Act (HIPAA) Nondiscrimination Provisions and Supporting Regulations in 45 CFR 146.121(h) and 121(i)(2)(i)
CMS-10295 09/09/2009 Recovery Act: Reporting Requirements for States Under FMAP Increase and TMA Provisions
CMS-10320 2012-08-14 Health Care Reform Insurance Web Portal Requirements
CMS-10316 09/17/2010 Medicare Prescription Drug Plan (PDP) and Medicare Advantage Prescription Drug Plan (MA-PD) Disenrollment Reasons Survey
CMS-10305 07/24/2012 Medicare Part C and Part D Data Validation (42 CFR 422.516g and 423.514g)
CMS-R-206 04/10/2009 Information Collection Requirements Referenced in HIPAA title I for the Group Market
CMS-R-205 04/10/2009 Information Collection Requirements Referenced in HIPAA title I for the Individual Market
CMS-10136 03/06/2012 Physician Group Practice Transition Demonstration (PGP-TD)Performance Assessment Tool ("PAT")
CMS-R-211 03/09/2011 Template for Child Health Plan Under Title XXI of the Social Security Act Children's Health Insurance Program
CMS-10220 12/10/2010 Provider Enrollment Chain and Ownership System (PECOS) Web Security Consent Form
CMS-10390 2012-08-13 Hospice Quality Reporting Program
CMS-367 10/01/2010 Medicaid Drug Rebate Program
CMS-10239 11/15/2007 Conditions of Participation for Critical Access Hospitals and Supporting Regulations in 42 CFR 485.65, 485.23, 485.618, 485.631, 485.635, 485.641, 485.643
CMS-10221 06/26/2007 Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs)
CMS-R-247 06/23/2006 Expanded Coverage for Diabetes Outpatient Self-Management Training Services and Supporting Regulations Contained in 42 CFR 410.141, 410.142, 410.143, 410.144, 410.145, 410.146, and and 414.63
CMS-10230 11/16/2007 PACE Audit Guide Version 1
CMS-R-48 11/15/2007 Conditions of Participation for Hospitals and Supporting Regulations in 482.12, 482.13, 482.21, 482.22, 482.23, 482.24, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53, 482.56, 482.57, 482.60, 482.61, 482.62, and 485.616 and 485.631
CMS-10328 03/25/2011 Medicare Self-Referral Disclosure Protocol
CMS-10409 09/02/2011 Long Term Care Hospital (LCTH) Quality Reporting Program-Pressure Ulcer Measure Data Set
CMS-10114 09/14/2011 NPI Application and Update Form
CMS-10367 03/11/2011 Medicaid State Plan Preprint for Use by States When Implementing Section 6505 of the [Patient Protection and] Affordable Care Act
CMS-R-185 03/01/2011 Granting and Withdrawal of Deeming Authority to Private Nonprofit Accreditation Organizations and of State Exemption Under State Laboratory Programs and Supporting Regulations
CMS-10296 08/28/2009 Electronic Health Record (EHR)Testing
CMS-10147 09/16/2011 Standardized Pharmacy Notice: Your Prescription Cannot be Filled (f/k/a Medicare Prescription Drug Coverage and Your Rights)
CMS-10362 03/25/2011 Autism Spectrum Disorders (ASD): State of the States Services and Supports for People with ASD
CMS-10286 10/07/2009 Notice of Research Exception under the Genetic Information Nondiscrimination Act
CMS-10313 04/06/2010 New Quality Measures for Medicare Advantage Organizations
CMS-1880 and CMS-1882 2012-03-13 Certification as a Supplier of Portable X-Ray and Portable X-Ray Survey Report Form and Supporting Regulations at 42 CFR Part 486.100-486.110
CMS-10298 10/09/2009 Data Collection For Developing Outpatient Therapy Payment Alternatives (DOTPA)
CMS-18F5 10/08/2010 Application For Hospital Insurance
CMS-10141 04/06/2010 Medicare Prescription Drug Benefit Plan
CMS-10036 10/24/2008 Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P
CMS-10300 10/09/2009 Additional State Plan Option for Providing Premium Assistance State Plan Templates Under Title XIX and XXI
CMS-10287 10/09/2009 Medicare Quality of Care Complaint Form
CMS-416 04/16/2010 Annual Early and Periodic Screening, Diagnostic and Treatment Report
CMS-10179 01/11/2007 Information Collection Requirements for Requests by Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System (LTCH PPS) for an Alternative Cost-to-Charge Ratio and Supporting Regulations in 42 CFR 412.84(i)(2), 412.525(a)(4)(ii), 412.525(a)(4)(iv)(A), 412.529(c)(3)(ii) and 412.529(c)(3)(iv)(A)
CMS-10158 05/31/2005 Beneficiary Survey on the Medicare Home Health Independence Demonstration
CMS-R-71 01/19/2005 Quality Improvement Organizations (QIO) Assumption of Responsibilities and Supporting Regulations in 42 C.F.R. Sections 412.44, 412.46, 431.630, 476.71, 476.73, 476.74, and 476.78
CMS-10319 10/29/2010 Pre-Existing Condition Insurance Plan-Program Solicitation and Contractor's Proposal Package
CMS-2540-10 03/11/2011 Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report
CMS-10361 04/01/2011 Request for Adjustments to MLR Standard for a States Individual Market
CMS-R-107 11/14/2008 Medicaid-Determining Third Party Liability (TPL) State Plan Preprint
CMS-10170 11/28/2008 Retiree Drug Subsidy (RDS) Payment Request and Instructions
CMS-10270 06/27/2008 Evaluation of the Home Health Pay for Performance Demonstration: Survey instrument
CMS-R-267 05/16/2008 Medicare Advantage Program: Application and Contract Requirements Referenced in 42 CFR Part 422
CMS-10299 10/02/2009 State Plan Amendment Template for Option to Cover Certain Children and Pregnant Women Lawfully Residing in U.S.
CMS-10095 04/30/2010 Detailed Explanation of Non-Coverage (42 CFR 422.626(e)(1)), and Notice of Medicare Non-Coverage (42 CFR 422.624(b)(1))
CMS-381 04/01/2011 Identification of Extension Units of Medicare Approved Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) Providers and Supporting Regulations in 42 CFR 485.701-485.729
CMS-10102 2012-04-27 National Implementation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
CMS-10110 12/12/2008 Manufacturer Submission of Average Sales Price (ASP) data for Medicare Part B Drugs and Biologicals
CMS-R-296 05/15/2009 Home Health Advance Beneficiary Notice (HHABN)
CMS-1763 05/15/2009 REQUEST FOR TERMINATION OF PREMIUM HOSPITAL AND/OR SUPPLEMENTARY MEDICAL INSURANCE
CMS-R-194 05/15/2009 Medicare Disproportionate Share Adjustment Procedures and Criteria and Supporting Regulations in 42 CFR 412.106
CMS-43 05/15/2009 APPLICATION FOR HOSPITAL INSURANCE BENEFITS FOR INDIVIDUALS WITH END STAGE RENAL DISEASE
CMS-R-297 04/19/2010 Request for Employment Information
CMS-R-0282 11/06/2009 Medicare Advantage Appeals and Grievance Data Disclosure Requirements (42 CFR section 422.111)
CMS-10191 10/28/2009 Medicare Parts C and D Universal Audit Guide
CMS-10197 04/02/2010 Evaluation of the Medicare National Competitive Bidding Program for DME
CMS-10123 and 10124 04/01/2011 Notice of Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-Coverage (CMS-10124)
CMS-R-263 2012-04-27 Site Investigation for Durable Medical Equipment (DME) Suppliers
CMS-10241 2012-03-02 Survey of Retail Prices: Payment and Utilization Rates, and Performance Rankings
CMS-R-26 10/08/2010 Clinical Laboratory Improvement Amendments (CLIA) and Supporting Regulations in 42 CFR 493.1-.2001
CMS-R-153 10/15/2010 Medicaid Drug Utilization Review (DUR) Annual Report
CMS-10358 10/22/2010 Medicaid Program; MMIS APD Template for Use by States When Implementing the Mandatory National Correct Coding Initiative in Medicaid, SMD Letter #10-017 dated September 1, 2010
CMS-2088-92 10/22/2010 Outpatient Rehabilitation Provider Cost Report utilized by Community Mental Health Centers
CMS-10165 04/30/2010 Electronic Health Records Demonstration System (EHRDS) - practice application and profile update system
CMS-10003 2012-07-06 Notice of Denial of Medical Coverage (or Payment)
CMS-10054 10/22/2010 Recognition of payment for new technology services for New Technology ambulatory payment classification (APC) groups under the Outpatient Prospective Payment System
CMS-2552-10 04/30/2010 Hospital and Health Care Complexes Cost Report and supporting Regulations in 42 CFR section 413.20 and section 413.24
CMS-10078 05/29/2009 Matching Grants to States for the Operation of High Risk Pools
CMS-10261 2012-07-06 Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a)
CMS-855O 2012-04-27 Medicare Registration Application
CMS-10185 2012-07-18 Medicare Part D Reporting Requirements and Supporting Regulations
CMS-1856 and CMS-1893 04/08/2011 Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services and Outpatient Physical Therapy-Speech Pathology Survey Report
CMS-10379 10/07/2011 Rate Increase Disclosure and Review Reporting Requirements (45 CFR Part 154)
CMS-265-11 10/07/2011 Independent Renal Dialysis Facility Cost Report And Supporting Regulations in 42 CFR Sections 413.20, 413.24, 413.174
CMS-10382 04/08/2011 Medicaid Emergency Psychiatric Demonstration
CMS-10388 04/29/2011 Section 1115 Demonstration HIV and AIDS Application Template
CMS-10340 10/07/2011 Collection of Encounter Data from Medicare Advantage Organizations
CMS-10237 2012-07-06 Part C Medicare Advantage and 1876 Cost Plan Expansion Application (CY 2013)
CMS-10137 2012-07-06 Application for New and Expanding Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug (MA-PD), including Cost Plans and Employer Group Waiver Plans
CMS-10384 03/25/2011 Health Insurance Assistance Database
CMS-10265 08/01/2008 Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid and SCHIP Act of 2007 (MMSEA) (P.L.110-173)
CMS-10273 06/05/2009 Evaluation of the Medicare Care Management Performance Demonstration and the Electronic Health Records Demonstration
CMS-R-10 08/15/2008 BPD-718: Advance Directives (Medicare and Medicaid)
CMS-10311 11/17/2010 Medicare program/Home Health Prospective Payment System Rate Update for CY 2010: Physician Narrative Requirement and Supporting Regulation in 42 CFR 424.22, CY 2011 Final Physician Face-to-Face Encounter in 42 CFR 424.22 (a)(1)(v), and changes to therapy coverage requirements at 42 CFR 409.44(c): (Associated Regulation: CMS-1510-F; RIN 0938-AP88)
CMS-10344 11/22/2010 Elimination of Cost-Sharing for full benefit dual-eligible Individuals Receiving Home and Community-Based Services
CMS-10346 11/22/2010 Appeals of Quality Bonus Payment Determinations
CMS-10349 11/22/2010 The Medicare Advantage and Prescription Drug Program: Customized Enrollee Data CFR 422.111(b)(11) and 423.128(b)(12)
CMS-10053 11/13/2009 Paid Feeding Assistants in Long Term Care Facilities and Supporting Regulations at CFR 42 Section 483.160
CMS-10171 05/14/2010 Coordination of Benefits between Part D Plans and Other Prescription Coverage Providers (CMS-10171)
CMS-10224 04/29/2011 Healthcare Common Procedure Coding System (HCPCS) Level II Code Modification Request Process
CMS-10209 11/04/2011 Medicare Advantage Chronic Care Improvement Program and Quality Improvement Project Reporting Tools
CMS-10291 10/21/2011 State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Web site and Hotline
CMS-10347 11/22/2010 Agent Broker Training Requirements
CMS-10348 11/22/2010 Changes to Close the Part D Coverage Gap, Improvements to MTM Programs, Independence of LTC Consultant Pharmacists
CMS-10350 11/22/2010 De Minimis for LIS Individuals and Uniform Exceptions and Appeals Process for Prescription Drug Plans and MA-PD Plans
CMS-10352 11/22/2010 Notification of Involuntary Disenrollment by the Centers for Medicare & Medicaid Services for Failure to Pay the Part D Income Related Monthly Adjustment Amount
CMS-R-131 09/10/2010 Advance Beneficiary Notice of Noncoverage (ABN)
CMS-P-0015A 05/28/2010 Medicare Current Beneficiary Survey
CMS-10408 10/10/2011 Early Retiree Reinsurance Program: Survey of Plan Sponsors
CMS-10240 05/28/2010 Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration
CMS-1728-94 05/28/2010 Home Health Agency Cost Report
CMS-265-94 05/28/2010 Independent Renal Dialysis Facility Cost Report
CMS-10317 06/18/2010 The Medicare Acute Care Episode (ACE) Demonstration
CMS-10069 06/18/2010 Medicare Waiver Demonstration Application
CMS-855S 2012-04-04 Medicare Enrollment Application— Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers
CMS-10333 2012-07-27 Consumer Assistance Program Grants
CMS-10396 05/31/2011 Medicare Part D Medication Therapy Management Program - Standardized Format
CMS-855 (A, B, I, R) 2012-04-04 Medicare Enrollment Applications
CMS-10366 11/18/2011 Nursing Home Quality Improvement Questionnaire
CMS-10203 2012-08-10 Medicare Health Outcomes Survey (HOS)
CMS-10308 06/04/2010 Parts C and D Complaints Resolution Performance Measures
CMS-10416 2012-05-16 State Exchange Certification Application
CMS-10288 06/12/2009 State Plan Preprint to Implement Required Dental Benefits Pursuant of CHIPRA 2009
CMS-10062 01/09/2009 Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments
CMS-10373 06/17/2011 Medical Loss Ratio - Quarterly Reporting for Mini-med Plans and Expatriate Plans
CMS-10097 07/02/2009 The Medicare Contractor Provider Satisfaction Survey (MCPSS)
CMS-10098 12/10/2010 Beneficiary Satisfcation Survey
CMS-10219 06/18/2010 Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection for Medicare Advantage
CMS-10289 06/12/2009 CHIPRA 2009 Dental Benefits: Implementation of Optional Dental-only Supplemental Coverage
CMS-10394 06/08/2011 Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement
CMS-10417 2012-09-21 Medicare Fee-for-Service Prepayment Medical Review
CMS-10393 06/10/2011 Medicare Beneficiary and Family-Centered Satisfaction Survey
CMS-10249 10/21/2011 Administrative Requirements for Section 6071 of the Deficit Reduction Act
CMS-10356 11/19/2010 Evaluation of Practice Models for Dual Eligibles and Medicare Beneficiaries with Serious Chronic Conditions
CMS-R-235 05/20/2011 Data Use Agreement Information Collection Requirements, model language, and supporting regulations in 45 CFR Section 5b
CMS-10252 05/20/2011 Data Use Agreement (DUA) Certificate of Disposition for Data Acquired from the Centers for Medicare & Medicaid Services (CMS)
CMS-10380 05/16/2011 Rate Review Grants to States and Territories Cycle I and II Funding Opportunity Announcement Application and Reporting
CMS-209 11/29/2011 Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1357, 493.1363, 493.1405, 493.1406, 493.1411, 493.1417, 493.1423, 493.1443, 493.1449, 493.1455, 493.1461, 493.1462, 493.1469, 493.1483, 493.1489 and 493.1491
CMS-29 11/29/2011 Request for Certification as a Rural Health Clinic Form and Supporting Regulations in 42 CFR 491.1-491.11
CMS-R-246 05/31/2011 Medicare Advantage and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS)
CMS-10418 04/02/2012 Annual MLR and Rebate Calculation Report
CMS-10292 05/18/2011 State Medicaid HIT Plan, Planning Advance Planning Document and Update, Implementation Advance Planning Document and Update and Annual IAPD for implementation of Section 4201 of the American Recovery and Reinvestment Act of 2009
CMS-10321 06/28/2011 Early Retiree Reinsurance Program
CMS-R-240 07/09/2010 Prospective Payments for Hospital Outpatient Service and Supporting Regulations is 42 CFR 413.65
CMS-10335 07/12/2010 Current State Practices Related to Payments to Providers for Health Care-Acquired Conditions
CMS-906 2012-09-04 The Fiscal Soundness Reporting Requirements
CMS-10079 01/15/2010 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64
CMS-64 12/10/2010 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program
CMS-21B 12/10/2010 State Children's Health Insurance Program Budget Report for the Title XXI Program State Plan Expenditures
CMS-37 12/10/2010 Medicaid Program Budget Report
CMS-10342 06/17/2011 Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711
CMS-10398 0012-05-03 State plan Home and Community-Based Services Administration and Operation
CMS-10368 12/23/2011 Dental Action Plan Template for Medicaid and CHIP Programs
CMS-179 12/16/2011 Medicaid State Plan Base Plan Pages
CMS-1561 07/23/2010 Health Insurance Benefit Agreement
CMS-R-244 07/30/2010 MEDICARE AND MEDICAID: PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE; Final) CONTAINED IN 42 CFR 460.12-460.210
CMS-10152 2012-08-10 Data Collection for Medicare Beneficiaries Receiving NaF-18 Positron Emissions Tomography (PET) to Identify Bone Metastasis in Cancer
CMS-R-257 08/15/2008 Medicare Advantage & Part D Disenrollment Requests Collected Through 1-800-MEDICARE
CMS-10190 08/14/2009 State Plan Preprints to Implement Section 6043 of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-Emergencies
CMS-R-284 2012-08-15 Medicaid Statistical Information System (MSIS)
CMS-10307 01/29/2010 Medical Necessity Disclosure under MHPAEA and Claims Denial Disclosure under MHPAEA
CMS-R-148 01/21/2011 Limitations on Provider Related Donations and Health Care Related Taxes; Limitation on Payments for Disproportionate Share Hospitals and Supporting Regulations in 42 CFR 433.68, 433.74, and 447.272
CMS-R-266 01/21/2011 Medicaid Disproportionate Share Hospital Annual Reporting
CMS-216 01/21/2011 Organ Procurement Organization/Histocompatibility Laboratory Statement of Reimbursable Costs, Manual Instructions and Supporting Regulations contained in 42 CFR 413.20 and 413.24
CMS-10402 07/15/2011 Medicaid State Plan Preprint for Use by States When Implementing Section 6401, Provider Screening and Other Enrollment Requirements Under Medicare, Medicaid and CHIP
CMS-10385 07/15/2011 Expedited Checklist: Medicaid Eligibility & Enrollment Systems-Advance Planning Document (E&E-APD)
CMS-1880 and CMS-1882 12/23/2011 Certification as a Supplier of Portable X-Ray and Portable X-Ray Survey Report Form and Supporting Regulations at 42 CFR Part 486.100-486.110
CMS-10275 07/23/2010 CAHPS Home Health Care Survey: (Associated Regulation: CMS-1510-P; RIN 0938-AP88)
CMS-10146 07/23/2010 Notice of Denial of Medicare Prescription Drug Coverage
CMS-R-249 07/23/2010 Hospice Cost and Data Report and supporting regulations 42 CFR 413.20 and 42 CFR 413.24
CMS-287-05 01/28/2011 Chain Home Office Cost Statement and supporting regulations in 42 CFR sections 413.17 and 413.20
CMS-R-308 07/23/2010 Children's Health Insurance Program
CMS-R-268 01/14/2011 CMS Survey Tool for http://www.cms.gov and http://www.medicare.gov
CMS-10142 01/04/2012 CY 2011 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
CMS-10066 01/25/2010 Detailed Notice of Discharge (DND)
CMS-21 12/10/2010 Quarterly Children's Health Insurance Program (CHIP) Statement of Expenditures for the Title XXI Program
CMS-10374 07/15/2011 Survey and Certification Training Staff Training Needs Assessment, Evaluation/Survey - Question Compilation
CMS-9042 07/15/2011 Accelerated Payments and Supporting Regulations 42 CFR, Section 412.116(f), 412.632(e), 413.64(g), 413.350(d), and 484.245
CMS-10236 12/12/2008 Disclosure of Financial Relationships Report (DFRR)
CMS-R-306 01/13/2012 Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities (PRTFs) for Individuals Under Age 21
CMS-10412 01/04/2012 Section 1115 Demonstration: Long Term Services and Supports and Other Service Models for Individuals with Disabilities and Chronic Conditions
CMS-R-262 01/04/2012 CY 2013 Plan Benefit Package (PBP) Software and Formulary Submission
CMS-10112 01/28/2011 Phone Surveys of Products and Services for Medicare Payment Validation and Supporting Regulations in 42 CFR 405.502
CMS-R-21 02/11/2011 Withholding Medicare Payments to Recover Medicaid Overpayments and Supporting Regulations in 42 CFR 447.31
CMS-437 02/11/2011 State Survey Agency Work Sheets for Verifying Exclusions from the Prospective Payment System and Supporting Regulations in 42 CFR Parts 412.25 - 412.27
CMS-1771 02/10/2011 Attending Physicians Statement and Documentation of Medicare Emergency and Supporting Regulations in 42 CFR Section 424.103
CMS-724 08/20/2010 Medicare/Medicaid Psychiatric Hospital Survey Data
CMS-R-74 01/04/2012 Income and Eligibility Verification System
CMS-222 02/11/2011 Independent Rural Health Center/Freestanding Federally Qualified Health Center Cost Report and Supporting Regulations 42 CFR 413.20 AND 42 CFR 413.24
CMS-10008 02/11/2011 Process and Information Required to Determine Eligibility of Drugs, Biologicals, and Radiopharmaceutical Agents for Transitional Pass-Through Status Under the Hospital Outpatient Prospective Payment System (OPPS)
CMS-116 08/20/2010 Clinical Laboratory Improvement Amendments Application for Certification
CMS-R-216 08/20/2010 Issuance of Advisory Opinions Concerning Physicians Referrals
CMS-10198 08/21/2009 Creditable Coverage Disclosure to CMS Online Form and Instructions
CMS-10151 09/05/2008 Data Collection for Medicare Beneficiaries Receiving Implantable Cardioverter-defibrillators for Primary Prevention of Sudden Cardiac Death
CMS-10421 0002-05-29 Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration
CMS-10215 08/20/2010 Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs
CMS-10052 08/20/2008 Recognition of pass-through payment for additional (new) categories of devices under the Outpatient Prospective Payment System and Supporting Regulations in 42 CFR, Part 419
CMS-10360 02/11/2011 Consumer Research on Public Reporting of Hospital Outpatient Measures (CMS-10360)
CMS-10106 02/18/2011 Medicare Authorization to Disclose Personal Health Information (CMS-10106)
CMS-10351 09/03/2010 ESRD PPS Transition Election and Attestations of Low-Volume
CMS-668B 02/07/2012 Post Clinical Laboratory Survey Questionnaire and Supporting Regulations in 42 CFR 493.1771, 493.1773, and 493.1777
CMS-1557 02/07/2012 Survey Report Form for Clinical Laboratory Improvement Amendments (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001
CMS-10161 02/02/2012 New Freedom Initiative - Web-based Reporting System for Grantees
CMS-372(S) 2012-04-04 Annual Report on Home and Community Based Services Waivers and Supporting Regulations in 42 CFR 440.180 and 441.300-310
CMS-10392 07/28/2011 Consumer Operated and Oriented Plan [CO-OP] Program
CMS-10424 2012-05-16 Cooperative Agreement to Support Establishment of the Affordable Care Act's Health Insurance Exchanges
CMS-855I 2012-01-30 Medicare Enrollment Application for Physician and Non-Physician Practitioners
CMS-855R 2012-06-15 Reassignment of Medicare Benefits
CMS-10406 03/06/2010 Probable Fraud Measurement Pilot
CMS–437A and CMS–437B 04/04/2012 State Agency Sheets for Verifying Exclusions from the Inpatient Prospective Payment System and Supporting Regulations in 42 CFR Parts 412.20–412.29
CMS-10427 2012-06-07 For-Profit PACE Study
CMS–10429 2012-06-27 Surveys of Physicians and Home Health Agencies to Assess Access Issues for Specific Medicare Beneficiaries as Defined in Section 3131(d) of the ACA
CMS-10423 2012-04-17 Health Plan Identifier, Other Entity Identifier, and Change to National Provider Identifier Requirements
CMS-10169 2012-07-27 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
CMS-10425 2012-09-21 Evaluation of Patient Satisfaction and Experience of Care for Medicare Beneficiaries with End-Stage Renal Disease (ERSD): Impact of the ESRD Prospective Payment System (PPS) and ESRD Quality Incentive Program (QIP)
CMS–643 2012-07-18 Hospice Survey and Deficiencies Report Form and Supporting Regulations
CMS–10422 2012-05-11 Payments for Services Furnished by Certain Primary Care Providers and Supporting Regulations in 42 CFR 438.6, 438.804, 447.400, and 447.410
CMS-10210 2012-05-11 Hospital Reporting Initiative – Hospital Quality Measures
CMS-10432 2012-05-11 Inpatient Psychiatric Facility Quality Reporting Program
CMS-10431 2012-05-11 PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
CMS-10436 2012-06-01 Evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration
CMS-10435 2012-06-01 Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection
CMS-10434 2012-06-08 Medicaid and CHIP Program (MACPro)
CMS–10389 2012-07-24 The Home and Community-Based Service (HCBS) Experience Survey
CMS-10433 2012-07-02 Initial Plan Data Collection to Support Qualified Health Plan (QHP) Certification and Other Financial Management and Exchange Operations
CMS-10438 2012-07-02 Data Collection to Support Eligibility Determinations and Enrollment for Employees in the Small Business Health Options Program
CMS-10439 2012-07-02 Data Collection to Support Eligibility Determinations and Enrollment for Small Businesses in the Small Business Health Options Program
CMS-10440 2012-07-02 Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Affordable Insurance Exchanges, Medicaid and Children’s Health Insurance Program Agencies
CMS-10428 2012-09-21 Pre-Existing Condition Insurance Plan (PCIP) Authorization to Share Personal Health Information
CMS-359 and CMS-360 2012-08-31 Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms
CMS-10028 2012-06-15 State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Report Form, and Resource Report Form
CMS-2567 2012-09-21 Deficiencies and Plan of Correction (CMS–2567) and Supporting Regulations contained in 42 CFR 488.18, 488.26, and 488.28
CMS–10447 2012-07-30 Durable Medical Equipment Face-to-Face Requirements (RIN 0938–AR11; CMS-1590-P)
CMS-10444 2012-08-10 Minimum Data Set for Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) demonstration program
CMS–10276 2012-07-30 Physician Quality Reporting System (RIN 0938–AR11; CMS-1590-P)
CMS-R-218 2012-07-06 ICRs contained in 45 CFR Part 162; HIPAA Standards for Electronic Transactions
CMS-10381 2012-08-10 ICD-10 Industry Readiness Assessment
CMS-10149 08/31/2012 Health Insurance Reform: Electronic Security Standards
CMS-10441 2012-07-06 Medicare Plan Finder Experiment
CMS-10445 2012-09-14 Medicare Advantage Quality Bonus Payment Demonstration
CMS-838 2012-09-17 Medicare Credit Balance Reporting Requirements and Supporting Regulations in 42 CFR 405.371, 405.378 and 413.20
CMS–10143 2012-09-17 Monthly State File of Medicaid/Medicare Dual Eligible Enrollees
CMS-846-849, CMS-10125, CMS-10126 2012-09-24 Durable Medical Equipment Medicare Administrative Contractor Certificate of Medical Necessity and Supporting Documentation Requirements