Emergency Ambulance Transports, Beneficiary Signature, and Foreign Hospital Services Information Collection

Content

ACTION:

Notice.

SUMMARY:

The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to
publish notice in the
Federal Register
concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection
of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send
comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and
utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated
burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection
techniques or other forms of information technology to minimize the information collection burden.

DATES:

Comments on the collection(s) of information must be received by the OMB desk officer by May 20, 2026.

ADDRESSES:

Written comments and recommendations for the proposed information collection should be sent within 30 days of publication
of this notice to www.reginfo.gov/public/do/PRAMain. Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by
using the search function.

To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice,
please access the CMS PRA website by copying and pasting the following web address into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT:

William Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION:

Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office
of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information”
is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A))
requires federal agencies to publish a 30-day notice in the
Federal Register
concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection
of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this
notice that summarizes the following proposed collection(s) of information for public comment.

1. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Emergency Ambulance Transports and Beneficiary Signature; Use: The statutory authority requiring a beneficiary's signature on a claim submitted by a provider is located in section 1835(a) and in 1814(a) of the Social Security Act (the Act), for Part B and Part A services, respectively. The authority requiring a beneficiary's signature for supplier claims is implicit in sections 1842(b)(3)(B)(ii) and in 1848(g)(4) of the Act. Federal regulations at 42 CFR 424.32(a)(3) state that all claims must be signed by the beneficiary or on behalf of the Beneficiary (in accordance with 424.36). Section 424.36(a) states that the beneficiary's signature is required on a claim unless the beneficiary has died or the provisions of 424.36(b), (c), or (d) apply.

For emergency and nonemergency ambulance transport services, where the beneficiary is physically or mentally incapable of
signing the claim (and the beneficiary's authorized representative is unavailable or unwilling to sign the claim), that it
is impractical and infeasible to require an ambulance provider or supplier to later locate the beneficiary or the person authorized
to sign on behalf of the beneficiary, before submitting the claim to Medicare for payment. Therefore, an exception was created
to the beneficiary signature requirement with respect to emergency and nonemergency ambulance transport services, where the
beneficiary is physically or mentally incapable of signing the claim, and if certain documentation requirements are met. Thus,
we added subsection (6) to paragraph (b) of 42 CFR 424.36. The information required in this ICR is needed to help ensure that
services were in fact rendered and were rendered as billed. Form Number: CMS-10242 (OMB control number: 0938-1049); Frequency: Occasionally; Affected Public: Private sector, Business or other for-profit, Not-for-profits institutions; Number of Respondents: 10,278; Total Annual Responses: 9,265,931; Total Annual Hours: 771,852. (For policy questions regarding this collection contact Frederick Grabau at 410-786-0206.)

1. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title: Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR 424.103; Use: Section 1866 of the Social Security Act states that any provider of services shall be qualified to participate in the Medicare program and shall be eligible for payments under Medicare if it files an agreement with the Secretary to meet the conditions outlined in this section of the Act. Section 1814(d)(1) of the Social Security Act and 42 CFR 424.100, allows payment of Medicare benefits for a Medicare beneficiary to a

nonparticipating hospital that does not have an agreement in effect with the Centers for Medicare and Medicaid Services. These
payments can be made if such services were emergency services and if CMS would be required to make the payment if the hospital
had an agreement in effect and met the conditions of payment. This form is used in connection with claims for emergency hospital
services provided by hospitals that do not have an agreement in effect under Section 1866 of the Social Security Act.

42 CFR 424.103(b) requires that before a non-participating hospital may be paid for emergency services rendered to a Medicare beneficiary, a
statement must be submitted that is sufficiently comprehensive to support that an emergency existed. Form CMS-1771 contains
a series of questions relating to the medical necessity of the emergency. The attending physician must attest that the hospitalization
was required under the regulatory emergency definition (42 CFR 424.101 attached) and give clinical documentation to support the claim. A photocopy of the beneficiary's hospital records may be used
in lieu of the CMS-1771 if the records contain all the information required by the form.; Form Number: CMS-1771 (OMB Control Number: 0938-0023); Frequency: Annually; Affected Public: Private Sector, Business or other for-profit and not-for-profit institutions; Number of Respondents: 100; Number of Responses: 200; Total Annual Hours: 50. (For policy questions regarding this collection contact Shauntari Cheely at 410-786-1818.)

William N. Parham, III, Director, Division of Information Collections and Regulatory Impacts, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2026-07634 Filed 4-17-26; 8:45 am] BILLING CODE 4120-01-P

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