[INSERT DATE]
OMB Human Resources and Housing Branch
Attn: Carolyn Lovett, CMS Desk Officer
New Executive Office Building
Room 10235
Washington, DC 20503
RE: CMS Form 855B – Ambulance Attachment
Dear Ms. Lovett:
On January 27, 2006, the Centers for Medicare & Medicaid Services (CMS) requested public comment concerning the Enrollment Application, Form No.: CMS-855 (OMB #9038-0685). Ambulance suppliers to enroll in the Medicare program as well as to advise CMS of material changes use this form.
I have two comments regarding the proposed revisions and CMS Form 855B. First, I support eliminating the requirement that ambulance suppliers provide a comprehensive list of all EMS field personnel employed by such supplier, and to update such list following any changes. Second, I strongly urge you to remove the requirement that ambulance suppliers complete Section D of the proposed Attachment 1 of the CMS-855B, which requires suppliers to provide CMS with a comprehensive list of all EMS vehicles used by the supplier, as well as a list of all equipment and supplies in each vehicle.
In my State, ________, ambulance suppliers are already required to register all EMS vehicles with the Department of __________. These vehicles are then inspected by a state agency, which maintains on file vehicle registrations and other documentation related to each vehicle. For this reason, such information is already accessible to Fiscal Intermediaries and Carriers. Elimination of this requirement will relieve ambulance suppliers - - and your contractors - - of a substantial and duplicative paperwork burden.
We urge you to remove the requirement that ambulance suppliers complete Section D of the proposed Attachment 1 of the CMS-855B. Thank you for your consideration.
Sincerely,
[YOUR NAME]