Medical Necessity Disclosure under MHPAEA and Claims Denial Disclosure under MHPAEA

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
191609	Claims Denial Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Electronic)	New
191608	Claims Denial Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Paper)	New
191607	Medical Necessity Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Electronic)	New
191606	Medical Necessity Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Paper)	New
191605	Medical Necessity Disclosure under MHPAEA(Processed By Issuer or Third Party Services) Sent w Claims Denial Dis) (Electronic)	New
191604	Medical Necessity Disclosure under MHPAEA(Processed By Issuer or Third Party Services) Sent w Claims Denial Dis) (Paper)	New
191603	Claims Denial Disclosure under MHPAEA (Processed In-house)(Paper)	New
191602	Claims Denial Disclosure under MHPAEA (Processed In-house)(Electronic))	New
191601	Medical Necessity Disclosure under MHPAEA (Processed In-house: sent w/Claims Denial Disclosure)(Electronic))	New
191600	Medical Necessity Disclosure under MHPAEA (Processed In-house: Sent w/Claims Denial Disclosure) (Paper)	New
191599	Medical Necessity Disclosure under MHPAEA (Processed In-House: Paper) : CMS-10307	New
191598	Medical Necessity Disclosure under MHPAEA (Processed In-House:Electronic)	New

ICR Details

OMB Control No: 0938-1080	ICR Reference No: 200912-0938-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Necessity Disclosure under MHPAEA and Claims Denial Disclosure under MHPAEA
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Preapproved	Conclusion Date: 01/27/2010
	Date Received in OIRA: 12/17/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved
Responses	509,600	0	0
Time Burden (Hours)	2,177	0	0
Cost Burden (Dollars)	1,174,737	0	0

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Abstract: Medical Necessity Disclosure under MHPAEA MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to provide, upon request, the criteria for medical necessity determinations made with respect to MH/SUD benefits to current or potential participants, beneficiaries, or contracting providers.Claims Denial Disclosure under MHPAEA MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to supply, upon request, the reason for any denial of payment for MH/SUD services to the participant or beneficiary involved in the case.

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Authorizing Statute(s): PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008
   US Code: 42 USC 300gg-5(a)(4) Name of Law: Public Health Service Act section 2705
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008
US Code: 42 USC 300gg-5(a)(4) Name of Law: Public Health Service Act section 2705

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP65	Final or interim final rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Medical Necessity Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Electronic)
Claims Denial Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Paper)
Claims Denial Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Electronic)
Medical Necessity Disclosure under MHPAEA (Processed In-House:Electronic)
Medical Necessity Disclosure under MHPAEA (Processed In-House: Paper) : CMS-10307
Medical Necessity Disclosure under MHPAEA (Processed In-house: Sent w/Claims Denial Disclosure) (Paper)
Medical Necessity Disclosure under MHPAEA (Processed In-house: sent w/Claims Denial Disclosure)(Electronic))
Claims Denial Disclosure under MHPAEA (Processed In-house)(Electronic))
Claims Denial Disclosure under MHPAEA (Processed In-house)(Paper)
Medical Necessity Disclosure under MHPAEA(Processed By Issuer or Third Party Services) Sent w Claims Denial Dis) (Paper)
Medical Necessity Disclosure under MHPAEA(Processed By Issuer or Third Party Services) Sent w Claims Denial Dis) (Electronic)
Medical Necessity Disclosure under MHPAEA (Processed By Issuer or Third Party Services) (Paper)

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	509,600	0	509,600	0	0	0
Annual Time Burden (Hours)	2,177	0	2,177	0	0	0
Annual Cost Burden (Dollars)	1,174,737	0	1,174,737	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in the burden arises from a specific provision (section 512(b)) of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) which requires that notice be provided in two circumstances: (1) upon request, plan administrators or health insurance issuers must forward the criteria for medical necessity determinations made with respect to mental health or substance use disorder (MH/SUD) benefits to current or potential participants, beneficiaries, or contracting providers; and (2) upon request, plan administrator or health insurance issuers must supply the reason for any denial of payment for MH/SUD services to the participant or beneficiary.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/17/2009

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