DOL will update
this record with copies of the final version of the notices and
guidance.
Inventory as of this Action
Requested
Previously Approved
02/28/2011
6 Months From Approved
01/31/2011
94,483
0
61,803
631
0
263
250,328
0
242,828
he Patient Protection and Affordable
Care Act, Public Law 111-148, (the Affordable Care Act) was enacted
by President Obama on March 23, 2010. As part of the Act, Congress
added PHS Act section 2719, which provides rules relating to
internal claims and appeals and external review processes. These
interim final regulations set forth rules implementing PHS Act
section 2719 for internal claims and appeals and external review
processes. With respect to internal claims and appeals processes
for group health coverage, PHS Act section 2719 and paragraph
(b)(2)(i) of the interim final regulations provide that group
health plans and health insurance issuers offering group health
insurance coverage must comply with the internal claims and appeals
processes set forth in 29 CFR 2560.503-1 (the DOL claims procedure
regulation) and update such processes in accordance with standards
established by the Secretary of Labor in paragraph (b)(2)(ii) of
the regulations. Also PHS Act section 2719 and these interim final
regulations provide that group health plans and issuers offering
group health insurance coverage must comply either with a State
external review process or a Federal review process. The
regulations provide a basis for determining when plans and issuers
must comply with an applicable State external review process and
when they must comply with the Federal external review process. The
ICR is being revised to provide procedures for the Federal external
review process.
The Patient Protection
and Affordable Care Act (the Affordable Care Act) was enacted by
President Obama on March 23, 2010; the Health Care and Education
Reconciliation Act (the Reconciliation Act), Pub. L. 111-152, was
enacted on March 30, 2010. The Affordable Care Act and the
Reconciliation Act reorganize, amend, and add to the provisions of
part A of title XXVII of the Public Health Service Act (PHS Act)
relating to group health plans and health insurance issuers in the
group and individual markets. Section 2719 of the PHS Act sets
forth standards for plans and issuers that are not grandfathered
health plans regarding both internal claims and appeals and
external review. The Departments of Labor, Health and Human
Services, and the Treasury (the Departments) published interim
final regulations implementing PHS Act section 2719 on July 23,
2010, at 75 FR 43330 (the interim final regulations). When the
interim final regulations were issued OMB approved an information
collection request (ICR) titled Affordable Care Act Internal
Claims and Appeals and External Review Procedures for
Non-grandfathered Plans under OMB Control Numbers 1210-0144
(Department of Labor), 1545-2182 (Internal Revenue Service,
Department of the Treasury), and 0938-1098 (Department of Health
and Human Services). The preamble to the interim final regulations
provides that the Departments would be issuing additional guidance
on the Federal external review process in the near future. The
preamble states that the Departments also would issue model notices
that could be used to satisfy the notice requirements under the
interim final regulations. This action revises the ICRs under the
OMB Control Numbers stated above to account for the hour and cost
burden associated with the interim Federal external review process.
The impact of the model notices, which also are being issued as
part of this action, was accounted for in the ICR when the interim
final regulations were issued. The Departments are requesting OMB
to approve an emergency PRA submission, because they would not be
able to publish the interim Federal external review guidance and
model notices on a timely basis if the usual PRA processes were
followed.
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.
Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act