Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers

Forms and Documents

Document Name	Status
Form CMS-10338 States With External Review Laws - 2013 Form and Instruction	Removed
Form CMS-10338 States With External Review Laws - 2012 Form and Instruction	Removed
Form CMS-10338 States With External Review Laws - 2011 Form and Instruction	Removed
Form CMS-10338 States With No External Review Laws - 2013 Form and Instruction	Removed
Form CMS-10338 States With No External Review Laws - 2012 Form and Instruction	Removed
Form CMS-10338 States With No External Review Laws - 2011 Form and Instruction	Removed
CMS-9993-IFC2 (76FR37208)-6-24-11.pdf Supplementary Document	2011-09-01
CMS-10338.CLAS Bulletin.pdf Supplementary Document	2011-06-22
CMS-10338.HHS SRG on Elections.pdf Supplementary Document	2011-06-22
CMS-10338.Technical Release and Model Notices.pdf Supplementary Document	2011-06-22
CMS-10338.Emergency Justification Appeals PRA.docx Supplementary Document	2011-06-22
CMS-10338 Supporting Statement Update Clean 10-18.docx Supporting Statement A	2011-11-09

IC Document Collections

IC ID	Document Title	Status
194657	States With External Review Laws - 2013 Form and Instruction	Removed
194656	States With External Review Laws - 2012 Form and Instruction	Removed
194655	States With External Review Laws - 2011 Form and Instruction	Removed
194345	States With No External Review Laws - 2013 Form and Instruction	Removed
194344	States With No External Review Laws - 2012 Form and Instruction	Removed
194343	States With No External Review Laws - 2011 Form and Instruction	Removed
193862	Recordkeeping Requirements	Removed
193861	Disclosures and Review Burden (2011-2013) Instruction	Modified
193860	Disclosure for 2012	Removed
193859	Disclosures for 2011	Removed

ICR Details

OMB Control No: 0938-1099	ICR Reference No: 201106-0938-021
Status: Historical Active	Previous ICR Reference No: 201009-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/01/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/17/2011
	Date Received in OIRA: 06/22/2011
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved. Please note: This approval corrects a previous errors in (1) the annual cost burden -- the prior estimate incorrectly included monetized burden hours, and (2) annual time burden and number of responses -- the previous estimates were for three years cumulatively, rather than an annual average across the three years of approval, which significantly overstated the burden of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	6 Months From Approved	11/30/2011
Responses	70,834,597	0	211,216,845
Time Burden (Hours)	930,267	0	2,762,824
Cost Burden (Dollars)	36,775,067	0	109,200,000

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Abstract: The information collection requirements included in the claims procedure regulation ensure that participants and beneficiaries (claimants) receive information regarding the plan's claims procedures and the plan's handling of specific benefit claims. This collection is necessary for the Federal external review process to provide an independent external review as requested by claimants.

Emergency Justfication: Please see the attached emergency justification.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2719 Name of Law: Appeals process
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AQ66	Final or interim final rulemaking	76 FR 37208	06/24/2011

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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: 1

IC Title	Form No.	Form Name
States With No External Review Laws - 2012	CMS-10338	CMS-10338.Deliberative Document
Disclosures and Review Burden (2011-2013)
Recordkeeping Requirements
States With No External Review Laws - 2011	CMS-10338	CMS-10338.Deliberative Document
States With No External Review Laws - 2013	CMS-10338	CMS-10338.Deliberative Document
States With External Review Laws - 2011	CMS-10338	CMS-10338.Deliberative Document
States With External Review Laws - 2012	CMS-10338	CMS-10338.Deliberative Document
States With External Review Laws - 2013	CMS-10338	CMS-10338.Deliberative Document
Disclosure for 2012
Disclosures for 2011

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ICR Summary of Burden

	Total Approved	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	70,834,597	211,216,845	0	-140,814,845	432,597	0
Annual Time Burden (Hours)	930,267	2,762,824	0	-1,562,824	-269,733	0
Annual Cost Burden (Dollars)	36,775,067	109,200,000	0	-58,100,000	-14,324,933	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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: This approval corrects a previous errors in (1) the annual cost burden -- the prior estimate incorrectly included monetized burden hours, and (2) annual time burden and number of responses -- the previous estimates were for three years cumulatively, rather than an annual average across the three years of approval, which significantly overstated the burden of this collection.

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Annual Cost to Federal Government: $3,782

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 06/22/2011

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