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

ICR 201303-0938-001

OMB: 0938-1099

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
193861 Modified
ICR Details
0938-1099 201303-0938-001
Historical Active 201106-0938-021
HHS/CMS 18839
Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers
Reinstatement without change of a previously approved collection   No
Regular
Approved with change 08/12/2013
Retrieve Notice of Action (NOA) 03/04/2013
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved
218,000,000 0 0
930,000 0 0
52,000,000 0 0

The information collection requirements included in the claims procedure regulation ensure that participants and beneficiaries (claimants) receive adequate information regarding the plan's claims procedures and the plan's handling of specific benefit claims. Participants and beneficiaries need to understand plan procedures and plan decisions in order to appropriately request benefits and/or appeal benefit denials. The information collection requirements are necessary for the Federal external review process to provide an independent external review as requested by claimants.

PL: Pub.L. 111 - 148 2719 Name of Law: Appeals process
  
None

Not associated with rulemaking

  77 FR 291 01/04/2012
78 FR 2408 01/11/2013
No

1
IC Title Form No. Form Name
Burden Estimates CMS-10338, CMS-10338, CMS-10338 CMS-10338 abd_model_notice ,   CMS-10338 final_iabd_model_notice ,   CMS-10338 external_final_decision_model_notice

  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 218,000,000 0 0 0 147,165,403 70,834,597
Annual Time Burden (Hours) 930,000 0 0 0 -267 930,267
Annual Cost Burden (Dollars) 52,000,000 0 0 0 15,224,933 36,775,067
No
No
The amended IFR made several major policy changes that increased the cost and hour burden estimates associated with this information collection request. In addition, the Department estimates that the number of responses will increase significantly from 70 million responses in 2011 to 297 million responses in 2013, as a result of the requirements contained within Section 2719 of the Public Health Services Act. Therefore, the total cost and hour burden estimates increased from $18,995,900 and 566,200 hours in 2011 to $51,647,800 and 1,222,800 hours in 2013. Please refer to the supporting statement for a detailed explanation of burden changes.

$8,283
No
No
Yes
No
No
Uncollected
Jamaa Hill 301 492-4190

  No

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.
03/04/2013


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