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
CMS-10338 Email response to plans and issuers electing private IRO process.pdf Supplementary Document	2013-02-14
CMS-10338 Email response to plans and issuers electing HHS process.pdf Supplementary Document	2013-02-14
CMS-10338_Supporting_Statement_Final_80713.docx Supporting Statement A	2013-08-07

IC Document Collections

IC ID	Document Title	Status
193861	Burden Estimates Instruction	Modified

ICR Details

OMB Control No: 0938-1099	ICR Reference No: 201303-0938-001
Status: Historical Active	Previous ICR Reference No: 201106-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: 18839
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: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/12/2013
	Date Received in OIRA: 03/04/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	218,000,000	0	0
Time Burden (Hours)	930,000	0	0
Cost Burden (Dollars)	52,000,000	0	0

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Abstract: 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.

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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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 291	01/04/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 2408	01/11/2013
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
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

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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	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

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 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.

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Annual Cost to Federal Government: $8,283

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: 03/04/2013

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