Proposed §156.230(e)(1) would require that QHP issuers make a good faith effort to provide written notice of discontinuation of a provider 30 days prior to the effective date of the change or otherwise as soon as practicable, to enrollees who are patients seen on a regular basis by the provider or who receive primary care from the provider whose contract is discontinuing. This is a third-party disclosure requirement. CMS is not proposing to collect this notice from QHP issuers in FFMs, therefore we are not specifying ways in which we will use the data. The purpose of this notice is to provide consumers information on when their providers will no longer be available in-network in their QHP. In proposed 156.230(f)(2), we require QHP issuers to provide a notice to enrollees of the possibility of out-of-network charges from an out-of-network provider in an in-network setting at least 10 calendar days prior to the service being provided to avoid counting the out-of-network costs against to the annual limitation on cost sharing.
PL:
Pub.L. 111 - 156 1311
Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
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.
CMS-10594- Supporting Statement Provider Network Coverage FR.pdf
Provider Network Coverage - Notice to Enrollees