REG-125592-10 (TD 9494), Affordable Care Act Internal Claims and Appeals and External review Disclosures.

Forms and Documents

Document Name	Status
2018-02-14_SS_1545-2182r.docx Supporting Statement A	2018-02-14

IC Document Collections

IC ID	Document Title	Status
193852	REG-125592-10 (TD 9494), Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.	Modified

ICR Details

OMB Control No: 1545-2182	ICR Reference No: 201711-1545-025
Status: Active	Previous ICR Reference No: 201402-1545-010
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: REG-125592-10 (TD 9494), Affordable Care Act Internal Claims and Appeals and External review Disclosures.
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/30/2018
	Date Received in OIRA: 03/21/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2018
Responses	278,412	0	62,000
Time Burden (Hours)	2,271	0	350
Cost Burden (Dollars)	1,143,236	0	0

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Abstract: Previously approved, Section 2719 of the Public Health Service Act, incorporated into Code section 9815 by section 1563(f) of the Patient Protection and Affordable Care Act, Public Law 111-148, requires group health plans and issuers of group health insurance coverage, in connection with internal appeals of claims denials, to provide claimants free of charge with any evidence relied upon in deciding the appeal that was not relied on in making the initial denial of the claim. This is a third party disclosure requirement. Individuals appealing a denial of a claim should be able to respond to any new evidence the plan or issuer relies on in the appeal, and this disclosure requirement is essential so that the claimant knows of the new evidence.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1010 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 152 2719 Name of Law: Health Care and Education Reconciliation Act
  

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:
	82 FR 47607	10/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12461	03/21/2018
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
REG-125592-10 (TD 9494), Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.

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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	278,412	62,000	0	0	216,412	0
Annual Time Burden (Hours)	2,271	350	0	0	1,921	0
Annual Cost Burden (Dollars)	1,143,236	0	0	0	1,143,236	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: No

Burden Reduction Due to:

Short Statement: In Summary, the burden associated with claims, appeals, and external review is 4,542 hours annually for 556,826 respondents. Because the burden is shared equally between the Department of Labor and the Department of the Treasury, the Department of Treasury’s share is 2,271 hours. Department of Labor provides the estimates and the estimates for the collection have changed since the last renewal. Because the final rule does not change the information collection requirements contained interim final regulations (and June 2011 amendment), most of the burden increase results from an increase in the number of non-grandfathered group health plans subject to the requirements of this information collection. A small portion also results from increases in wage rates and increases in postage rates.

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Annual Cost to Federal Government: $26,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 03/21/2018

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