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)
The number of burden hours have
been reduced from 21,334 to 17,439, a total reduction of 3,895
burden hours. The burden hour reduction is due to the decrease in
the number of respondents.
$0
No
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.
CMS-10594 - Supporting Statement -.docx
Provider Network Coverage - Notice to Enrollees