Notice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act (CMS-10330)

ICR 202108-0938-010

OMB: 0938-1094

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2021-08-25
Supplementary Document
2021-08-31
IC Document Collections
IC ID
Document
Title
Status
193322
Modified
193321
Modified
ICR Details
0938-1094 202108-0938-010
Received in OIRA 201904-0938-015
HHS/CMS CCIIO
Notice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act (CMS-10330)
Revision of a currently approved collection   No
Emergency 09/10/2021
09/09/2021
  Requested Previously Approved
6 Months From Approved 07/31/2022
15,752 70,612
814 524
4,371 6,857

Sections 2712 and 2719A of the Public Health Service Act (PHS Act), as added by the Affordable Care Act, contain rescission notice, and patient protection disclosure requirements that are subject to the Paperwork Reduction Act of 1995. The No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2021, amended section 2719A of the PHS Act to sunset when the new emergency services protections under the No Surprises Act take effect. The provisions of section 2719A of the PHS Act will no longer apply with respect to plan years beginning on or after January 1, 2022. The No Surprises Act re-codified the patient protections related to choice of health care professional under section 2719A of the PHS Act in newly added section 9822 of the Internal Revenue Code, section 722 of the Employee Retirement Income Security Act, and section 2799A-7 of the PHS Act and extended the applicability of these provisions to grandfathered health plans for plan years beginning on or after January 1, 2022. The rescission notice will be used by health plans to provide advance notice to certain individuals that their coverage may be rescinded as a result of fraud or intentional misrepresentation of material fact. The patient protection notification will be used by health plans to inform certain individuals of their right to choose a primary care provider or pediatrician and to use obstetrical/gynecological services without prior authorization. The related provisions are finalized in the 2015 final regulations titled “Final Rules under the Affordable Care Act for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections” (80 FR 72192, November 18, 2015) and 2021 interim final regulations titled “Requirements Related to Surprise Billing; Part I”. The 2015 final regulations also require that, if State law prohibits balance billing, or a plan or issuer is contractually responsible for any amounts balanced billed by an out-of-network emergency services provider, a plan or issuer must provide a participant, beneficiary or enrollee adequate and prominent notice of their lack of financial responsibility with respect to amounts balanced billed in order to prevent inadvertent payment by the individual. Plans and issuers will not be required to provide this notice for plan years beginning on or after January 1, 2022.
The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection request for some provisions in the Consolidated Appropriations Act of 2021 (Appropriations Act) enacted on December 27, 2020, related to the No Surprises Act be processed in accordance with the implementing regulations of the Paperwork Reduction Act of 1995 (PRA) at 5 CFR 1320.13(a)(2)(i). We believe that public harm will result if the standard, non-emergency clearance procedures are followed. CMS is also requesting waiver of the notice requirement set forth in 5 CFR 1320.13(d). Specifically, we are requesting emergency approval for the revisions to the information collection requirement related to notice of right to designate a primary care provider (45 CFR 149.310(a)(4)). The No Surprises Act extends the applicability of the patient protections for choice of health care professionals to grandfathered health plans. The requirement on plans and health insurance issuers to provide this notice applies for plan years (in the individual market, policy years) beginning on or after January 1, 2022. It is in public interest that individuals receive the protections under the No Surprises Act on the date on which those protections go into effect. Following the standard PRA process will not provide grandfathered plans and health insurance issuers, sufficient time to implement this new requirement.

PL: Pub.L. 111 - 148 2711 Name of Law: No lifetime or annual limits.
   PL: Pub.L. 111 - 148 2712 86 FR 36872 Name of Law: Prohibition on rescissions.
   PL: Pub.L. 111 - 148 2719A Name of Law: Patient Protections.
  
PL: Pub.L. 116 - 260 No Surprises Act Name of Law: Consolidated Appropriations Act, 2021

0938-AU63 Final or interim final rulemaking 86 FR 36872 07/13/2021

No

2
IC Title Form No. Form Name
Section 2712 - Rules regarding rescissions
Section 2719A - Patient Protections

  Total Request 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 15,752 70,612 -54,860 0 0 0
Annual Time Burden (Hours) 814 524 290 0 0 0
Annual Cost Burden (Dollars) 4,371 6,857 -2,486 0 0 0
No
No
Burden hours for rescission notices have decreased by approximately 49 hours (from 294 to 245) annually because of a decrease in the estimated number of rescissions due to a decrease in the estimated number of individual market issuers and policies. Burden hours for one-time costs related to patient protection disclosure have increased by approximately 339 hours (from 230 to 569) annually due to an increase in the number of affected plans and issuers and use of updated data. Therefore, there is a total increase in burden of 290 hours.

$0
No
    No
    No
Yes
No
No
No
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.
09/09/2021


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