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rescinded as a result of fraud or intentional misrepresentation of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.
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.
CMS-10330 Supporting Statement - Emergency .docx
CMS-10330.Emergency Justification - Signed.pdf
Section 2719A - Patient Protections