Complaints Submission Process
under the No Surprises Act (CMS-10779)
New
collection (Request for a new OMB Control Number)
Yes
Emergency
12/01/2021
11/24/2021
Requested
Previously Approved
6 Months From Approved
1,800
0
900
0
48,726
0
Enacted on December 27, 2020, the No
Surprises Act, which was enacted as part of the Consolidated
Appropriations Act (CAA), amended the Employee Retirement Income
Security Act of 1974 (ERISA), the Public Health Service Act (PHS
Act), and the Internal Revenue Code of 1986 (Code). The No Surprise
Act implements provisions that protect individuals from surprise
medical bills for emergency services, air ambulance services
furnished by nonparticipating providers, and non-emergency services
furnished by nonparticipating providers at participating facilities
in certain circumstances. Additionally, the No Surprises Act sets
forth a complaints processes with respect to potential violations
of balance billing requirements set forth in the No Surprises Act.
The No Surprises Act provides federal protections against surprise
billing and limits out-of-network cost sharing under many of the
circumstances in which surprise medical bills arise most
frequently. The 2021 interim final regulations “Requirements
Related to Surprise Billing; Part I” (86 FR 36872, 2021 interim
final regulations) issued by the Departments of Health and Humans
Services (HHS), Department of Labor (DOL), the Department of
Treasury (collectively, the Departments), implement provisions of
the No Surprises Act that apply to group health plans, health
insurance issuers offering group or individual health insurance
coverage that provide protections against balance billing and
out-of-network cost sharing with respect to emergency services,
non-emergency services furnished by nonparticipating providers at
certain participating health care facilities, and air ambulance
services furnished by nonparticipating providers of air ambulance
services. The No Surprises Act and the 2021 interim final
regulations directs the Departments of Labor, Health and Human
Services, and the Department of Treasury (collectively, “the
Departments”) to establish a process to receive complaints
regarding violations of the application of qualifying payment
amount (QPA) requirements by group health plans and health
insurance issuers offering group or individual health coverage. The
No Surprises Act also directs HHS to establish a process to receive
consumer complaints regarding violations by health care providers,
facilities, and providers of air ambulance services regarding
balance billing requirements and to respond to such complaints
within 60 days.
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 following information
collection requirement (ICR): complaints process for surprise
medical bills (45 CFR 149.150 and 149.450; 29 CFR 2510 & 2590).
The cost-sharing and balance billing requirements on plans,
issuers, health care providers, facilities, and providers of air
ambulance services in the No Surprises Act apply for plan years (in
the individual market, policy years) beginning on or after January
1, 2022. This ICR contains a critical protection for individuals to
submit a complaint in respect to potential violations of balance
billing requirements set forth in the No Surprises Act. It is in
the public interest that individuals receive this protection under
the No Surprises Act on the date on which those protections go into
effect. Following the standard PRA process will not provide the
Department of Health and Human Services (HHS), the Department of
Labor (DOL), the Department of Treasury (collectively, “the
Departments”), sufficient time to implement this new
requirement.
The information collection is necessary to
establish a process to receive complaints regarding violations of
the application of qualifying payment amount requirements by group
health plans and health insurance issuers offering group or
individual health coverage as required by the No Surprises Act
(enacted on December 27, 2020). The No Surprises Act also directs
HHS to establish a process to receive consumer complaints regarding
violations by health care providers, facilities, and providers of
air ambulance services regarding balance billing requirements and
to respond to such complaints within 60 days. The data collection
will assist CMS in requesting information from non-federal
governmental plans and issuers, health care providers, facilities,
providers of air ambulance services, and individuals to review and
process a complaint for potential violations of balance billing
requirements.
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
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.
Form CMS-10779 Complaints Related to Surprise Billing
CMS-10779 - Emergency Justification.docx
Complaints Related to Surprise Billing