Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in (CMS-10780)

ICR 202108-0938-017

OMB:

Federal Form Document

ICR Details
202108-0938-017
Received in OIRA
HHS/CMS CCIIO -10780
Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in (CMS-10780)
New collection (Request for a new OMB Control Number)   Yes
Emergency 09/10/2021
09/09/2021
  Requested Previously Approved
6 Months From Approved
58,676,716 0
4,886,380 0
0 0

On December 27, 2020, the Consolidated Appropriations Act, 2021 (Pub. L. 116-260), which included the No Surprises Act, was signed into law. 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” (2021 interim final regulations) issued by the Departments of Health and Humans Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management, implement provisions of the No Surprises Act that apply to group health plans, health insurance issuers offering group or individual health insurance coverage, and carriers in the Federal Employees Health Benefits (FEHB) Program 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 2021 interim final regulations prohibit nonparticipating providers, emergency facilities, and providers of air ambulance services from balance billing participants, beneficiaries, and enrollees in certain situations unless they satisfy certain notice and consent requirements. The No Surprises Act and the 2021 interim final regulations require group health plans and issuers of health insurance coverage to provide information about qualifying payment amounts to nonparticipating providers and facilities and to provide disclosures on patient protections against balance billing to participants, beneficiaries and enrollees. Self-insured plans opting in to State law are required to provide a disclosure to participants. Certain nonparticipating providers and nonparticipating emergency facilities may are provide participants, beneficiaries, and enrollees with notice and obtain their consent to waive balance billing protections, provided certain requirements are met. In addition, certain providers and facilities are required to provide disclosures on patient protections against balance billing to participants, beneficiaries and enrollees.
Specifically, we are requesting emergency approval for the following information collection requirements (ICRs): (i) information to be shared about the qualifying payment amount (45 CFR 149.140(d)); (ii) audits of the qualifying payment amount (45 CFR 149.140(f)); (iii) disclosure for self-insured plans opting in to state law (45 CFR 149.30); (iv) notice and consent to waive balance billing protections, retention of certain documents, and notice to plan or issuer (45 CFR 149.410(b)-(e), 45 CFR 149.420(c) - (i)); (v) provider disclosure on patient protections against balance billing (45 CFR 149.430); and (vi) plan and issuer disclosure on patient protections against balance billing (section 2799A-5(c) of the Public Health Service Act). 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. These ICRs contain critical protections for participants, beneficiaries, and enrollees against balance billing. It is in the 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 plans, health insurance issuers, facilities, health care providers, and providers of air ambulance services sufficient time to implement these new requirements. 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).

PL: Pub.L. 116 - 260 Title I of Division BB Name of Law: Consolidated Appropriations Act, 2021
  
PL: Pub.L. 116 - 260 Title I of Division BB Name of Law: Consolidated Appropriations Act, 2021

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

No

  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 58,676,716 0 58,676,716 0 0 0
Annual Time Burden (Hours) 4,886,380 0 4,886,380 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new collection of information.

$0
No
    No
    No
Yes
No
No
No
Jamaa Hill 301 492-4190

  Yes
  The notice and consent documents and disclosures on balance billing protections provided by plans and issuers and nonparticipating providers and facilities will provide information to participants, beneficiaries, or enrollees regarding the protections against surprise medical bills. The requirements related to the notice and consent documents will help ensure that individuals are not pressured to waive their rights and that individuals will only waive their rights if they wish to obtain the services of a nonparticipating provider for a specific reason. Plans and issuers will be provided the information they need in order to determine if balance billing protections apply to specific items and services provided by a nonparticipating provider or nonparticipating emergency facility or if the enrollee provided consent to waive those protections.
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.
09/09/2021


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