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: 0938-1401
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1401 can be found here:
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).
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.