The CAA added provisions applicable to
group health plans and health insurance issuers in the group and
individual markets in a new Part D of title XXVII of the Public
Health Service Act (PHS Act) and also added new provisions to part
7 of the Employee Retirement Income Security Act (ERISA), and
Subchapter B of chapter 100 of the Internal Revenue Code (Code).
Section 102 of the No Surprises Act added Code section 9816, ERISA
section 716, and PHS Act section 2799A-1, which contain limitations
on cost sharing and requirements for initial payments for emergency
services. Section 103 of the No Surprises Act amended Code section
9816, ERISA section 716, and PHS Act section 2799A-1 to establish a
Federal independent dispute resolution (Federal IDR) process that
nonparticipating providers or facilities and group health plans and
health insurance issuers in the group and individual market may use
following the end of an unsuccessful open negotiation period to
determine the out-of-network rate for certain services. More
specifically, the Federal IDR provisions may be used to determine
the out-of-network rate for certain emergency services,
nonemergency items and services furnished by nonparticipating
providers at participating health care facilities, where an
All-Payer Model Agreement or specified state law does not apply.
Section 105 of the No Surprises Act created Code section 9817,
ERISA section 717, and PHS Act section 2799A-2 which contain
limitations on cost sharing and requirements for initial payments
for air ambulance services, and allow plans and issuers and
providers of air ambulance services to access the Federal IDR
process. CAA provisions that apply to health care providers and
facilities, and providers of air ambulance services, such as
requirements around cost sharing, prohibitions on balance billing
for certain items and services, and requirements related to
disclosures about balance billing protections, were added to title
XXVII of the PHS Act in a new part E.
Under section 5 CFR
1320.13(a)(2)(ii), an unanticipated event has occurred. On February
23, 2022, the U.S. District Court for the Eastern District of Texas
issued an adverse ruling relating to the IFR. In response to the
court ruling changes to the descriptions of certain data elements
that will be collected need to be made to conform with the court’s
order prior to the launching of the electronic processing
system.
The Departments have removed
language from the ICR to be consistent with the federal court
ruling in the U.S. District Court for the Eastern District of Texas
on the Interim Final Rule, Requirements Related to Surprise
Billing; Part II (Texas Medical Association v. HHS). The ruling
vacated certain provisions of the IFR related to payment
determinations under the federal IDR process. In response, changes
to the descriptions of certain data elements need to be made to
conform with the court’s order. More specifically, the court
vacated provisions of the IFR directing certified IDR entities to
select the offer closest to the Qualifying Payment Amount, unless
it is shown to be materially different from the appropriate
out-of-network rate. The increase in burden is not a result of the
revisions to the ICR. The increase in burden is a result of the
updated data inputs and mailing cost.
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.
1210-0169 Tri-dept PRA supporting statement 4.5.22 FINAL.docx
Request of Extension of Time Periods for Extenuating Circumstances