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 202203-0938-004
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⚠️ Notice: This information collection may be outdated.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)
Extension without change of a currently approved collection
Yes
Regular
03/17/2022
Requested
Previously Approved
36 Months From Approved
03/31/2022
58,676,716
58,676,716
4,886,380
4,886,380
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.
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.