No Surprises Act: IDR Process

Forms and Documents

Document Name	Status
1210-0169 Tri-dept PRA supporting statement 4.25.2022 FINAL.docx Supporting Statement A	2022-04-25

IC Document Collections

IC ID	Document Title	Status
249371	Request of Extension of Time Periods for Extenuating Circumstances Other-Request of Extension of Time Periods for Extenuating Circu	Modified
248857	IDR Entity Certification and IDR Entity Monthly Reporting Other-IDR Certification Application	Modified
248850	Federal IDR Process for Air Ambulance Services Other-Notice of Open Negotiation	Modified
248846	Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities Other-Notice of Open Negotiation	Modified

ICR Details

OMB Control No: 1210-0169	ICR Reference No: 202204-1210-002
Status: Received in OIRA	Previous ICR Reference No: 202202-1210-002
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: No Surprises Act: IDR Process
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 04/25/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2022
Responses	36,964	18,483
Time Burden (Hours)	68,193	34,097
Cost Burden (Dollars)	545,727	278,390

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Abstract: 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.

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Authorizing Statute(s): PL: Pub.L. 116 - 260 103 and 105 Name of Law: Consolidated Appropriations Act, 2021
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 62206	11/09/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 24346	04/25/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Federal IDR Process for Air Ambulance Services
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities
IDR Entity Certification and IDR Entity Monthly Reporting
Request of Extension of Time Periods for Extenuating Circumstances

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ICR Summary of Burden

	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	36,964	18,483	0	0	18,481	0
Annual Time Burden (Hours)	68,193	34,097	0	0	34,096	0
Annual Cost Burden (Dollars)	545,727	278,390	0	0	267,337	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The change in burden estimate is the result of reporting the annual burden, whereas the 6-month burden total was reported in the most recent emergency submission. The Department has made clarifying edits to the following forms that do not impact the burden: Open Negotiation Period Notice, Notice of IDR Initiation, Notice of Certified IDR Entity Selection, Notice of Offer (Data Elements), and Certified IDR Entity Written Determination. More information is provided in Q15 of the Supporting Statement.

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Annual Cost to Federal Government: $1,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage:  The Department has made clarifying changes to the following forms: Open Negotiation Period Notice, Notice of IDR Initiation, Notice of Certified IDR Entity Selection, Notice of Offer (Data Elements), and Certified IDR Entity Written Determination. More information is provided in Q15 of the Supporting Statement.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/25/2022

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