Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338)

ICR 202205-0938-010

OMB: 0938-1099

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2022-05-09
Supporting Statement A
2022-05-09
IC Document Collections
ICR Details
0938-1099 202205-0938-010
Received in OIRA 202110-0938-001
HHS/CMS CCIIO
Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338)
Reinstatement without change of a previously approved collection   No
Regular 05/09/2022
  Requested Previously Approved
36 Months From Approved
516,581,066 0
1,198,692 0
149,806,832 0

These interim final regulations set forth rules implementing revisions to the Public Health Service (PHS) Act section 2719 for internal claims and appeals and external review processes to implement Section 110 of the No Surprises Act (NSA), which protects participants, beneficiaries, and enrollees in group health plans and group and individual health insurance coverage from receiving surprise medical bills when they receive emergency services, non-emergency services from non-participating providers at participating facilities, and air ambulance services, under certain circumstances. Specifically Section 110 of the NSA amends section 2719 of the PHS Act to require the external review process to apply to participants, beneficiaries, and enrollees of such plans with respect to any adverse determination by a plan or issuer under section 2799A-1 or 2799A-2 of the PHS Act. These protections also extend to grandfathered plans.

PL: Pub.L. 110 - 110 No Surprises Act Name of Law: Consolidated Appropriations Act, 2021
   US Code: 45 USC 147.136 Name of Law: Internal claims and appeals and external review processes
  
PL: Pub.L. 110 - 110 No Surprises Act Name of Law: Consolidated Appropriations Act, 2021
US Code: 45 USC 147.136 Name of Law: Internal claims and appeals and external review processes

Not associated with rulemaking

  87 FR 8016 02/11/2022
87 FR 26760 05/05/2022
Yes

2
IC Title Form No. Form Name
Burden Estimates - Appeals
Internal Claims and Appeals and External Review Procedures

  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 516,581,066 0 0 0 0 516,581,066
Annual Time Burden (Hours) 1,198,692 0 0 0 0 1,198,692
Annual Cost Burden (Dollars) 149,806,832 0 0 0 0 149,806,832
No
No

$79,022
No
    No
    No
Yes
No
No
No
Jamaa Hill 301 492-4190

  No

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.
05/09/2022


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