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.
The Departments have updated
the number of the IDR disputes that would be submitted annually as
part of the Federal IDR process from 22,000 disputes to 420,000
disputes. Therefore, the hour burden has significantly increased.
In addition, the Departments have removed the hour burden for the
additional information to be shared with the initial payment or
notice of denial of payment, as this burden will now be included in
HHS OMB Control Number 0938-1401. The Departments have also removed
the following forms, as they will be included in the following HHS
PRA package, "Patient Provider Dispute Resolution Requirements
Related to Surprise Billing: Part II (CMS-10853)": o Standard Form:
“Good Faith Estimate for Health Care Items and Services” Under the
No Surprises Act. o Standard Form: Patient-Provider Dispute
Resolution (PPDR) Dispute Initiation Form. o Standard Form: Online
PPDR Initiation Form o Standard Notice: Ineligible for PPDR or
Additional Information Needed. o Patient-Provider SDR Entity
Certification Application Data Elements o Independent Dispute
Resolution and PPDR; Vendor Management Data Elements. o PPDR
Process Data Elements o Standard Notice: SDR Determination Notice
to Parties Provided Under the No Surprises Act. o Standard Notice:
SDR Entity Notification to Health Care Providers and Facilities and
Uninsured (or Self-Pay) Individuals o Standard Notice: Uninsured
(or Self-Pay) Individual and Provider or Facility Settle on a
Payment Amount After Initiating Patient Provider Dispute
Resolution. o Standard Notice: SDR Entity Notification to Health
Care Provider or Facility and Uninsured (or Self-Pay) Individual
Confirming Receipt of Dispute Settlement and Action. o Standard
Notice: Uninsured (or Self-Pay) Individual, Provider or Facility’s
Notification to Secretary of Health and Human Services The
Departments have also removed the form, “Good Faith Estimates
Template Notice,” as the form has been included in HHS OMB Control
Number 0938-1433. Furthermore, the Departments have combined the
hour and cost burden for nonparticipating providers or
nonparticipating emergency Facilities and air ambulance providers,
into one IC. The Departments have also removed the cost burden for
the requirement that certified IDR entities collect the
administrative fee on behalf of the Departments, as the Departments
propose to require each party participating in the Federal IDR
process to pay the administrative fee directly to the Departments.
The Departments have also added the hour burden for the
registration of group health plans and health insurance issuers.
Finally, the Departments have updated the wage rates and postage
costs. As a result, the number of responses has increased by
922,628 responses, the hour burden has increased by 1,481,469
hours, and the cost burden has increased by $10,592,979.
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.
Consolidated 1210-0169 Tri-dept PRA supporting statement 11.02.2023.docx
Registration of Group Health Plans and Health Insurance Issuers