Patient Provider Dispute Resolution Requirements Related to Surprise Billing: Part II (CMS-10853)

ICR 202309-0938-001

OMB:

Federal Form Document

ICR Details
202309-0938-001
Received in OIRA
HHS/CMS CCIIO - 10853
Patient Provider Dispute Resolution Requirements Related to Surprise Billing: Part II (CMS-10853)
New collection (Request for a new OMB Control Number)   No
Regular 09/11/2023
  Requested Previously Approved
36 Months From Approved
26,659 0
322,189 0
0 0

The No Surprises Act adds a new Part E of title XXVII of the PHS Act establishing requirements applicable to health care providers, and facilities. Specifically, the No Surprises Act adds provisions at new PHS Act sections 2799B-6 and 2799B-7, which require providers and facilities to provide a good faith estimate of the total expected charges to uninsured individuals, under certain circumstances, upon their request, for scheduled items and services, and allow uninsured individuals to avail themselves to a patient-provider dispute resolution process if their billed charges after receiving such items or services is substantially in excess of the expected charges listed in the good faith estimate furnished by the provider ot facility. PHS Act section 2799B-6 (2)(A) requires a health care provider or facility to provide a notification of the good faith estimate of expected charges to a plan or issuer in the case the individual is enrolled in such a plan or coverage and is seeking to have a claim for such item or services submitted to such plan or coverage. The good faith estimate of expected charges from the health care provider or facility will inform the advanced explanation of benefits that must be provided by the plan or issuer, as required by PHS Act section 2799A-1(f), in the case the individual is enrolled in such a plan or coverage and is seeking to have a claim for such item or services submitted to such plan or coverage.

PL: Pub.L. 116 - 260 116 260 Title I of Division BB Name of Law: Consolidated Appropriations Act, 2021
  
US Code: 45 USC 149.620 Name of Law: Surprise Billing and Transparency Requirements

Not associated with rulemaking

  88 FR 27517 05/02/2023
88 FR 56023 08/17/2023
Yes

  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 26,659 0 26,659 0 0 0
Annual Time Burden (Hours) 322,189 0 322,189 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new collection of information.

$12,600,000
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.
09/11/2023


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