Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

Forms and Documents

Document Name	Status
SS_1545-2165_2023lvd-pt2.docx Supporting Statement A	2023-09-18

IC Document Collections

IC ID	Document Title	Status
191315	Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008	Modified

ICR Details

OMB Control No: 1545-2165	ICR Reference No: 202309-1545-007
Status: Received in OIRA	Previous ICR Reference No: 202207-1545-007
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/19/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2025
Responses	1,323,153	1,413,420
Time Burden (Hours)	941,555	31,574
Cost Burden (Dollars)	329,579	4,235,310

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Abstract: Section 9812 of the Code requires group health plans maintained by an employer with more than 50 employees to disclose upon request to participants and beneficiaries of the plan the medical necessity criteria used in making decisions regarding claims for benefits under the plan.

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Authorizing Statute(s): PL: Pub.L. 110 - 343 511 and 512 Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addicition Equity Act of 2008
   US Code: 26 USC 9812 Name of Law: Parity in the application of certain limits to mental health benefits
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1545-BQ29	Proposed rulemaking	88 FR 51552	08/03/2023

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

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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	1,323,153	1,413,420	0	-90,267	0	0
Annual Time Burden (Hours)	941,555	31,574	0	909,981	0	0
Annual Cost Burden (Dollars)	329,579	4,235,310	0	-3,905,731	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: The Departments are proposing amendments to regulations implementing MHPAEA and proposes new regulations for the comparative analyses required under MHPAEA, as amended by the CAA, 2021. Specifically, this rule would amend existing and add new definitions, amend the existing NQTL standard to prevent plans and issuers from using NQTLs to place greater limits on access to MH/SUD benefits as compared to medical/surgical benefits, and add additional examples on the application of NQTLs to clarify and safeguard the protections of MHPAEA. Additionally, these proposed rules would set forth the content requirements for the comparative analyses and specify how plans and issuers must make these comparative analyses available to the Departments, any applicable State authority, and to participants, beneficiaries, and enrollees. In addition, the data inputs, mailing costs, and wage rates have been updated. As a result, the number of responses has decreased by 90,267, the hour burden has decreased by 909,981 hours, and the cost burden has decreased by $-3,905,731.

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Annual Cost to Federal Government: $26,913,080

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.     Yes

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:  No

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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: 09/19/2023

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