The information collection
requirements contained in the proposed rule titled “Transparency in
Coverage,” published November 27, 2019 (84 FR 65464), would require
group health plans and health insurance issuers offering coverage
in the individual and group markets to disclose to a participant,
beneficiary, or enrollee (or an authorized representative on behalf
of such individual), the estimated cost-sharing liability for
covered items or services from a particular provider or providers,
thereby allowing a participant, beneficiary, or enrollee to obtain
an accurate estimate and understanding of their potential
out-of-pocket expenses and to effectively shop for covered items
and services. Group health plans and health insurance issuers would
be required to make such information available through a
self-service tool on an internet website. The self-service tool
must provide the information through real-time responses and allow
users to search for cost-sharing information for covered items and
services. The self-service tool must also allow users to input
information necessary to learn the out-of-network allowed amount
for a covered item or service and have the capability to refine and
reorder results. Group health plans and health insurance issuers
would also be required to make this information available as a
disclosure in written form. Both the self-service tool and the
paper disclosure would be required to include several disclaimer
statements relevant to information provided through the disclosure
and could be provided by using a model notice developed by the
Departments. Additionally, group health plans and health insurance
issuers would be subject requirements to disclose in-network
provider negotiated rates and historical payment data for allowed
amounts for covered items and services furnished by out-of-network
providers through two digital files in a machine-readable format to
be specified by the Departments. The Negotiated Rate file and the
Allowed Amount file must be posted publicly on an internet
website.
The purpose of this submission is to establish
the information collection request currently approved under
0938-1429 as a Sponsoring Common Form. During the associated
rulemaking (85 FR 72158) as well as in the subsequent submission to
OMB, the ICR explicitly stated that it would be using the Request
for Common Form (RCF) process. Once approved, the Departments would
submit RCFs for their respective Departments. Due to an
administrative oversight, CMS did not submit 0938-1429 as an ICR
sponsoring a common form. With this submission we are correcting
the oversight. We note that no changes have been made to the ICR,
that is, no new requirements, no removed requirements, no additions
or deletions to the respondent populations and no changes to time
or cost burden. Two formatting changes were made to the supporting
statement document. The supporting statement has been retitled to
contain the correct OMB control number and the file was converted
from a PDF file to a Word file.
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
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.
Form CMS-10715 Allowed Amount File
0938-1429.Supplementary Note to File.docx
Customer Service Representatives Training