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 overall burden has
decreased from 28,618,546 to 7,591,925 hours, resulting in a total
burden reduction of 21,026,621 hours. Consequently, the associated
cost has decreased from $1,036,852,972 to $28,618,546, resulting in
a reduction of $1,008,234,426. Although the introduction of the
proposed rule to incorporate the contraceptive disclosure into the
existing internet-based self-service tool led to a slight increase
in burden, the significant reduction in the overall burden is
primarily due to removal of first- and second-year one-time burden
for issuers and TPAs to develop and implement their internet-based
self-service tool, which were incurred in 2022 and 2023.
Additionally, the overall reduction in burden is partially due to
the updated count of issuers and TPAs, resulting in a decreased
total number of these entities. In addition to these changes in
burden, CMS has updated the CFR citations in this Transparency in
Coverage Supporting Statement’s ICR section headings to correct
errors in the prior version of the Transparency in Coverage
Supporting Statement. The citation in the section heading for the
ICRs Regarding Requirements for Disclosures to Participants,
Beneficiaries, or Enrollees was updated from 45 CFR 147.210(b) to
45 CFR 147.211(b). The citation in the section heading for ICRs
Regarding Requirements for Public Disclosure of In-network Rates,
Historical Allowed Amount Data for Covered Items and Services from
Out-of-Network Providers and Prescription Drug Pricing Information
was updated from 45 CFR 147.21 to 45 CFR 147.212.
$0
No
No
No
Yes
No
No
No
Jamaa Hill 301 492-4190
Yes
The purpose of this submission is to revise
the information collection request currently approved under
0938-1429 as a Sponsoring Common Form.
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 Contraceptive Disclosure
CMS 10715 Transparency in Coverage Supporting Statement CL.docx
Contraceptive Disclosure