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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1080
ICR Reference No:
202102-0938-014
Status:
Active
Previous ICR Reference No:
201908-0938-016
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medical Necessity Disclosure Under MHPAEA and Claims Denial Disclosure Under MHPAEA (CMS-10307)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
09/28/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/24/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2024
36 Months From Approved
09/30/2021
Responses
987,713
0
1,081,928
Time Burden (Hours)
82,310
0
43,327
Cost Burden (Dollars)
0
0
1,369,301
Abstract:
Medical Necessity Disclosure under MHPAEA The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (P.L.110-343) requires that group health plans and group health insurance issuers offering mental health or substance use disorder (MH/SUD) benefits in addition to medical and surgical (med/surg) benefits ensure that that they do not apply any more restrictive financial requirements (e.g., co-pays, deductibles) and/or treatment limitations (e.g., visit limits) to MH/SUD benefits than those requirements and/or limitations applied to substantially all med/surg benefits.Medical Necessity Disclosure under MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to provide, upon request, the criteria for medical necessity determinations made with respect to MH/SUD benefits to current or potential participants, beneficiaries, or contracting providers. The Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (75 FR 5410, February 2, 2010) sets forth rules for providing criteria for medical necessity determinations. The final rules retain the provisions from the interim final rules and extend them to small employers and the individual market. CMS oversees non-Federal governmental plans or related health insurance and health insurance plans offered in the individual market.MHPAEA section 512(b) specifically amends the Public Health Service (PHS) Act to require plan administrators or health insurance issuers to supply, upon request, the reason for any denial of payment for MH/SUD services to the participant or beneficiary involved in the case.
Authorizing Statute(s):
US Code:
42 USC 300gg-5(a)(4)
Name of Law: Public Health Service Act section 2705
PL:
Pub.L. 110 - 343 512(b)
Name of Law: Mental Health Parity and Addiction Equity Act of 2008
Citations for New Statutory Requirements:
PL: Pub.L. 110 - 343 512(b) Name of Law: Mental Health Parity and Addiction Equity Act of 2008
US Code: 42 USC 300gg-5(a)(4) Name of Law: Public Health Service Act section 2705
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR 68330
10/28/2020
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 9349
02/12/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Claims Denial Disclosure under MHPAEA
Claims Denial Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper]
Claims Denial Disclosure under MHPAEA [Processed In-House] [Electronic]
Claims Denial Disclosure under MHPAEA [Processed In-House] [Paper]
Disclosure Request Form
CMS-10307
Disclosure Request Form
Disclosure under MHPAEA [Processed By Issuer in the Individual Market]
Medical Necessity Disclosure under MHPAEA
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Electronic]
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Electronic]
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Paper]
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Electronic]
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Paper]
Medical Necessity Disclosure under MHPAEA [Sent with Claims Denial Disclosure] [Processed By Issuer or Third Party Service] [Paper]
Medical Necessity Disclosure under MHPAEA sent with Claims Denial Disclosure
ICR Summary of Burden
Total Approved
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
987,713
1,081,928
0
0
-94,215
0
Annual Time Burden (Hours)
82,310
43,327
0
0
38,983
0
Annual Cost Burden (Dollars)
0
1,369,301
0
0
-1,369,301
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The total burden related to medical necessity disclosures and claims denial disclosures increased by approximately 38,983 hours (from 43,327 to 82,310) because burden to group health plans administered by issuers and third party administrators previously reported as capital costs are now reported as hour burden, taking into account a reduction in the estimated number of issuer/state combinations in the individual market (from 2,045 to 1,293) which reduced the number of medical necessity disclosures and related burden hours. Additionally, burden related to the optional disclosure request form decreased by approximately 1,442 hours (from 15,394 to 13,952) because of a reduction in the estimated number of issuer/state combinations in the individual market (from 184,733 to 167,425 requests). Capital costs have decreased by approximately $1,577,604 (from $1,754,612 to $177,008) as a result of change in reporting.
Annual Cost to Federal Government:
$0
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.
No
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]?
Yes
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
Agency Contact:
Jamaa Hill 301 492-4190
Common Form ICR:
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:
(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:
02/24/2021
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