View Information Collection Request (ICR) Package

OMB Control No: 1545-2182	ICR Reference No: 202111-1545-011
Status: Historical Active	Previous ICR Reference No: 202102-1545-021
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Affordable Care Act Internal Claims and Appeals and External review Disclosures.
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 03/18/2022
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/09/2022
	Date Received in OIRA: 03/10/2022
Terms of Clearance: Supporting statement updated during OMB review. Prior to the expiration of this package in six months, Treasury shall undertake standard notice and comment procedures.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	6 Months From Approved	07/31/2024
Responses	190,913	0	278,412
Time Burden (Hours)	1,621	0	2,271
Cost Burden (Dollars)	813,839	0	1,143,236

Abstract: This collection of information request includes the information collection and third party notice and disclosure requirements that a plan must satisfy under final regulations implementing provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review process. The No Surprise Act extends the balance billing protections related to external reviews to grandfathered plans. The definitions of group health plan and health insurance issuer that are cited in section 110 of the No Surprises Act include both grandfathered and non-grandfathered plans and coverage. Accordingly, the practical effect of section 110 of the No Surprises Act is that grandfathered health plans must provide external review for adverse benefit determinations involving benefits subject to these surprise billing protections. Grandfathered and non-grandfathered plans must provide claimants, free of charge, any new or additional evidence considered, relied upon, or generated by the plan or issuer in connection with the claim, and the requirement to comply either with a State external review process or a Federal review process. The disclosure requirements of the Federal external review process require (1) a preliminary review by plans of requests for external appeals; (2) Independent Review Organizations (IROs) to notify claimants of eligibility and acceptance for external review; (3) the plan or issuer to provide IROs with documentation and other information considered in making adverse benefit determination; (4) the IRO to forward to the plan or issuer any information submitted by the claimant; (5) plans to notify the claimant and IRO if it reverses its decision; (6) the IRO to notify the claimant and plan of the result of the final external appeal; 7) the IRO to maintain records for six years.

Emergency Justfication: The Department of Labor’s Employee Benefit Security Administration (EBSA), in conjunction with the Office of Personnel Management (OPM), the Department of The Treasury, Internal Revenue Service (IRS), and the Department of Health and Human Services (HHS), issued a joint Interim Final Rule (IFR), Requirements Related to Surprise Billing; Part II, which implements provisions of the No Surprises Act. The No Surprises Act was enacted on December 27, 2020, as title I of Division BB of the Consolidated Appropriations Act, 2021. The No Surprises Act establishes new protections from surprise billing and excessive cost-sharing for consumers receiving health care items and services. Section 102 of the No Surprises Act contains limitations on cost sharing and requirements for initial payments for emergency services. Section 103 establishes a federal independent dispute resolution (IDR) process that allows plans and issuers and out-of-network providers to resolve disputes on out-of-network rates. Section 105 contains limitations on cost sharing and requirements for initial payments for air ambulance services, and allows plans, issuers, and providers of air ambulance services to access the federal IDR process. The IFR implements many of the law’s requirements for group health plans, health insurance issuers, carriers under the Federal Employees Health Benefits (FEHB) Program, health care providers and facilities, and air ambulance service providers. The requirements in the No Surprises Act apply for plan years (in the individual market, policy years) beginning on or after January 1, 2022. The Secretaries and OPM Director have determined that it would be impracticable and contrary to the public interest to delay putting the provisions in these interim final rules in place until after a full public notice and comment process has been completed. Although this effective date may have allowed for the regulations, if promulgated with the full notice and comment rulemaking process, to be applicable in time for the applicability date of the provisions in the No Surprises Act, this timeframe would not provide sufficient time for the regulated entities to implement the requirements. It has been determined that this information must also be collected prior to the time periods established under Part 1320 of the Paperwork Reduction Act (PRA) and that this information is essential to the mission of EBSA to implement the provisions of the No Surprises Act.

Authorizing Statute(s): PL: Pub.L. 116 - 260 110 Name of Law: Consolidated Appropriations Act , 2021
PL: Pub.L. 111 - 148 2719 Name of Law: he Patient Protection and Affordable Care Act

Citations for New Statutory Requirements: PL: Pub.L. 116 - 260 110 Name of Law: Consolidated Appropriatons Act, 2021

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1545-BQ05	Final or interim final rulemaking	86 FR 55980	10/07/2021

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute
Annual Number of Responses	190,913	278,412	-87,499
Annual Time Burden (Hours)	1,621	2,271	-650
Annual Cost Burden (Dollars)	813,839	1,143,236	-329,397

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 No Surprise Act extends the balance billing protection related to external reviews to grandfathered plans. Under Section 110 of the No Surprises Act, grandfathered health plans must provide external review for adverse benefit determinations involving benefits subject to these surprise billing protections. Adjustments to the burden estimates result from updated estimates on the number of ERISA-covered plans and policyholders and increases in wage rates and postage rates. These updated data inputs decrease the hour burden by 650 hours compared with the prior submission and decrease the cost burden by $329,397 compared with the prior submission.

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: Kari DiCecco 202 317-5500 kari.l.dicecco@irscounsel.treas.gov

View ICR - OIRA Conclusion