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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:
1210-0169
ICR Reference No:
202202-1210-002
Status:
Historical Active
Previous ICR Reference No:
202110-1210-002
Agency/Subagency:
DOL/EBSA
Agency Tracking No:
Title:
No Surprises Act: IDR Process
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
Yes
Type of Review Request:
Emergency
Approval Requested By:
04/08/2022
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/11/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/05/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2022
04/30/2022
04/30/2022
Responses
18,483
0
18,338
Time Burden (Hours)
34,097
0
32,974
Cost Burden (Dollars)
278,390
0
99,300
Abstract:
The CAA added provisions applicable to group health plans and health insurance issuers in the group and individual markets in a new Part D of title XXVII of the Public Health Service Act (PHS Act) and also added new provisions to part 7 of the Employee Retirement Income Security Act (ERISA), and Subchapter B of chapter 100 of the Internal Revenue Code (Code). Section 102 of the No Surprises Act added Code section 9816, ERISA section 716, and PHS Act section 2799A-1, which contain limitations on cost sharing and requirements for initial payments for emergency services. Section 103 of the No Surprises Act amended Code section 9816, ERISA section 716, and PHS Act section 2799A-1 to establish a Federal independent dispute resolution (Federal IDR) process that nonparticipating providers or facilities and group health plans and health insurance issuers in the group and individual market may use following the end of an unsuccessful open negotiation period to determine the out-of-network rate for certain services. More specifically, the Federal IDR provisions may be used to determine the out-of-network rate for certain emergency services, nonemergency items and services furnished by nonparticipating providers at participating health care facilities, where an All-Payer Model Agreement or specified state law does not apply. Section 105 of the No Surprises Act created Code section 9817, ERISA section 717, and PHS Act section 2799A-2 which contain limitations on cost sharing and requirements for initial payments for air ambulance services, and allow plans and issuers and providers of air ambulance services to access the Federal IDR process. CAA provisions that apply to health care providers and facilities, and providers of air ambulance services, such as requirements around cost sharing, prohibitions on balance billing for certain items and services, and requirements related to disclosures about balance billing protections, were added to title XXVII of the PHS Act in a new part E.
Emergency Justfication:
Under section 5 CFR 1320.13(a)(2)(ii), an unanticipated event has occurred. On February 23, 2022, the U.S. District Court for the Eastern District of Texas issued an adverse ruling relating to the IFR. In response to the court ruling changes to the descriptions of certain data elements that will be collected need to be made to conform with the court’s order prior to the launching of the electronic processing system.
Authorizing Statute(s):
PL:
Pub.L. 116 - 260 103 and 105
Name of Law: Consolidated Appropriations Act, 2021
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1210-AC00
Final or interim final rulemaking
86 FR 55980
10/07/2021
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
86 FR 55980
10/07/2021
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
Federal IDR Process for Air Ambulance Services
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities
IDR Entity Certification and IDR Entity Monthly Reporting
Request of Extension of Time Periods for Extenuating Circumstances
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
18,483
18,338
0
0
145
0
Annual Time Burden (Hours)
34,097
32,974
0
0
1,123
0
Annual Cost Burden (Dollars)
278,390
99,300
0
0
179,090
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 Departments have removed language from the ICR to be consistent with the federal court ruling in the U.S. District Court for the Eastern District of Texas on the Interim Final Rule, Requirements Related to Surprise Billing; Part II (Texas Medical Association v. HHS). The ruling vacated certain provisions of the IFR related to payment determinations under the federal IDR process. In response, changes to the descriptions of certain data elements need to be made to conform with the court’s order. More specifically, the court vacated provisions of the IFR directing certified IDR entities to select the offer closest to the Qualifying Payment Amount, unless it is shown to be materially different from the appropriate out-of-network rate. The increase in burden is not a result of the revisions to the ICR. The increase in burden is a result of the updated data inputs and mailing cost.
Annual Cost to Federal Government:
$1,000,000
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]?
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
Agency Contact:
James Butikofer 202 693-8434 Butikofer.James@dol.gov
Common Form ICR:
Yes
Description/Changes for Common Form Usage:
Approved RCFs using this ICR
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
TREAS/IRS
202204-1545-001CF
No Surprise Act: IDR Process
Active
Federal IDR Process for Air Ambulance Services , Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities, IDR Entity Certification and IDR Entity Monthly Reporting, Request of Extension of Time Periods for Extenuating Circumstances
HHS/CMS
202204-0938-001CF
Requirements Related to No Surprise Billing Act, Part II (Independent Dispute Resolution Process) (CMS-10791)
Active
Federal IDR Process for Air Ambulance Services , Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities, IDR Entity Certification and IDR Entity Monthly Reporting, Request of Extension of Time Periods for Extenuating Circumstances
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:
04/05/2022
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