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OMB Control No: 1545-2182	ICR Reference No: 202301-1545-016
Status: Active	Previous ICR Reference No: 202111-1545-011
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: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/08/2023
	Date Received in OIRA: 04/01/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	06/30/2023
Responses	390,574	0	190,913
Time Burden (Hours)	19,047	0	1,621
Cost Burden (Dollars)	602,026	0	813,839

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.

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: The 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:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 48071	08/05/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 19189	03/31/2023
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	390,574	190,913	199,661
Annual Time Burden (Hours)	19,047	1,621	17,426
Annual Cost Burden (Dollars)	602,026	813,839	-211,813

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: 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. The burden of the service providers has now been counted toward the hour burden, rather than the cost burden. These changes increase the hour burden by 17,426 hours compared with the prior submission and decrease the cost burden by $211,813.

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