DOL will update this record with copies of the final version of the notices and guidance.
Inventory as of this Action
Requested
Previously Approved
02/28/2011
6 Months From Approved
01/31/2011
94,483
0
61,803
631
0
263
250,328
0
242,828
he Patient Protection and Affordable Care Act, Public Law 111-148, (the Affordable Care Act) was enacted by President Obama on March 23, 2010. As part of the Act, Congress added PHS Act section 2719, which provides rules relating to internal claims and appeals and external review processes. These interim final regulations set forth rules implementing PHS Act section 2719 for internal claims and appeals and external review processes. With respect to internal claims and appeals processes for group health coverage, PHS Act section 2719 and paragraph (b)(2)(i) of the interim final regulations provide that group health plans and health insurance issuers offering group health insurance coverage must comply with the internal claims and appeals processes set forth in 29 CFR 2560.503-1 (the DOL claims procedure regulation) and update such processes in accordance with standards established by the Secretary of Labor in paragraph (b)(2)(ii) of the regulations.
Also PHS Act section 2719 and these interim final regulations provide that group health plans and issuers offering group health insurance coverage must comply either with a State external review process or a Federal review process. The regulations provide a basis for determining when plans and issuers must comply with an applicable State external review process and when they must comply with the Federal external review process.
The ICR is being revised to provide procedures for the Federal external review process.
The Patient Protection and Affordable Care Act (the ÂAffordable Care ActÂ) was enacted by President Obama on March 23, 2010; the Health Care and Education Reconciliation Act (the ÂReconciliation ActÂ), Pub. L. 111-152, was enacted on March 30, 2010. The Affordable Care Act and the Reconciliation Act reorganize, amend, and add to the provisions of part A of title XXVII of the Public Health Service Act (PHS Act) relating to group health plans and health insurance issuers in the group and individual markets.
Section 2719 of the PHS Act sets forth standards for plans and issuers that are not grandfathered health plans regarding both internal claims and appeals and external review. The Departments of Labor, Health and Human Services, and the Treasury (the Departments) published interim final regulations implementing PHS Act section 2719 on July 23, 2010, at 75 FR 43330 (Âthe interim final regulationsÂ). When the interim final regulations were issued OMB approved an information collection request (ICR) titled ÂAffordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Plans under OMB Control Numbers 1210-0144 (Department of Labor), 1545-2182 (Internal Revenue Service, Department of the Treasury), and 0938-1098 (Department of Health and Human Services).
The preamble to the interim final regulations provides that the Departments would be issuing additional guidance on the Federal external review process in the near future. The preamble states that the Departments also would issue model notices that could be used to satisfy the notice requirements under the interim final regulations. This action revises the ICRs under the OMB Control Numbers stated above to account for the hour and cost burden associated with the interim Federal external review process. The impact of the model notices, which also are being issued as part of this action, was accounted for in the ICR when the interim final regulations were issued.
The Departments are requesting OMB to approve an emergency PRA submission, because they would not be able to publish the interim Federal external review guidance and model notices on a timely basis if the usual PRA processes were followed.
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.
Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act