The Patient Protection and Affordable
Care Act (the Affordable Care Act) was enacted by President Obama
on March 23, 2010. Section 2719A of the PHS Act, as added by the
Affordable Care Act, and the Departments interim final regulation
(29 CFR 2590.715-2719A) that if a group health plan, or a health
insurance issuer offering group or individual health insurance
coverage, requires or provides for designation by a participant,
beneficiary, or enrollee of a participating primary care provider,
then the plan or issuer must permit each participant, beneficiary,
or enrollee to designate any participating primary care provider
who is available to accept the participant, beneficiary, or
enrollee. The statute and the interim final regulations impose a
requirement for the designation of a pediatrician similar to the
requirement for the designation of a primary care physician.
Specifically, if a plan or issuer requires or provides for the
designation of a participating primary care provider for a child by
a participant, beneficiary, or enrollee, the plan or issuer must
permit the designation of a physician (allopathic or osteopathic)
who specializes in pediatrics as the child's primary care provider
if the provider participates in the network of the plan or issuer.
The statute and these interim final regulations also provide that a
group health plan, or a health insurance issuer may not require
authorization or referral by the plan, issuer, or any person
(including a primary care provider) for a female participant,
beneficiary, or enrollee who seeks obstetrical or gynecological
care provided by an in-network health care professional who
specializes in obstetrics or gynecology. When applicable, it is
important that individuals enrolled in a plan or health insurance
coverage know of their rights to (1) choose a primary care provider
or a pediatrician when a plan or issuer requires participants or
subscribers to designate a primary care physician; or (2) obtain
obstetrical or gynecological care without prior authorization.
Accordingly, paragraph (a)(4) of the interim final regulations
requires such plans and issuers to provide a notice to participants
(in the individual market, primary subscribers) of these rights
when applicable. Model language is provided in these interim final
regulations. The notice must be provided whenever the plan or
issuer provides a participant with a summary plan description or
other similar description of benefits under the plan or health
insurance coverage, or in the individual market, provides a primary
subscriber with a policy, certificate, or contract of health
insurance.
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.
SSPPACAPatientProtectionsNotice2010.doc
Affordable Care Act Patient Protection Notice