Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

ICR 201904-1545-004

OMB: 1545-2165

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2019-06-10
ICR Details
1545-2165 201904-1545-004
Active 201602-1545-027
TREAS/IRS
Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008
Revision of a currently approved collection   No
Regular
Approved without change 08/28/2019
Retrieve Notice of Action (NOA) 06/25/2019
  Inventory as of this Action Requested Previously Approved
08/31/2022 36 Months From Approved 08/31/2019
1,217,875 0 114,000
27,206 0 5,988
3,649,360 0 256,000

Section 9812 of the Code requires group health plans maintained by an employer with more than 50 employees to disclose upon request to participants and beneficiaries of the plan the medical necessity criteria used in making decisions regarding claims for benefits under the plan.

US Code: 26 USC 9812 Name of Law: Parity in the application of certain limits to mental health benefits
   PL: Pub.L. 110 - 343 511 Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addicition Equity Act of 2008
  
None

Not associated with rulemaking

  84 FR 7417 03/05/2019
84 FR 29586 06/24/2019
Yes

1
IC Title Form No. Form Name
Notice of Medical Necessity Criteria under the Mental Health Parity and Addiction Equity Act of 2008

  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 1,217,875 114,000 0 0 1,103,875 0
Annual Time Burden (Hours) 27,206 5,988 0 0 21,218 0
Annual Cost Burden (Dollars) 3,649,360 256,000 0 0 3,393,360 0
No
No
The increase in hour burden is associated with the ICRs related to the new draft model disclosure request form the Department is issuing in order to meet the MHPAEA-related requirements in the 21st Century Cures Act.

$0
No
    Yes
    No
No
No
No
Uncollected
Jennifer Solomon 202 317-5500 jennifer.r.solomon@irscounsel.treas.gov

  No

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.
06/25/2019


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