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.
The change in burden estimate
is the result of reporting the annual burden, whereas the 6-month
burden total was reported in the most recent emergency submission.
The Department has made clarifying edits to the following forms
that do not impact the burden: Open Negotiation Period Notice,
Notice of IDR Initiation, Notice of Certified IDR Entity Selection,
Notice of Offer (Data Elements), and Certified IDR Entity Written
Determination. More information is provided in Q15 of the
Supporting Statement.
$1,000,000
No
No
No
No
No
No
No
James Butikofer 202 693-8434
Butikofer.James@dol.gov
Yes
The Department has made clarifying changes to
the following forms: Open Negotiation Period Notice, Notice of IDR
Initiation, Notice of Certified IDR Entity Selection, Notice of
Offer (Data Elements), and Certified IDR Entity Written
Determination. More information is provided in Q15 of the
Supporting Statement.
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
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.
1210-0169 Tri-dept PRA supporting statement 4.25.2022 FINAL.docx
Request of Extension of Time Periods for Extenuating Circumstances