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

ICR 202309-1545-007

OMB: 1545-2165

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2023-09-18
ICR Details
1545-2165 202309-1545-007
Received in OIRA 202207-1545-007
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 09/19/2023
  Requested Previously Approved
36 Months From Approved 10/31/2025
1,323,153 1,413,420
941,555 31,574
329,579 4,235,310

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.

PL: Pub.L. 110 - 343 511 and 512 Name of Law: Paul Wellstone and Pete Domenici Mental Health Parity and Addicition Equity Act of 2008
   US Code: 26 USC 9812 Name of Law: Parity in the application of certain limits to mental health benefits
  
None

1545-BQ29 Proposed rulemaking 88 FR 51552 08/03/2023

No

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

  Total Request 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 1,323,153 1,413,420 0 -90,267 0 0
Annual Time Burden (Hours) 941,555 31,574 0 909,981 0 0
Annual Cost Burden (Dollars) 329,579 4,235,310 0 -3,905,731 0 0
Yes
Changing Regulations
No
The Departments are proposing amendments to regulations implementing MHPAEA and proposes new regulations for the comparative analyses required under MHPAEA, as amended by the CAA, 2021. Specifically, this rule would amend existing and add new definitions, amend the existing NQTL standard to prevent plans and issuers from using NQTLs to place greater limits on access to MH/SUD benefits as compared to medical/surgical benefits, and add additional examples on the application of NQTLs to clarify and safeguard the protections of MHPAEA. Additionally, these proposed rules would set forth the content requirements for the comparative analyses and specify how plans and issuers must make these comparative analyses available to the Departments, any applicable State authority, and to participants, beneficiaries, and enrollees. In addition, the data inputs, mailing costs, and wage rates have been updated. As a result, the number of responses has decreased by 90,267, the hour burden has decreased by 909,981 hours, and the cost burden has decreased by $-3,905,731.

$26,913,080
No
    Yes
    No
No
No
No
No
Mara Blumenthal 202 693-8538 blumenthal.mara@dol.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.
09/19/2023


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