Notice2022-16856
Proposed Collection; Comment Request for Affordable Care Act Internal Claims and Appeals and External Review Disclosures
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
August 5, 2022
Issuing agencies
Treasury DepartmentInternal Revenue Service
Abstract
The Internal Revenue Service, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on continuing information collections, as required by the Paperwork Reduction Act of 1995. The IRS is soliciting comments concerning the Affordable Care Act internal claims and appeals and external review disclosures.
Full Text
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<title>Federal Register, Volume 87 Issue 150 (Friday, August 5, 2022)</title>
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[Federal Register Volume 87, Number 150 (Friday, August 5, 2022)]
[Notices]
[Pages 48071-48072]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-16856]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
Proposed Collection; Comment Request for Affordable Care Act
Internal Claims and Appeals and External Review Disclosures
AGENCY: Internal Revenue Service (IRS), Treasury.
ACTION: Notice and request for comments.
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SUMMARY: The Internal Revenue Service, as part of its continuing effort
to reduce paperwork and respondent burden, invites the general public
and other Federal agencies to take this opportunity to comment on
continuing information collections, as required by the Paperwork
Reduction Act of 1995. The IRS is soliciting comments concerning the
Affordable Care Act internal claims and appeals and external review
disclosures.
DATES: Written comments should be received on or before October 3, 2022
to be assured of consideration
ADDRESSES: Direct all written comments to Andres Garcia, Internal
Revenue Service, Room 6526, 1111 Constitution Avenue NW, Washington, DC
20224, or by email to <a href="/cdn-cgi/l/email-protection#cbbbb9aae5a8a4a6a6aea5bfb88ba2b9b8e5aca4bd"><span class="__cf_email__" data-cfemail="522220337c313d3f3f373c2621123b20217c353d24">[email protected]</span></a>. Include OMB control number
1545-2182 or Affordable Care Act Internal Claims and Appeals and
External review Disclosures, in the subject line of the message.
FOR FURTHER INFORMATION CONTACT: Requests for additional information or
copies of the form should be directed to Kerry Dennis at (202) 317-
5751, or at Internal Revenue Service, Room 6526, 1111 Constitution
Avenue NW, Washington DC 20224, or through the internet, at
<a href="/cdn-cgi/l/email-protection#e6ad8394949fc8aac8a28388888f95a68f9495c8818990"><span class="__cf_email__" data-cfemail="a2e9c7d0d0db8cee8ce6c7cccccbd1e2cbd0d18cc5cdd4">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
Title: Affordable Care Act Internal Claims and Appeals and External
review Disclosures.
OMB Number: 1545-2182.
Regulation Number: T.D. 9494 and T.D. 9955.
Abstract: This collection of information request includes the
information collection and third- party notice and disclosure
requirements that a plan must satisfy under final regulations
implementing provisions of the Affordable Care Act pertaining to
internal claims and appeals, and the external review process. The No
Surprise Act extends the balance billing protections related to
external reviews to grandfathered plans. The definitions of group
health plan and health insurance issuer that are cited in section 110
of the No Surprises Act include both grandfathered and non-
grandfathered plans and coverage. Accordingly, the practical effect of
section 110 of the No Surprises Act is that grandfathered health plans
must provide external review for adverse benefit determinations
involving benefits subject to these surprise billing protections.
Grandfathered and non-grandfathered plans must provide claimants, free
of charge, any new or additional evidence considered, relied upon, or
generated by the plan or issuer in connection with the claim, and the
requirement to comply either with a State external review process or a
Federal review process. The disclosure requirements of the Federal
external review process require (1) a preliminary review by plans of
requests for external appeals; (2) Independent Review Organizations
(IROs) to notify claimants of eligibility and acceptance for external
review; (3) the plan or issuer to provide IROs with documentation and
other
[[Page 48072]]
information considered in making adverse benefit determination; (4) the
IRO to forward to the plan or issuer any information submitted by the
claimant; (5) plans to notify the claimant and IRO if it reverses its
decision; (6) the IRO to notify the claimant and plan of the result of
the final external appeal; (7) the IRO to maintain records for six
years.
Current Actions: There is a change to the paperwork burden
previously approved by OMB. Adjustments to the burden estimates result
from updated estimates on the number of ERISA-covered plans and
policyholders.
Type of Review: Extension of a currently approved collection.
Affected Public: Businesses or other for-profits, Not-for-profit
institutions.
Group Health Plans Internal Claims and Appeals and External Review
Processes
Estimated Number of Respondents: 314,560.
Estimated Time per Respondent: .5 hours.
Estimated Total Annual Burden Hours: 14,432 hours.
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
Estimated Number of Respondents: 76,014.
Estimated Total Annual Burden Hours: .4 hours.
Estimated Number of Respondents: 4,615.
Total Estimated Time per Respondent: 390,574.
Total Estimated Annual Burden Hours: 19,047 hours.
The following paragraph applies to all the collections of
information covered by this notice.
An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless the collection of
information displays a valid OMB control number. Books or records
relating to a collection of information must be retained if their
contents may become material in the administration of any internal
revenue law. Generally, tax returns and tax return information are
confidential, as required by 26 U.S.C. 6103.
Request for Comments: Comments submitted in response to this notice
will be summarized and/or included in the request for OMB approval. All
comments will become a matter of public record. Comments are invited
on: (a) whether the collection of information is necessary for the
proper performance of the functions of the agency, including whether
the information shall have practical utility; (b) the accuracy of the
agency's estimate of the burden of the collection of information; (c)
ways to enhance the quality, utility, and clarity of the information to
be collected; (d) ways to minimize the burden of the collection of
information on respondents, including through the use of automated
collection techniques or other forms of information technology; and (e)
estimates of capital or start-up costs and costs of operation,
maintenance, and purchase of services to provide information.
Approved: August 2, 2022.
Kerry L. Dennis,
Tax Analyst.
[FR Doc. 2022-16856 Filed 8-4-22; 8:45 am]
BILLING CODE 4830-01-P
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