Proposed Rule2022-19798
Request for Information; Advanced Explanation of Benefits and Good Faith Estimate for Covered Individuals
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
September 16, 2022
Issuing agencies
Personnel Management OfficeTreasury DepartmentInternal Revenue ServiceLabor DepartmentEmployee Benefits Security AdministrationHealth and Human Services Department
Abstract
This document is a request for information (RFI) to inform DOL, HHS, and the Treasury (collectively, the Departments) and OPM's rulemaking for advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA). This RFI seeks information and recommendations on transferring data from providers and facilities to plans, issuers, and carriers; other policy approaches; and the economic impacts of implementing these requirements.
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<title>Federal Register, Volume 87 Issue 179 (Friday, September 16, 2022)</title>
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[Federal Register Volume 87, Number 179 (Friday, September 16, 2022)]
[Proposed Rules]
[Pages 56905-56912]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-19798]
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Proposed Rules
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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Federal Register / Vol. 87 , No. 179 / Friday, September 16, 2022 /
Proposed Rules
[[Page 56905]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Chapter I
RIN 3206-AO45
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Chapter I
RIN 1545-BQ37
DEPARTMENT OF LABOR
Employee Benefits Security Administration
29 CFR Chapter XXV
RIN 1210-AC14
DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Subchapter B
[CMS-9900-NC]
RIN 0938-AU98
Request for Information; Advanced Explanation of Benefits and
Good Faith Estimate for Covered Individuals
AGENCY: Office of Personnel Management (OPM); Internal Revenue Service,
Department of the Treasury; Employee Benefits Security Administration
(EBSA), Department of Labor (DOL); and Centers for Medicare & Medicaid
Services (CMS), Department of Health and Human Services (HHS).
ACTION: Request for information.
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SUMMARY: This document is a request for information (RFI) to inform
DOL, HHS, and the Treasury (collectively, the Departments) and OPM's
rulemaking for advanced explanation of benefits (AEOB) and good faith
estimate (GFE) requirements of the No Surprises Act, which was enacted
as part of the Consolidated Appropriations Act, 2021 (CAA). This RFI
seeks information and recommendations on transferring data from
providers and facilities to plans, issuers, and carriers; other policy
approaches; and the economic impacts of implementing these
requirements.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below by November 15, 2022.
ADDRESSES: In commenting, refer to file code CMS-9900-NC.
Comments, including mass comment submissions, must be submitted in
one of the following three ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this
regulation to <a href="https://www.regulations.gov">https://www.regulations.gov</a>. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-9900-NC, P.O. Box 8013,
Baltimore, MD 21244-8013.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-9900-NC, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Padma Babubhai Shah, Office of Personnel Management (OPM), (202)
606-4056.
Emily Ames, Centers for Medicare & Medicaid Services (CMS), (301)
492-4246.
William Fischer, Internal Revenue Service (IRS), (202) 317-5500.
Elizabeth Schumacher or Frank Kolb, Employee Benefits Security
Administration (EBSA), (202) 693-8335.
Customer Service Information: Information from OPM on health
benefits plans offered under the FEHB Program can be found on the OPM
website (<a href="http://www.opm.gov/healthcare-insurance/healthcare/">www.opm.gov/healthcare-insurance/healthcare/</a>). Individuals
interested in obtaining information from the Department of Labor (DOL)
concerning employment-based health coverage laws may call the EBSA
Toll-Free Hotline at 1-866-444-EBSA (3272) or visit DOL's website
(<a href="http://www.dol.gov/ebsa">www.dol.gov/ebsa</a>). In addition, information from HHS on private health
insurance for consumers can be found on the CMS website (<a href="http://www.cms.gov/cciio">www.cms.gov/cciio</a>) and information on the No Surprises Act can be found at
<a href="http://www.cms.gov/NoSurprises">www.cms.gov/NoSurprises</a>.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. The Departments and OPM post
all comments received before the close of the comment period on the
following website as soon as possible after they have been received:
<a href="http://www.regulations.gov">www.regulations.gov</a>. Follow the search instructions on that website to
view public comments. The Departments and OPM will not post on
<a href="http://Regulations.gov">Regulations.gov</a> public comments that make threats to individuals or
institutions or suggest that an individual will take actions to harm
another individual. The Departments and OPM continue to encourage
individuals not to submit duplicative comments. We will post acceptable
comments from multiple unique commenters even if the content is
identical or nearly identical to other comments.
I. Background
On December 27, 2020, the Consolidated Appropriations Act, 2021
(CAA), which includes the No Surprises Act, was enacted.\1\ The No
Surprises Act provides Federal protections against surprise billing and
limits out-of-network cost sharing under many of the circumstances in
which surprise bills arise most frequently. Surprise billing occurs
when an individual receives an unexpected medical bill from a health
care provider or facility, including providers of air ambulance
services, after receiving medical services from a provider or facility
that, usually unknown to the covered individual, is a nonparticipating
provider or facility in the individual's health plan or health
insurance coverage.
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\1\ Public Law 116-260 (December 27, 2020).
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Public Health Service (PHS) Act section 2799B-6, as added by
section
[[Page 56906]]
112 of title I of Division BB of the CAA, requires providers and
facilities,\2\ upon an individual's scheduling of an item or service,
or upon an individual's request, to inquire if the individual is
enrolled in a group health plan or group or individual health insurance
coverage. If the individual is enrolled in a plan or coverage and is
seeking to have a claim for such item or service submitted to such plan
or coverage, providers and facilities must provide to the plan, issuer,
or carrier, a good faith estimate (GFE) of the expected charges for
furnishing the scheduled item or service (and any items or services
reasonably expected to be provided in conjunction with those items or
services, including those provided by another provider or facility),
along with the expected billing and diagnostic codes for these items or
services. If the individual is not enrolled or is not seeking to have a
claim for such item or service submitted to such plan or coverage (that
is, an uninsured or self-pay individual), providers and facilities must
provide the GFE directly to the individual, as described in PHS Act
section 2799B-6 and implementing regulations at 45 CFR 149.610. The
Department of Health and Human Services (HHS) interprets the
requirements described in PHS Act section 2799B-6 to apply to providers
and facilities furnishing items or services to individuals covered by
the Federal Employees Health Benefits (FEHB) Program in the same manner
as for individuals enrolled in a group health plan or group or
individual health insurance coverage.\3\
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\2\ Under 45 CFR 149.610(a)(2)(vii) through (viii), ``[h]ealth
care provider (provider)'' is defined for purposes of the GFE
requirements as ``a physician or other health care provider who is
acting within the scope of practice of that provider's license or
certification under applicable State law, including a provider of
air ambulance services.'' ``Health care facility (facility)'' is
defined for purposes of the GFE requirements as ``an institution
(such as a hospital or hospital outpatient department, critical
access hospital, ambulatory surgical center, rural health center,
federally qualified health center, laboratory, or imaging center) in
any State in which State or applicable local law provides for the
licensing of such an institution, that is licensed as such an
institution pursuant to such law or is approved by the agency of
such State or locality responsible for licensing such institution as
meeting the standards established for such licensing.''
\3\ See 86 FR 55980, 55983 at FN 12.
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If the uninsured (or self-pay) individual schedules an item or
service to be furnished by the provider or facility at least 3 business
days in advance of the date the item or service is expected to be
furnished, the GFE must be provided within 1 business day after the
date of scheduling the item or service. However, if the item or service
is scheduled at least 10 business days in advance of the date the item
or service is expected to be furnished, or if the uninsured (or self-
pay) individual requests the information, the GFE must be provided no
later than 3 business days after the date of the request.\4\ These
provisions apply beginning on January 1, 2022.
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\4\ PHS Act section 2799B-6.
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Internal Revenue Code (Code) section 9816(f), Employee Retirement
Income Security Act of 1974 (ERISA) section 716(f), and PHS Act section
2799A-1(f), as added by section 111 of title I of Division BB of the
CAA, require group health plans and health insurance issuers offering
group or individual health insurance coverage, upon receiving a GFE
regarding an item or service as described in PHS Act section 2799B-6,
to send a covered individual, through mail or electronic means, as
requested by the covered individual, an advanced explanation of
benefits (AEOB) in clear and understandable language. Pursuant to 5
U.S.C. 8902(p), FEHB carriers must comply with AEOB requirements in the
same manner as those provisions apply to a group health plan or health
insurance issuer offering group or individual health insurance
coverage. The plan, issuer, or carrier must provide an AEOB to the
covered individual no later than 1 business day after the plan, issuer,
or carrier receives the GFE. However, if such item or service was
scheduled at least 10 business days before such item or service is to
be furnished (or if the covered individual requested the information)
the plan, issuer, or carrier must provide an AEOB to the covered
individual within 3 business days after the date on which the plan,
issuer, or carrier receives the GFE or request. The AEOB must include
the following information: (1) the network status of the provider or
facility; (2) the contracted rate for the item or service, or if the
provider or facility is not a participating provider or facility, a
description of how the covered individual can obtain information on
providers and facilities that are participating; (3) the GFE received
from the provider or facility; (4) a GFE of the amount the plan or
coverage is responsible for paying; (5) the amount of any cost sharing
which the covered individual would be responsible for paying with
respect to the GFE received from the provider or facility; (6) a GFE of
the amount that the covered individual has incurred towards meeting the
limit of the financial responsibility (including with respect to
deductibles and out-of-pocket maximums) under the plan or coverage as
of the date of the AEOB; and (7) disclaimers indicating whether
coverage is subject to any medical management techniques (including
concurrent review, prior authorization, and step-therapy or fail-first
protocols). The AEOB must also indicate that the information provided
is only an estimate based on the items and services reasonably expected
to be furnished, at the time of scheduling (or requesting) the item or
service, and is subject to change; and any other information or
disclaimer the plan, issuer, or carrier determines is appropriate and
that is consistent with information and disclaimers required under this
section of the statute. These provisions apply with respect to plan
years (in the individual market, policy years) beginning on or after
January 1, 2022.
HHS issued regulations implementing PHS Act section 2799B-6 related
to GFEs for uninsured (or self-pay) individuals in interim final
rulemaking that was published in the Federal Register on October 7,
2021, but deferred enforcement of the portion of PHS Act section 2799B-
6 related to GFEs for covered individuals who are seeking to have a
claim submitted to their plan or issuer for scheduled items or
services.\5\ In the preamble to that rule (and as stated in guidance
issued by the Departments), the Departments also deferred enforcement
of Code section 9816(f), ERISA section 716(f), and PHS Act section
2799A-1(f) related to the requirement that plans and issuers provide an
AEOB.\6\ The decision to defer enforcement was made in response to
stakeholder requests that the Departments first establish standards for
the data transfer from providers and facilities to plans and issuers,
and give plans, issuers, providers, and facilities enough time to build
the infrastructure necessary to support the transfers. The Departments
agreed that compliance with these sections was likely not possible by
January 1, 2022, and indicated an intent to undertake notice and
comment rulemaking in the future to implement these provisions,
including establishing appropriate data transfer standards. Until that
time, HHS is deferring enforcement of the
[[Page 56907]]
requirement that providers and facilities must provide a GFE to plans
and issuers for covered individuals enrolled in a health plan or
coverage and seeking to have a claim submitted for scheduled (or
requested) items or services to their plan or coverage, and the
Departments are deferring enforcement of the requirement that plans and
issuers must provide these covered individuals with an AEOB. FEHB
carriers' compliance will be concurrent and consistent with
implementing regulations issued by the Departments, subject to OPM
regulation and FEHB contract terms.
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\5\ Requirements Related to Surprise Billing; Part II, 86 FR
55980, 55983 (October 7, 2021), available at <a href="https://www.federalregister.gov/documents/2021/10/07/2021-21441/requirements-related-to-surprise-billing-part-ii">https://www.federalregister.gov/documents/2021/10/07/2021-21441/requirements-related-to-surprise-billing-part-ii</a>.
\6\ Id.; FAQs about Affordable Care Act and Consolidated
Appropriations Act, 2021 Implementation Part 49 (August 20, 2021),
Q6, available at <a href="https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-49.pdf">https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-49.pdf</a> and <a href="https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/FAQs-Part-49.pdf">https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/FAQs-Part-49.pdf</a>.
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II. Solicitation of Public Comments
Recognizing the complex issues involved in developing regulations
to implement Code section 9816(f), ERISA section 716(f), and PHS Act
sections 2799A-1(f) and 2799B-6, the Departments and OPM are requesting
information from the public on a range of issues to better inform
future rulemaking. The Departments and OPM welcome comments from all
interested members of the public, including individuals potentially
eligible to receive an AEOB, organizations serving or representing the
interests of such individuals, health care providers and facilities,
group health plans and health insurance issuers, carriers, third-party
vendors, states, standards development organizations, and other health
programs.
A. Transferring Data From Providers and Facilities to Plans, Issuers,
and Carriers
As noted previously, the Departments and OPM have not yet
established regulatory standards for the transfer of GFE data from
providers and facilities to plans, issuers, and carriers. However, as
CMS indicated in a blog post on December 8, 2021,\7\ the Health Level 7
(HL7[supreg]) Fast Healthcare Interoperability Resources (FHIR[supreg])
standard holds potential for supporting interoperability and enabling
new entrants and competition throughout the health care industry. FHIR
is a standard that was developed specifically to support
interoperability and securely facilitate the exchange of health care
information between systems. In the time since the FHIR standard was
first created, the health care industry has rapidly embraced the
standard through substantial investments in industry pilots,
specification development, and the deployment of FHIR-based Application
Programming Interfaces (APIs) supporting a variety of business
needs.\8\ Some industry-led FHIR Accelerator<SUP>TM</SUP> programs,
such as Da Vinci and CARIN,\9\ have created implementation guides (IGs)
that CMS has recommended for use in meeting the requirements of the CMS
Interoperability and Patient Access final rule for Patient Access and
Provider Directory APIs.\10\ In 2021, the Da Vinci FHIR
Accelerator<SUP>TM</SUP> program launched a Patient Cost Transparency
project dedicated to developing an IG that could be used to exchange
AEOB and GFE information. This IG uses a FHIR-based API for exchange of
AEOB and GFE data from providers to payers and is currently published
as a Standard for Trial Use (STU). The current version of the STU is
useable by industry today, and the Patient Cost Transparency workgroup
continues to revise and update draft standard versions based on public
comments received through the ballot process. The ballot process
supports industry consensus on the IG and ensures its usability by all
stakeholders--including payers, providers, and vendors--to ultimately
serve patients and ensure they have access to the information they
need.
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\7\ Interoperability and the Connected Health Care System
(December 8, 2021), available at <a href="https://www.cms.gov/blog/interoperability-and-connected-health-care-system">https://www.cms.gov/blog/interoperability-and-connected-health-care-system</a>.
\8\ Medicare and Medicaid Programs; Patient Protection and
Affordable Care Act; Interoperability and Patient Access for
Medicare Advantage Organization and Medicaid Managed Care Plans,
State Medicaid Agencies, CHIP Agencies and CHIP Managed Care
Entities, Issuers of Qualified Health Plans on the Federally-
Facilitated Exchanges, and Health Care Providers (CMS
Interoperability and Patient Access final rule), 85 FR 25510 (May 1,
2020), available at <a href="https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf">https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf</a>.
\9\ CMS supports Da Vinci and CARIN by funding contracts to
build implementation guides (IGs). CARIN is an accelerator project
responsible for the IG used for the Patient Access API. Other
accelerators include Gravity (social risk data), Codex (Cancer), and
Helios (Public Health).
\10\ 85 FR 25510.
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The Departments and OPM invite the public to use their expertise
and the information in this section to respond to the questions in this
RFI in their comments. The input may help inform development of future
regulations.
<bullet> What issues should the Departments and OPM consider as
they weigh policies to encourage the use of a FHIR-based API for the
real-time exchange of AEOB and GFE data?
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) requires the Secretary of HHS to adopt standards and operating
rules for certain transactions that apply to covered entities (health
plans, health care clearinghouses, and certain health care providers).
The types of transactions to which these requirements apply are
specified in section 1173(a)(2) of the Social Security Act. However,
transactions related to advance cost estimates, such as exchanges of
AEOB and GFE data, are not contemplated in section 1173(a)(2) of the
Social Security Act and are therefore not among the financial and
administrative transactions for which the Secretary of HHS must adopt
HIPAA standards. As such, no law or regulation currently requires
plans, issuers, carriers, providers, or facilities to use a specific
transaction standard to exchange AEOB or GFE data. Instead, the
Secretaries of the Treasury, Labor, and HHS (the Secretaries) have
general rulemaking authority to establish standards necessary to
implement the provisions of Code section 9816(f), ERISA section 716(f),
and PHS Act section 2799A-1(f).
Although HIPAA Administrative Simplification provisions do not
apply to the exchange of AEOB and GFE data, HIPAA Privacy and Security
requirements do. Plans, issuers, carriers, providers, and facilities
that conduct certain health care transactions electronically are
generally considered covered entities under the HIPAA Privacy and
Security Rules and must comply with HIPAA Privacy and Security
requirements in exchanging AEOB and GFE data.\11\
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\11\ 45 CFR part 160 and subparts A and E of 45 CFR part 164.
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The Departments and OPM solicit feedback on the following:
<bullet> What privacy concerns does the transfer of AEOB and GFE
data raise, considering these transfers would list the individual's
scheduled (or requested) item or service, including the expected
billing and diagnostic codes for that item or service? Does the
exchange of AEOB and GFE data create new or unique privacy concerns for
individuals enrolled in a plan or coverage? Are there any special
considerations that Departments should take into account regarding
individuals who are enrolled in a plan or coverage along with other
members of their household? How should the Departments and OPM address
these concerns?
Additionally, the Office of the National Coordinator for Health
Information Technology (ONC) Health IT Certification Program \12\
consists of specified standards, implementation specifications, and
certification criteria that health IT modules, including electronic
health records systems, can meet.
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\12\ See ONC Health IT Certification Program, available at
<a href="https://www.healthit.gov/topic/certification-ehrs/certification-health-it">https://www.healthit.gov/topic/certification-ehrs/certification-health-it</a>.
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[[Page 56908]]
<bullet> How could updates to this program support the ability of
providers and facilities to exchange GFE information with plans,
issuers, and carriers or support alignment between the exchange of GFE
information and the other processes providers and facilities may engage
in involving the exchange of clinical and administrative data, such as
electronic prior authorization?
<bullet> Would the availability of certification criteria under the
ONC Health IT Certification Program for use by plans, issuers, and
carriers, or health IT developers serving plans, issuers, and carriers,
help to enable interoperability of API technology adopted by these
entities?
Many providers and facilities exchange information with plans,
issuers, and carriers using manual or paper-based technologies, such as
portals, fax machines, or call centers. Up to 46 percent of prior
authorization requests are still submitted by fax, and 60 percent
require a telephone call during the prior authorization process.\13\
The Departments and OPM are also interested in understanding if there
are plans, issuers, and carriers that are small, rural, or have other
characteristics (such as being new or financially vulnerable, or
operating only in the individual or small group market), such that
deploying standards-based API technology might pose a significant
barrier to the plan's, issuer's, or carrier's ability to provide
coverage to consumers.
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\13\ America's Health Insurance Plans (AHIP), New Fast PATH
Initiative Aims to Improve Prior Authorization for Patients and
Doctors (January 6, 2020), available at <a href="https://www.ahip.org/new-fast-path-initiative-aims-to-improve-prior-authorization-for-patients-and-doctors/">https://www.ahip.org/new-fast-path-initiative-aims-to-improve-prior-authorization-for-patients-and-doctors/</a>.
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<bullet> What, if any, burdens or barriers would be encountered by
small, rural, or other providers, facilities, plans, issuers, and
carriers in complying with industry-wide standards-based API technology
requirements for the exchange of AEOB and GFE data? How many small,
rural, or other providers, facilities, plans, issuers, and carriers
would encounter these burdens or barriers in complying with such
technology requirements?
<bullet> Are there any approaches that the Departments and OPM
should consider, or flexibility that should be provided (such as an
exception or a phased-in approach to requiring providers and payers to
adopt a standards-based API to exchange AEOB and GFE data), to account
for small, rural, or other providers, facilities, plans, issuers, and
carriers?
<bullet> If the Departments and OPM were to provide such
flexibility, what factors should they consider in defining eligible
providers, facilities, plans, issuers, and carriers?
B. Other Policy Considerations
In addition to issues related to how providers and facilities would
transfer GFEs to plans, issuers, and carriers, there are also issues
related to ensuring that providers and facilities transfer the
necessary data for plans, issuers, and carriers to prepare accurate
AEOBs that take into account how the No Surprises Act's or a State's
surprise billing laws may affect an individual's benefits related to
the items or services specified in the AEOB, and the individual's
financial responsibility for these items or services.\14\ Under the No
Surprises Act and its implementing regulations, nonparticipating
providers of nonemergency items or services performed with respect to a
visit to certain participating facilities are generally prohibited from
charging individuals cost-sharing amounts greater than those that would
apply in-network, and are prohibited from balance billing the
individual; and, for these services, plans and issuers must count this
cost sharing toward any in-network deductibles and out-of-pocket
maximums. The same general standards also apply with respect to
emergency services (including post-stabilization services, under
certain circumstances) performed by nonparticipating providers and
facilities, and to air ambulance services furnished by nonparticipating
air ambulance service providers.
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\14\ Code section 9816(f), ERISA section 716(f), and PHS Act
section 2799A-1(f).
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Additionally, with respect to post-stabilization services furnished
by nonparticipating providers or facilities, and nonemergency services
performed by nonparticipating providers with respect to patient visits
to certain participating facilities, the nonparticipating provider or
facility under certain circumstances may seek the individual's consent
to waive those protections.\15\ The Departments and OPM request comment
on the following questions in order to understand how to ensure that
plans, issuers, and carriers have the requisite information to prepare
an AEOB that takes into account an individual's consent, or lack of
consent, to waiving balance billing and cost-sharing protections.\16\
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\15\ For more detailed information on these requirements, see 86
FR 36872.
\16\ References to the GFE in these questions refer to the GFE
that providers and facilities must provide to plans, issuers, and
carriers with respect to individuals enrolled in a plan or coverage
(and seeking to have a claim for the item or service submitted to
such plan or coverage) upon scheduling an item or service or
requesting a GFE, as specified in section 2799B-6 of the PHS Act, as
opposed to the GFE required to be included in the notice and consent
to be treated by a nonparticipating provider under section 2799B-
2(d)(2)(B) of the PHS Act and 45 CFR 149.420(d)(2).
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<bullet> Should a nonparticipating provider of nonemergency
services be required to inform a plan, issuer, or carrier, as part of
or concurrently with the GFE, whether the requested or scheduled items
or services would be furnished with respect to the individual's visit
to a participating facility? Should this requirement depend on whether
the GFE was requested, as opposed to whether the furnishing of the
items or services has been scheduled?
<bullet> In instances in which it is permissible for a
nonparticipating provider or facility to request consent from an
individual to waive the No Surprises Act's balance billing and cost-
sharing protections, should the provider or facility be required to
inform a plan, issuer, or carrier of the individual's consent, as part
of or concurrently with providing the GFE, if it has already obtained
the individual's consent? Should the nonparticipating provider or
facility also be required to inform a plan, issuer, or carrier if the
provider or facility intends to seek consent, or if the individual has
already declined to give consent?
<bullet> If a nonparticipating provider is required to inform a
plan, issuer, or carrier about the facility in which services are
scheduled to be furnished, or if a nonparticipating provider or
facility is required to inform a plan, issuer, or carrier about the
status of a consent to waive the No Surprises Act's balance billing and
cost-sharing protections, how should the nonparticipating provider or
facility communicate the information? For example, should it be
communicated as part of the GFE or in a separate document?
<bullet> In some cases in which an appointment for a
nonparticipating provider or facility to furnish items or services at a
facility is scheduled at least 72 hours prior to the date on which the
individual is to be furnished the items or services, the provider (or
the participating facility on behalf on the provider) or facility may
provide notice and seek the patient's consent to waive the No Surprises
Act's balance billing and cost-sharing protections not later than 72
hours prior to the date on which the individual is to be furnished the
items or services. In cases in which the appointment is scheduled
within 72 hours prior to the date on which the items or services are to
be furnished,
[[Page 56909]]
providers and facilities are required to provide the notice on the date
the appointment to furnish the items or services is scheduled. When an
individual is provided the notice on the same date that the items or
services are to be furnished, providers and facilities are required to
provide the notice no later than 3 hours prior to furnishing items or
services to which the notice and consent requirements apply. If a
nonparticipating provider or facility is required to inform a plan,
issuer, or carrier, as part of or concurrently with the GFE, about the
status of a consent to waive the No Surprises Act's balance billing and
cost-sharing protections, how should the notice and consent timing
requirement be coordinated with AEOB and GFE timing requirements?
Additionally, provisions of the No Surprises Act's or a State's
surprise billing laws may affect an individual's benefits related to
the items and services specified in an AEOB, as well as the
individual's financial responsibility for those items or services.
Therefore, the Departments and OPM seek information on the following:
<bullet> Generally, how should the AEOB reflect the way in which
the No Surprises Act's or a State's surprise billing and cost-sharing
protections may affect an individual's benefits related to the items or
services specified in an AEOB, and the individual's financial
responsibility for these items or services?
<bullet> In instances in which a plan, issuer, or carrier has been
notified by a provider or facility that consent has been obtained from
an individual to waive the No Surprises Act's or a State's surprise
billing and cost-sharing protections, should the cost and benefit data
in the AEOB explicitly reflect that those protections do not apply?
Should the AEOB specifically state that the data is premised on the
relevant provisions not applying as a result of the individual's
consent? Should the AEOB reflect two different sets of cost and benefit
data instead, one set reflecting that the No Surprises Act's or a
State's surprise billing and cost-sharing protections do not apply, and
one set reflecting the application of these protections (to account for
the possibility that the individual might later revoke consent \17\)?
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\17\ See 86 FR 36909 (discussing individuals' right to revoke
consent regarding items and services not yet furnished).
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<bullet> In instances in which the plan, issuer, or carrier, at the
time it is preparing the AEOB, has knowledge that the No Surprises
Act's or a State's surprise billing and cost-sharing protections would
apply unless individual consent has been given, but the plan, issuer,
or carrier does not know whether consent has been given by the
individual to waive those protections, should the AEOB include two sets
of cost and benefit data, one set that would apply if consent is given,
and one set that would apply if consent is not given?
The AEOB content requirements are similar to the Transparency in
Coverage internet-based self-service tool requirements.\18\ Under those
Transparency in Coverage requirements, plans, issuers, and carriers
\19\ must make available to covered individuals (or an authorized
representative) personalized enrollee cost-sharing information,
including, when applicable, in-network rates for all covered health
care items and services through an internet-based self-service tool and
in paper form upon request. This information must be available for plan
years (in the individual market, policy years) beginning on or after
January 1, 2023, with respect to the 500 items and services identified
by the Departments in Table 1 in the preamble to the Transparency in
Coverage final rule; \20\ and with respect to all covered items and
services, for plan or policy years beginning on or after January 1,
2024.\21\ The Departments and OPM request input on how these
requirements interact, or could interact, with AEOB requirements.
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\18\ Transparency in Coverage, 85 FR 72158 (November 12, 2020),
available at <a href="https://www.govinfo.gov/content/pkg/FR-2020-11-12/pdf/2020-24591.pdf">https://www.govinfo.gov/content/pkg/FR-2020-11-12/pdf/2020-24591.pdf</a>; 26 CFR 54.9815-2715A2(b); 29 CFR 2590.715-2715A2(b);
and 45 CFR 147.211(b).
\19\ OPM instructed FEHB carriers to comply with the
Transparency in Coverage Final Rule in Carrier Letter 2021-03
(February 17, 2021), available at <a href="https://www.opm.gov/healthcare-insurance/healthcare/carriers/2021/2021-03.pdf">https://www.opm.gov/healthcare-insurance/healthcare/carriers/2021/2021-03.pdf</a>.
\20\ 85 FR 72182 through 72190.
\21\ 26 CFR 54.9815-2715A2(c)(1); 29 CFR 2590.715-2715A2(c)(1);
and 45 CFR 147.211(c)(1).
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<bullet> To what extent could the Departments' and OPM's
coordination of the internet-based self-service tool requirements with
AEOB requirements help minimize the burden on plans, issuers, and
carriers in implementing both requirements?
<bullet> Can plans, issuers, and carriers leverage technical work
done to comply with the internet-based self-service tool requirements
to help streamline the process for complying with AEOB requirements?
<bullet> What, if any, obstacles would be encountered if plans,
issuers, and carriers were required to provide AEOBs to covered
individuals for all covered items or services (rather than a specified
subset, similar to the rule for the first year of the internet-based
self-service tool requirement) beginning with the first year of
implementation of the AEOB provisions?
Some stakeholders have commented that a plan, issuer, or carrier
providing a covered individual with an AEOB should also be required to
provide a copy of the AEOB to the provider or facility that furnished
the plan, issuer, or carrier with the GFE.
<bullet> Are there reasons why the Departments and OPM should or
should not propose a requirement that plans, issuers, and carriers
provide a copy of the AEOB to the provider or facility, as opposed to
allowing such a transfer but not requiring it?
Code section 9816(f), ERISA section 716(f), and PHS Act section
2799A-1(f) allow covered individuals to make a request for an AEOB
directly to their plan, issuer, or carrier. The plan, issuer, or
carrier must provide an AEOB upon request to the covered individual no
later than 3 business days after the date on which the plan, issuer, or
carrier receives the request.\22\ The Departments and OPM are
interested in recommendations for implementing this provision without
placing unnecessary burden on plans, issuers, carriers, providers, and
facilities.
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\22\ The plan, issuer, or carrier must provide the AEOB no later
than 1 business day after the plan, issuer, or carrier receives the
GFE, or if such item or service was scheduled at least 10 business
days before such item or service is to be furnished (or if the
covered individual requested the information), the plan, issuer, or
carrier must provide an AEOB to the covered individual within 3
business days after the date on which the plan, issuer, or carrier
receives the GFE or request. Code section 9816(f), ERISA section
716(f), and PHS Act section 2799A-1(f).
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<bullet> What, if any, burdens or barriers should be considered if
the Departments and OPM propose to require plans, issuers, and carriers
to communicate a covered individual's request for an AEOB to a
particular provider or facility in order to receive GFE information
from the provider or facility for use in formulating the requested
AEOB?
Many individuals have multiple forms of health insurance coverage,
including those to which AEOB requirements do not apply (such as
Federal health care programs like Medicare, Medicaid, and TRICARE; \23\
[[Page 56910]]
and excepted benefits such as limited-scope dental and vision
benefits).\24\
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\23\ A Federal health care program (as defined in section
1128B(f) of the Social Security Act) is not considered to be a
``group health plan,'' ``health insurance coverage,'' ``individual
health insurance coverage,'' ``group health insurance coverage,'' or
a ``health insurance issuer,'' as referenced in Code section 9832,
ERISA section 733, and PHS Act section 2791.
\24\ Code section 9832(c)(2), ERISA section 733(c)(2), PHS Act
section 2791(c)(2) exclude limited-scope dental or vision benefits,
if offered separately, from the Code, ERISA, and PHS Act
requirements, respectively.
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<bullet> What approaches should be considered when proposing
requirements related to the AEOB and GFE that account for, or do not
account for, secondary and tertiary payers?
<bullet> What approaches should be considered to address
application of the requirements related to the AEOB and GFE that
account for, or do not account for, unique benefit designs, such as
account-based plans?
Code section 9816(f)(2), ERISA section 716(f)(2), and PHS Act
section 2799A-1(f)(2) provide that in the case of a covered individual
scheduled to receive an item or service that is a specified item or
service, the Secretaries may modify any timing requirements relating to
the provision of the AEOB to such covered individual with respect to
such specified item or service. Under the statute, the term ``specified
item or service'' means an item or service that has low utilization or
significant variation in costs (such as when furnished as part of a
complex treatment), as specified by the Secretaries.\25\ The statute
also provides that any modification made by the Secretaries may not
result in the provision of the notification after the covered
individual has been furnished the specified item or service.\26\ The
Director of OPM (Director) may modify any timing requirements relating
to the provision of the AEOB to a FEHB covered individual in the same
manner as any modification is authorized to be made by the Secretaries,
subject to OPM regulation and FEHB contract terms.
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\25\ Code section 9816(f)(2)(B), ERISA section 716(f)(2)(B), and
PHS Act section 2799A-1(f)(2)(B).
\26\ Code section 9816(f)(2)(A), ERISA section 716(f)(2)(A), and
PHS Act section 2799A-1(f)(2)(A).
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<bullet> What factors should the Departments and OPM consider when
determining what items or services have low utilization or significant
variation in costs (such as when furnished as part of a complex
treatment) for the purposes of modifying AEOB timing requirements, and
why?
<bullet> What are some examples of items or services that have low
utilization or significant variation in costs (such as when furnished
as part of a complex treatment) that the Departments and OPM should
consider designating as specified items or services? Would designation
of items or services as specified items or services vary by provider or
facility type, or other variables, and why?
<bullet> How should AEOB timing requirements be modified with
respect to the specified items or services, and why?
PHS Act section 2799B-6 requires GFEs, among other things, to
include the expected billing and diagnostic codes for such items or
services. Code section 9816(f)(1), ERISA section 716(f)(1), and PHS Act
section 2799A-1(f)(1) require AEOBs to include the contracted rate
under a plan or coverage for items or services (based on the billing
and diagnostic codes provided by the provider or facility) expected to
be provided by participating providers or participating facilities.
Following issuance of interim final rules for GFEs for uninsured (or
self-pay) individuals, HHS received feedback from providers and
facilities that it is not always possible to provide a diagnosis code
without first seeing and evaluating an individual, particularly with
respect to initial screening visits or evaluation and management
visits; or if there is not a relevant diagnosis code for an item or
service, such as for certain dental screenings or procedures. In
response to this feedback, HHS indicated in guidance that a provider or
facility is required to provide a diagnosis code only where one is
required for the calculation of the GFE for an uninsured (or self-pay)
individual.\27\
---------------------------------------------------------------------------
\27\ FAQs About Consolidated Appropriations Act, 2021
Implementation--Good Faith Estimates (GFE) for Uninsured (or Self-
Pay) Individuals--Part 2 (April 5, 2022), available at <a href="https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-Good-Faith-Estimates-FAQ-Part-2.pdf">https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-Good-Faith-Estimates-FAQ-Part-2.pdf</a>.
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<bullet> The Departments and OPM are interested in plans',
issuers', and carriers' perspectives on whether a diagnosis code would
be required for the calculation of the AEOB. Are there items or
services for which a plan, issuer, or carrier would not be able to
determine points of information such as: (1) the contracted rate; (2)
the coverage level (that is, if the plan or issuer covers an item or
service associated with one diagnosis at a higher rate than an item or
service associated with another); or (3) whether an item or service is
covered (that is, if the item or service is covered for one diagnosis
but not another) for an item or service based on the service code and
other information in the GFE in the absence of a diagnosis code?
In developing processes for the AEOB and GFE for covered
individuals, some industry groups have suggested that the provider or
facility should verify the individual's enrollment status in a health
plan or coverage for the scheduled (or requested) items or services
with the plan, issuer, or carrier. Based on the results of this
verification, the provider or facility would either provide the
individual with a GFE that meets the requirements for GFEs for
uninsured (or self-pay) individuals under 45 CFR 149.610, or provide a
GFE for covered individuals to the individual's plan, issuer, or
carrier.\28\ The Departments and OPM are interested in feedback on the
potential impacts on providers, facilities, plans, issuers, or carriers
if this verification were to be required.
---------------------------------------------------------------------------
\28\ See Council for Affordable Quality Healthcare, Inc. (CAQH)
Committee on Operating Rules for Information Exchange (CORE),
Establishing the Building Blocks for Price Transparency: Industry
Guidance on Provider to Payer Approaches for Good Faith Estimate
Exchanges (2021), available at <a href="https://www.caqh.org/sites/default/files/CORE%20-%20Price%20Transparency%20Whitepaper_v4.pdf">https://www.caqh.org/sites/default/files/CORE%20-%20Price%20Transparency%20Whitepaper_v4.pdf</a>.
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<bullet> What, if any, additional burden would be created by
requiring providers, facilities, plans, issuers, and carriers to
conduct (1) verification to determine whether an individual is
uninsured, self-pay, or enrolled in a health plan or coverage for AEOB
and GFE purposes; (2) verification of coverage for each item or service
expected to be included in an AEOB or GFE; or (3) verification of
coverage from multiple payers? Do providers and facilities already
perform these types of verifications in the regular course of business,
such that minimal additional burden would be imposed?
<bullet> Would it alleviate burden to allow providers and
facilities, for purposes of verifying coverage, to rely on an
individual's representation regarding whether the individual is
enrolled in a health plan or coverage and seeking to have a claim for
the items or services submitted to the plan or coverage? What might be
the implications of taking this approach?
On January 20, 2021, President Biden issued Executive Order 13985,
``Advancing Racial Equity and Support for Underserved Communities
Through the Federal Government,'' \29\ directing that as a policy
matter, ``the Federal government should pursue a comprehensive approach
to advancing equity for all, including people of color and others who
have been historically
---------------------------------------------------------------------------
\29\ 86 FR 7009 (January 20, 2021), available at <a href="https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf">https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf</a>.
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[[Page 56911]]
underserved, marginalized, and adversely affected by persistent poverty
and inequality.'' Executive Order 13985 also directs each agency to
assess whether, and to what extent, its programs and policies
perpetuate systemic barriers to opportunities and benefits for people
of color and other underserved communities.
Consistent with Executive Order 13985, the Departments and OPM are
exploring how best to ensure that plans', issuers', and carriers'
communication to covered individuals is accessible, linguistically
tailored, and at an appropriate literacy level. The Departments and OPM
also remind plans, issuers, and carriers of any existing obligations to
comply with requirements to provide effective communication (including
materials disseminated by way of electronic and information technology
for individuals with disabilities) under the Americans with
Disabilities Act of 1990 and section 504 of the Rehabilitation Act of
1973, to provide meaningful access for individuals with limited English
proficiency under title VI of the Civil Rights Act of 1964, and to
comply with nondiscrimination requirements under section 1557 of the
Affordable Care Act.
The Departments and OPM request public comment and feedback on the
following questions:
<bullet> What unique barriers and challenges do underserved and
marginalized communities face in understanding and accessing health
care that the Departments and OPM should account for in implementing
the AEOB and GFE requirements for covered individuals?
<bullet> What steps should the Departments and OPM consider to help
ensure that all covered individuals, particularly those from
underserved and marginalized communities, are aware of the opportunity
to request AEOBs and GFEs and are able to utilize the information they
receive in order to facilitate meaningful decision-making regarding
their health care?
<bullet> Code section 9816(f), ERISA section 716(f), and PHS Act
sections 2799A-1(f) and 2799B-6 require the AEOB and GFE to be provided
in clear and understandable language. What additional approaches should
be considered that would facilitate the provision of AEOBs and GFEs
that are accessible, linguistically tailored, and at an appropriate
literacy level for covered individuals, particularly those from
underserved and marginalized communities and those with disabilities or
limited English proficiency? Is there any specific language or phrasing
that should be used to help mitigate any potential consumer confusion?
<bullet> Should the Departments and OPM consider adopting AEOB
language access requirements that are similar to the Departments'
existing requirements for group health plans and health insurance
issuers, such as the internal claims and appeals and external review
and Summary of Benefits and Coverage (SBC) requirements to provide oral
language services, notices in non-English languages, and non-English
language statements in English versions of notices indicating how to
access language services? \30\ If so, what is the best way to ensure
that information about language access services is communicated far
enough in advance to facilitate the provision of the AEOB in the
language that is most accessible to the individual?
---------------------------------------------------------------------------
\30\ For example, the rules governing internal claims and
appeals and external review processes under 26 CFR 54.9815-2719(e),
29 CFR 2590.715-2719(e), and 45 CFR 147.136(e) require plans and
issuers to provide oral language services, notices in non-English
languages, and non-English language statements in English versions
of notices indicating how to access language services, with respect
to notices sent to an address in a United States county where ten
percent or more of the population residing in the county is literate
only in the same non-English language. Additionally, the SBC and
Uniform Glossary regulations at 26 CFR 54.9815-2715(a)(5), 29 CFR
2590.715-2715(a)(5), and 45 CFR 147.200(a)(5) require group health
plans and health insurance issuers to provide the SBC in a
culturally and linguistically appropriate manner, in accordance with
the thresholds and standards of 26 CFR 54.9815-2719(e), 29 CFR
2590.715-2719(e), and 45 CFR 147.136(e). The regulations governing
the style and format of summary plan descriptions (SPD) under ERISA
at 29 CFR 2520.102-2 require the SPD to be provided in non-English
languages if, for a plan that covers fewer than 100 participants, 25
percent or more of all plan participants are literate only in the
same non-English language; or, for a plan that covers 100 or more
participants, if the lesser of: (1) 500 or more participants; or (2)
10 percent or more of all plan participants are literate only in the
same non-English language.
---------------------------------------------------------------------------
C. Economic Impacts
The Departments and OPM are interested in understanding the
potential economic impacts of implementing requirements related to the
AEOB and GFE for covered individuals.
<bullet> Specifically, the Departments and OPM are interested in
estimates of the time and cost burdens on providers and facilities, and
separately on plans, issuers, and carriers, for building and
maintaining a standards-based API for the real-time exchange of AEOB
and GFE data.
<bullet> The Departments and OPM also seek comment on the extent to
which providers, facilities, plans, issuers, and carriers are building
and maintaining standards-based APIs for multiple purposes, or already
have standards-based APIs in place that they can leverage to implement
AEOB and GFE requirements. The Departments and OPM are also interested
in how establishing standards-based APIs for these purposes may align
with other HHS program requirements to implement standards-based APIs,
such as requirements for certain payers covered under the CMS
Interoperability and Patient Access final rule \31\ to use specific
standards to implement the Patient and Provider Access APIs, as well as
requirements applicable to health IT developers with health IT modules
certified to certain criteria under the ONC Health IT Certification
Program that provide standards-based API technology to providers and
facilities as part of certified health IT products. In circumstances in
which providers, facilities, plans, issuers, and carriers use or plan
to use standards-based API technology for multiple purposes, the
Departments and OPM are interested in estimates of the time and cost
burden specifically related to AEOB and GFE implementation, separated
out from the total cost of implementing and using this technology for
multiple purposes, to accurately reflect the burden of implementing
AEOB and GFE requirements.
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\31\ Medicare and Medicaid Programs; Patient Protection and
Affordable Care Act; Interoperability and Patient Access for
Medicare Advantage Organization and Medicaid Managed Care Plans,
State Medicaid Agencies, CHIP Agencies and CHIP Managed Care
Entities, Issuers of Qualified Health Plans on the Federally-
Facilitated Exchanges, and Health Care Providers Final Rule, 85 FR
25510 (May 1, 2020), available at <a href="https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf">https://www.govinfo.gov/content/pkg/FR-2020-05-01/pdf/2020-05050.pdf</a>.
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<bullet> What would be the costs for purchasing and implementing a
standards-based API for the real-time exchange of AEOB and GFE data
from a third-party vendor, compared to building standards-based API
functionality in-house? What percent of providers, facilities, plans,
issuers, and carriers are likely to either purchase and implement the
API via a third-party vendor compared to building and implementing the
API in-house? How do these costs compare to alternative methods of
exchanging AEOB and GFE data, such as through an internet portal or by
fax?
[[Page 56912]]
In the Requirements Related to Surprise Billing; Part II interim
final rule, HHS estimated that a total of 511,748 providers associated
with health care facilities, individual physician practitioners, and
wholly physician-owned private practices would incur the burden and
costs associated with generating a GFE for uninsured (or self-pay)
individuals.\32\
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\32\ 86 FR 56080 (October 7, 2021).
---------------------------------------------------------------------------
<bullet> Are there factors that should be considered that might
alter the number of providers and facilities that would incur the
burden and cost of providing a GFE to plans, issuers, and carriers for
covered individuals?
Some states have adopted laws requiring providers and facilities;
or plans and issuers; or both providers and facilities and payers, to
provide cost estimates to consumers before health care items or
services are furnished. These laws vary with respect to the entities
covered, the items or services to which requirements apply, how
individualized the estimates must be, the format and timing of the
estimates, the contents of the estimates, other accompanying
requirements, and enforcement of these requirements. The Departments
and OPM request feedback on the potential impacts of these policies.
<bullet> The Departments and OPM are interested in studies or other
evidence related to the implementation and any effects of State laws
that require entities to provide expected charges for health care items
or services to consumers in advance of receiving these items or
services. The Departments and OPM are particularly interested in
publicly available studies or evidence.
<bullet> Is there other information that the Departments and OPM
could find useful for quantifying the benefits of implementing
requirements related to AEOB and GFE for covered individuals?
III. Collection of Information Requirements
Please note, this is a request for information (RFI) only. In
accordance with the implementing regulations of the Paperwork Reduction
Act of 1995 (PRA), specifically 5 CFR 1320.3(h)(4), this general
solicitation is exempt from the PRA. Facts or opinions submitted in
response to general solicitations of comments from the public,
published in the Federal Register or other publications, regardless of
the form or format thereof, provided that no person is required to
supply specific information pertaining to the commenter, other than
that necessary for self-identification, as a condition of the agency's
full consideration, are not generally considered information
collections and therefore not subject to the PRA.
This RFI is issued solely for information and planning purposes; it
does not constitute a Request for Proposal (RFP), applications,
proposal abstracts, or quotations. This RFI does not commit the U.S.
Government to contract for any supplies or services or make a grant
award. Further, the Departments and OPM are not seeking proposals
through this RFI and will not accept unsolicited proposals. Responders
are advised that the U.S. Government will not pay for any information
or administrative costs incurred in response to this RFI; all costs
associated with responding to this RFI will be solely at the interested
party's expense. The Departments and OPM note that not responding to
this RFI does not preclude participation in any future procurement, if
conducted. It is the responsibility of the potential responders to
monitor this RFI announcement for additional information pertaining to
this request. In addition, the Departments and OPM will not respond to
questions about the policy issues raised in this RFI.
The Departments and OPM will actively consider all input as the
Departments and OPM develop future regulatory proposals or future
subregulatory policy guidance. The Departments and OPM may or may not
choose to contact individual responders. These communications would be
for the sole purpose of clarifying statements in the responders'
written responses. Contractor support personnel may be used to review
responses to this RFI. Responses to this notice are not offers and
cannot be accepted by the U.S. Government to form a binding contract or
issue a grant. Information obtained as a result of this RFI may be used
by the U.S. Government for program planning on a non-attribution basis.
Responders should not include any information that might be considered
proprietary or confidential. This RFI should not be construed as a
commitment or authorization to incur cost for which reimbursement would
be required or sought. All submissions become U.S. Government property
and will not be returned. In addition, the Departments and OPM may
publicly post the public comments received, or a summary of those
public comments.
Signed at Washington DC.
Laurie Bodenheimer,
Associate Director, Healthcare and Insurance, Office of Personnel
Management.
Signed at Washington DC.
Rachel D. Levy,
Associate Chief Counsel (Employee Benefits, Exempt Organizations, and
Employment Taxes) Internal Revenue Service, Department of the Treasury.
Signed at Washington DC.
Carol A. Weiser,
Benefits Tax Counsel, Department of the Treasury.
Signed at Washington DC.
Ali Khawar,
Acting Assistant Secretary, Employee Benefits Security Administration,
U.S. Department of Labor.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2022-19798 Filed 9-14-22; 4:15 pm]
BILLING CODE 6523-63-P; 4830-01-P; 4510-29-P; 4120-01-P
</pre></body>
</html>Indexed from Federal Register on September 16, 2022.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.