Notice2024-10900
Agency Information Collection Activities: Proposed Collection; Comment Request
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
May 17, 2024
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Full Text
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<title>Federal Register, Volume 89 Issue 97 (Friday, May 17, 2024)</title>
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[Federal Register Volume 89, Number 97 (Friday, May 17, 2024)]
[Notices]
[Pages 43406-43407]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-10900]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-10307]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of information
(including each proposed extension or reinstatement of an existing
collection of information) and to allow 60 days for public comment on
the proposed action. Interested persons are invited to send comments
regarding our burden estimates or any other aspect of this collection
of information, including the necessity and utility of the proposed
information collection for the proper performance of the agency's
functions, the accuracy of the estimated burden, ways to enhance the
quality, utility, and clarity of the information to be collected, and
the use of automated collection techniques or other forms of
information technology to minimize the information collection burden.
DATES: Comments must be received by July 16, 2024.
ADDRESSES: When commenting, please reference the document identifier or
OMB control number. To be assured consideration, comments and
recommendations must be submitted in any one of the following ways:
1. Electronically. You may send your comments electronically to
<a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) that are accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number: __, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, please access
the CMS PRA website by copying and pasting the following web address
into your web browser: <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing">https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing</a>.
FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION:
Contents
This notice sets out a summary of the use and burden associated
with the following information collections. More detailed information
can be found in each collection's supporting statement and associated
materials (see ADDRESSES).
CMS-10307 Medical Necessity and Claims Denial Disclosures Under MHPAEA
Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain
approval from the Office of Management and Budget (OMB) for each
collection of information they conduct or sponsor. The term
``collection of information'' is defined in 44 U.S.C. 3502(3) and 5 CFR
1320.3(c) and includes agency requests or requirements that members of
the public submit reports, keep records, or provide information to a
third party. Section 3506(c)(2)(A) of the PRA requires federal agencies
to publish a 60-day notice in the Federal Register concerning each
proposed collection of information, including each proposed extension
or reinstatement of an existing collection of information, before
submitting the collection to OMB for approval. To comply with this
requirement, CMS is publishing this notice.
Information Collection
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medical Necessity
and Claims Denial Disclosures under MHPAEA; Use: The Paul Wellstone and
Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA) (Pub. L.110-343) generally requires that group health plans
and group health insurance issuers offering both medical and surgical
(med/surg) and mental health or substance use disorder (MH/SUD)
benefits do not apply any more restrictive financial requirements
(e.g., co-pays, deductibles) and/or treatment limitations (e.g., visit
limits) to MH/SUD benefits than those requirements and/or limitations
applied to substantially all med/surg benefits. The Patient Protection
and Affordable Care Act, Public Law 111-148, was enacted on March 23,
2010, and the Health Care and Education Reconciliation Act of 2010,
Public Law 111-152, was enacted on March 30, 2010. These statutes are
collectively known as the ``Affordable Care Act'' (ACA). The ACA
extended MHPAEA to apply to the individual health insurance market.
Additionally, the Department of Health and Human Services (HHS) final
regulation regarding essential health benefits (EHB) requires health
insurance issuers offering non-grandfathered health insurance coverage
in the individual and small group markets, through an Exchange or
outside of an Exchange, to comply with the requirements of the MHPAEA
regulations to satisfy the
[[Page 43407]]
requirement to cover EHB (45 CFR 147.150 and 156.115).
Medical Necessity Disclosure Under MHPAEA
MHPAEA specifically amends the Public Health Service (PHS) Act to
require plan administrators or health insurance issuers to provide,
upon request, the criteria for medical necessity determinations made
with respect to MH/SUD benefits to current or potential participants,
beneficiaries, or contracting providers. The Final Rules under MHPAEA
set forth rules for providing criteria for medical necessity
determinations. CMS administers MHPAEA with respect to self-insured,
non-Federal governmental plans in all States, and health insurance
issuers in two States.
Claims Denial Disclosure Under MHPAEA
MHPAEA specifically amends the PHS Act to require plan
administrators or health insurance issuers to provide, upon request,
the reason for any denial or reimbursement of payment for MH/SUD
services to the participant or beneficiary involved in the case. The
Final Rules under MHPAEA at 45 CFR 146.136(d)(2) implement MHPAEA. CMS
administers MHPAEA with respect to self-insured, non-Federal
governmental plans in all States and health insurance issuers in two
States, and the regulation provides a safe harbor such that non-Federal
governmental plans (and issuers offering coverage in connection with
such plans) are deemed to comply with requirements of paragraph (d)(2)
of 45 CFR 146.136 if they provide the reason for claims denial in a
form and manner consistent with ERISA requirements found in 29 CFR
2560.503-1. Section 146.136(d)(3) clarifies that PHS Act section 2719
governing internal claims and appeals and external review as
implemented by 45 CFR 147.136, covers MHPAEA claims denials and
requires that, when a non-quantitative treatment limitation (NQTL) is
the basis for a claims denial, that a non-grandfathered plan or issuer
must provide the processes, strategies, evidentiary standard, and other
factors used in developing and applying the NQTL with respect to med/
surg benefits and MH/SUD benefits.
Disclosure Request Form
Group health plan participants, beneficiaries, covered individuals
in the individual market, or persons acting on their behalf, may use
this optional model form to request information from plans regarding
the medical necessity and claims denials disclosures referenced above.
Form Number: CMS-10307 (OMB control number: 0938-1080); Frequency: On
Occasion; Affected Public: State, Local, or Tribal Governments, Private
Sector, Individuals; Number of Respondents: 282,657; Total Annual
Responses: 1,125,558; Total Annual Hours: 93,797. (For policy questions
regarding this collection contact Erik Gomez at 667-414-0682.)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-10900 Filed 5-16-24; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on May 17, 2024.
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