Notice2025-07395
Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans
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
April 30, 2025
Issuing agencies
Labor Department
Abstract
The Department of Labor (DOL) is submitting this Employee Benefits Security Administration (EBSA)-sponsored information collection request (ICR) to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995 (PRA). Public comments on the ICR are invited.
Full Text
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<title>Federal Register, Volume 90 Issue 82 (Wednesday, April 30, 2025)</title>
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[Federal Register Volume 90, Number 82 (Wednesday, April 30, 2025)]
[Notices]
[Pages 17982-17983]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-07395]
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DEPARTMENT OF LABOR
Agency Information Collection Activities; Submission for OMB
Review; Comment Request; Affordable Care Act Internal Claims and
Appeals and External Review Procedures for ERISA Plans
ACTION: Notice of availability; request for comments.
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SUMMARY: The Department of Labor (DOL) is submitting this Employee
Benefits Security Administration (EBSA)-sponsored information
collection request (ICR) to the Office of Management and Budget (OMB)
for review and approval in accordance with the Paperwork Reduction Act
of 1995 (PRA). Public comments on the ICR are invited.
DATES: The OMB will consider all written comments that the agency
receives on or before May 30, 2025.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
FOR FURTHER INFORMATION CONTACT: Michael Howell by telephone at 202-
693-6782, or by email at <a href="/cdn-cgi/l/email-protection#b7f3f8fbe8e7e5f6e8e7e2f5fbfef4f7d3d8db99d0d8c1"><span class="__cf_email__" data-cfemail="8ecac1c2d1dedccfd1dedbccc2c7cdceeae1e2a0e9e1f8">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: The Patient Protection and Affordable Care
Act, Public Law 111-148, (the Affordable Care Act or the Act) was
enacted on March 23, 2010. As part of the Act, Congress added Public
Health Service Act (the PHS Act) section 2719, which provides rules
relating to internal claims and appeals and external review processes.
The Department of Labor, Internal Revenue Service, and the Health and
Human Services Department
[[Page 17983]]
(the Departments) issued final regulations (80 FR 72191) that set forth
rules implementing PHS Act section 2719 for internal claims and appeals
and external review processes. With respect to internal claims and
appeals processes for group health coverage, PHS Act section 2719 and
paragraph (b)(2)(i) of the final regulations provide that group health
plans and health insurance issuers offering group health insurance
coverage must comply with the internal claims and appeals processes set
forth in 29 CFR 2560.503-1 (the DOL claims procedure regulation) and
update such processes in accordance with standards established by the
Secretary of Labor in paragraph (b)(2)(ii) of the regulations.
The DOL claims procedure regulation requires plans to provide every
claimant who is denied a claim with a written or electronic notice that
contains the specific reasons for denial, a reference to the relevant
plan provisions on which the denial is based, a description of any
additional information necessary to perfect the claim, and a
description of steps to be taken if the participant or beneficiary
wishes to appeal the denial. The regulation also requires that any
adverse decision upon review be in writing (including electronic means)
and include specific reasons for the decision, as well as references to
relevant plan provisions. Paragraph (b)(2)(ii)(C) of the final
regulations adds a requirement that non-grandfathered ERISA-covered
group health plans provide to the claimant, free of charge, any new or
additional evidence considered relied upon, or generated by the plan or
issuer in connection with the claim.
In addition, the PHS Act section 2719 and the final regulations
provide that group health plans and issuers offering group health
insurance coverage must comply either with a State external review
process or a Federal review process. The regulations provide a basis
for determining when plans and issuers must comply with an applicable
State external review process and when they must comply with the
Federal external review process.
The No Surprises Act extends the balance billing protection 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.
The claims procedure regulation imposes information collection
requirements as part of the reasonable procedures that an employee
benefit plan must establish regarding the handling of a benefit claim.
These requirements include third-party notice and disclosure
requirements that the plan must satisfy by providing information to
participants and beneficiaries of the plan. For additional substantive
information about this ICR, see the related notice published in the
Federal Register on July 9, 2024 (89 FR 56416).
Comments are invited on: (1) whether the collection of information
is necessary for the proper performance of the functions of the
Department, including whether the information will have practical
utility; (2) the accuracy of the agency's estimates of the burden and
cost of the collection of information, including the validity of the
methodology and assumptions used; (3) ways to enhance the quality,
utility and clarity of the information collection; and (4) ways to
minimize the burden of the collection of information on those who are
to respond, including the use of automated collection techniques or
other forms of information technology.
This information collection is subject to the PRA. A Federal agency
generally cannot conduct or sponsor a collection of information, and
the public is generally not required to respond to an information
collection, unless the OMB approves it and displays a currently valid
OMB Control Number. In addition, notwithstanding any other provisions
of law, no person shall generally be subject to penalty for failing to
comply with a collection of information that does not display a valid
OMB Control Number. See 5 CFR 1320.5(a) and 1320.6.
DOL seeks PRA authorization for this information collection for
three (3) years. OMB authorization for an ICR cannot be for more than
three (3) years without renewal. The DOL notes that information
collection requirements submitted to the OMB for existing ICRs receive
a month-to-month extension while they undergo review.
Agency: DOL-EBSA.
Title of Collection: Affordable Care Act Internal Claims and
Appeals and External Review Procedures for ERISA Plans.
OMB Control Number: 1210-0144.
Affected Public: Private sector, Businesses or other for-profits,
Not-for-profit institutions.
Total Estimated Number of Respondents: 1,294,150.
Total Estimated Number of Responses: 187,601.
Total Estimated Annual Time Burden: 18,370 hours.
Total Estimated Annual Other Costs Burden: $ 613,741.
(Authority: 44 U.S.C. 3507(a)(1)(D))
Michael Howell,
Senior Paperwork Reduction Act Analyst.
[FR Doc. 2025-07395 Filed 4-29-25; 8:45 am]
BILLING CODE 4510-29-P
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