2022-06810. 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.

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 2, 2022.

ADDRESSES:

Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/​public/​do/​PRAMain. Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function.

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) if the information will be processed and used in a timely manner; (3) 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; (4) ways to enhance the quality, utility and clarity of the information collection; and (5) 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.

FOR FURTHER INFORMATION CONTACT:

Mara Blumenthal by telephone at 202-693-8538, or by email at [e-mail].

SUPPLEMENTARY INFORMATION:

Under the Affordable Care 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 Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued final implementing regulations on November 18, 2015 (80 FR 72191). With respect to internal claims and appeals processes for group health coverage, PHS Act section 2719 and paragraph (b)(2)(i) of the interim 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 No Surprises Act of 2020 extended the balance billing protections related to external reviews to grandfathered plans. This collection of information request includes the information collection and third-party notice and disclosure requirements that a plan must satisfy under the statutes and regulations. For additional substantive information about this ICR, see the related notice published in the Federal Register on November 9, 2021 (86 FR 62206).

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 and not-for-profit institutions.

Total Estimated Number of Respondents: 2,007,298.

Total Estimated Number of Responses: 390,574.

Total Estimated Annual Time Burden: 19,047 hours.

Total Estimated Annual Other Costs Burden: $602,026.

(Authority: 44 U.S.C. 3507(a)(1)(D))

Dated: March 25, 2022.

Mara Blumenthal,

Senior PRA Analyst.