[Federal Register Volume 77, Number 36 (Thursday, February 23, 2012)]
[Notices]
[Pages 10781-10782]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-4202]


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DEPARTMENT OF LABOR

Employee Benefits Security Administration


Proposed Extension of Information Collection Request Submitted 
for Public Comment; Affordable Care Act Internal Claims and Appeals and 
External Review Procedures for Non-Grandfathered Plans

AGENCY: Employee Benefits Security Administration, Department of Labor.

ACTION: Notice.

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SUMMARY: The Department of Labor (the Department), in accordance with 
the Paperwork Reduction Act of 1995 (PRA 95) (44 U.S.C. 3506(c)(2)(A)), 
provides the general public and Federal agencies with an opportunity to 
comment on proposed and continuing collections of information. This 
helps the Department assess the impact of its information collection 
requirements and minimize the reporting burden on the public and helps 
the public understand the Department's information collection 
requirements and provide the requested data in the desired format. 
Currently, the Employee Benefits Security Administration (EBSA) is 
soliciting comments on the revision of the information collection 
provisions of its interim final rule at 29 CFR Part 2590.715-2719, 
Internal Claims and Appeals and External Review Processes for Non-
grandfathered Plans, that was published in the Federal Register on June 
24, 2011 (76 FR 37208). A copy of the information collection request 
(ICR) may be obtained by contacting the office listed in the ADDRESSES 
section of this notice.

DATES: Written comments must be submitted to the office shown in the 
Addresses section on or before April 23, 2012.

ADDRESSES: Direct all written comments regarding the information 
collection request and burden estimates to G. Christopher Cosby, Office 
of Policy and Research, Employee Benefits Security Administration, U.S. 
Department of Labor, 200 Constitution Avenue NW., Room N-5647, 
Washington, DC 20210. Telephone: (202) 693-8410; Fax: (202) 219-4745. 
These are not toll-free numbers. Comments may also be submitted 
electronically to the following Internet email address: 
[email protected].

SUPPLEMENTARY INFORMATION:

I. Background

    The Patient Protection and Affordable Care Act, Public Law 111-148, 
(the Affordable Care Act) was enacted by President Obama on March 23, 
2010. As part of the Act, Congress added Public Health Service Act (PHS 
Act) section 2719, which provides rules relating to internal claims and 
appeals and external review processes. The Department, in conjunction 
with the Departments of the Treasury and Department of Health and Human 
Services (collectively, the Departments), issued interim final 
regulations on July 23, 2010 (75 FR 43330), which 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 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.
    Also, PHS Act section 2719 and the interim 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 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.
    On June 24, 2011, the Department amended the interim final 
regulations. Two amendments revised the ICR. The first amendment 
provides that plans no longer are required to include diagnosis and 
treatment codes on notices of adverse benefit determination and final 
internal adverse benefit determination. Instead, they must notify 
claimants of the opportunity to receive the codes on request and plans 
and issuers must provide the codes upon request. The Departments expect 
that this change will lower costs, because plans and issuers no longer 
will have to provide the codes on the notices. Plans and issuers will 
incur a cost to establish procedures to receive, process, and mail the 
codes upon request.
    The second amendment also changes the method plans and issuers must 
use to determine who is eligible to receive a notice in a culturally 
and linguistically appropriate manner, and the information that must be 
provided to such persons. The previous rule was based on the number of 
employees at a firm. The new rule is based on whether a participant or 
beneficiary resides in a county where ten percent or more of the 
population residing in the county is literate only in the same non-
English language.
    On December 15, 2011, the Office of Management and Budget (OMB) 
approved the amendments to the ICR under the emergency procedures for 
review and clearance in accordance with the Paperwork Reduction Act of 
1995 (Pub. L. 104-13, 44 U.S.C. Chapter 35) and 5 CFR 1320.13 under OMB

[[Page 10782]]

Control Number 1210-0144. OMB's approval of the revision currently is 
schedule to expire on June 30, 2012.

II. Current Actions

    This notice requests public comment pertaining to the Department's 
request for extension of OMB's approval of its revision to OMB Control 
Number 1210-0144. After considering comments received in response to 
this notice, the Department intends to submit an ICR to OMB for 
continuing approval. No change to the existing ICR is proposed or made 
at this time. The Department notes that an agency may not conduct or 
sponsor, and a person is not required to respond to, an information 
collection unless it displays a valid OMB control number. A summary of 
the ICR and the current burden estimates follows:
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Internal Claims and Appeals and External 
Review Processes for Non-Grandfathered Plans.
    Type of Review: Revision of a currently approved collection of 
information.
    OMB Number: 1210-0144.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 1,020,374.
    Frequency of Responses: On occasion.
    Responses: 111,328.
    Estimated Total Burden Hours: 466
    Estimated Total Burden Cost (Operating and Maintenance): 
$1,257,726.

III. Desired Focus of Comments

    The Department is particularly interested in comments that:
     Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
     Evaluate the accuracy of the agency's estimate of the 
burden of the proposed collection of information, including the 
validity of the methodology and assumptions used;
     Enhance the quality, utility, and clarity of the 
information to be collected; and
     Minimize the burden of the collection of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., by 
permitting electronic submissions of responses.
    Comments submitted in response to this notice will be summarized 
and/or included in the ICR for OMB approval of the extension of the 
information collection; they will also become a matter of public 
record.

    Dated: February 13, 2012.
Joseph S. Piacentini,
 Director, Office of Policy and Research, Employee Benefits Security 
Administration.
[FR Doc. 2012-4202 Filed 2-22-12; 8:45 am]
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