[Federal Register Volume 87, Number 150 (Friday, August 5, 2022)]
[Notices]
[Pages 48071-48072]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-16856]


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DEPARTMENT OF THE TREASURY

Internal Revenue Service


Proposed Collection; Comment Request for Affordable Care Act 
Internal Claims and Appeals and External Review Disclosures

AGENCY: Internal Revenue Service (IRS), Treasury.

ACTION: Notice and request for comments.

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SUMMARY: The Internal Revenue Service, as part of its continuing effort 
to reduce paperwork and respondent burden, invites the general public 
and other Federal agencies to take this opportunity to comment on 
continuing information collections, as required by the Paperwork 
Reduction Act of 1995. The IRS is soliciting comments concerning the 
Affordable Care Act internal claims and appeals and external review 
disclosures.

DATES: Written comments should be received on or before October 3, 2022 
to be assured of consideration

ADDRESSES: Direct all written comments to Andres Garcia, Internal 
Revenue Service, Room 6526, 1111 Constitution Avenue NW, Washington, DC 
20224, or by email to [email protected]. Include OMB control number 
1545-2182 or Affordable Care Act Internal Claims and Appeals and 
External review Disclosures, in the subject line of the message.

FOR FURTHER INFORMATION CONTACT: Requests for additional information or 
copies of the form should be directed to Kerry Dennis at (202) 317-
5751, or at Internal Revenue Service, Room 6526, 1111 Constitution 
Avenue NW, Washington DC 20224, or through the internet, at 
[email protected].

SUPPLEMENTARY INFORMATION: 
    Title: Affordable Care Act Internal Claims and Appeals and External 
review Disclosures.
    OMB Number: 1545-2182.
    Regulation Number: T.D. 9494 and T.D. 9955.
    Abstract: This collection of information request includes the 
information collection and third- party notice and disclosure 
requirements that a plan must satisfy under final regulations 
implementing provisions of the Affordable Care Act pertaining to 
internal claims and appeals, and the external review process. The No 
Surprise Act extends the balance billing protections 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. 
Grandfathered and non-grandfathered plans must provide claimants, free 
of charge, any new or additional evidence considered, relied upon, or 
generated by the plan or issuer in connection with the claim, and the 
requirement to comply either with a State external review process or a 
Federal review process. The disclosure requirements of the Federal 
external review process require (1) a preliminary review by plans of 
requests for external appeals; (2) Independent Review Organizations 
(IROs) to notify claimants of eligibility and acceptance for external 
review; (3) the plan or issuer to provide IROs with documentation and 
other

[[Page 48072]]

information considered in making adverse benefit determination; (4) the 
IRO to forward to the plan or issuer any information submitted by the 
claimant; (5) plans to notify the claimant and IRO if it reverses its 
decision; (6) the IRO to notify the claimant and plan of the result of 
the final external appeal; (7) the IRO to maintain records for six 
years.
    Current Actions: There is a change to the paperwork burden 
previously approved by OMB. Adjustments to the burden estimates result 
from updated estimates on the number of ERISA-covered plans and 
policyholders.
    Type of Review: Extension of a currently approved collection.
    Affected Public: Businesses or other for-profits, Not-for-profit 
institutions.

Group Health Plans Internal Claims and Appeals and External Review 
Processes

    Estimated Number of Respondents: 314,560.
    Estimated Time per Respondent: .5 hours.
    Estimated Total Annual Burden Hours: 14,432 hours.

Procedures for Federal External Review and Model Notices Relating to 
Internal Claims and Appeals and External Review Under the Patient 
Protection and Affordable Care Act

    Estimated Number of Respondents: 76,014.
    Estimated Total Annual Burden Hours: .4 hours.
    Estimated Number of Respondents: 4,615.
    Total Estimated Time per Respondent: 390,574.
    Total Estimated Annual Burden Hours: 19,047 hours.
    The following paragraph applies to all the collections of 
information covered by this notice.
    An agency may not conduct or sponsor, and a person is not required 
to respond to, a collection of information unless the collection of 
information displays a valid OMB control number. Books or records 
relating to a collection of information must be retained if their 
contents may become material in the administration of any internal 
revenue law. Generally, tax returns and tax return information are 
confidential, as required by 26 U.S.C. 6103.
    Request for Comments: Comments submitted in response to this notice 
will be summarized and/or included in the request for OMB approval. All 
comments will become a matter of public record. Comments are invited 
on: (a) whether the collection of information is necessary for the 
proper performance of the functions of the agency, including whether 
the information shall have practical utility; (b) the accuracy of the 
agency's estimate of the burden of the collection of information; (c) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; (d) ways to minimize the burden of the collection of 
information on respondents, including through the use of automated 
collection techniques or other forms of information technology; and (e) 
estimates of capital or start-up costs and costs of operation, 
maintenance, and purchase of services to provide information.

    Approved: August 2, 2022.
Kerry L. Dennis,
Tax Analyst.
[FR Doc. 2022-16856 Filed 8-4-22; 8:45 am]
BILLING CODE 4830-01-P