On March 4, the IRS issued an information collection request under the Paperwork Reduction Act (“PRA”) regarding the ACA’s external review process’ notice and disclosure requirements and the No Surprises Act (“NSA”). The PRA provides the public with an opportunity to comment to help the IRS assess the impact and minimize the burden of the IRS’ information collection requirements.
As background, under the NSA, both grandfathered and non-grandfathered health plans must provide external review for adverse benefit determinations involving benefits subject to the NSA’s surprise billing protections. Among other things, these 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. The federal external review process requires:
- a preliminary review by plans of requests for external appeals;
- Independent Review Organizations (“IROs”) to notify claimants of eligibility and acceptance for external review;
- the plan or issuer to provide IROs with documentation and other information considered in making adverse benefit determination;
- 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;
- the IRO to notify the claimant and plan of the result of the final external appeal; and
- the IRO to maintain records for six years.
The IRS previously estimated this burden to be 19,047 hours but decreased the estimate by 677 hours, so it is now 18,370 hours. The IRS said this is because it overestimated the number of ERISA-covered plans and policyholders.
In the information collection request, the IRS requests comments on:
- whether the collection of information is necessary for the proper performance of the functions of the IRS, including whether the information has practical utility;
- the accuracy of the IRS’ estimate of the burden of the collection of information;
- ways to enhance the quality, utility, and clarity of the information to be collected;
- ways to minimize the burden of the collection of information, including through the use of automated collection techniques or other forms of information technology; and
- estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information.
Comments are due by May 4.
