Agency Information Collection Activities: Submission for OMB Review; Comment Request, 57984-57986 [2017-26524]
Download as PDF
<![CDATA[
sradovich on DSK3GMQ082PROD with NOTICES
57984
Federal Register / Vol. 82, No. 235 / Friday, December 8, 2017 / Notices
Specifically, respondent’s
advertisements prominently stated the
amount of the finance charge and the
number of payments or period of
repayment for certain vehicles—all
triggering terms under the TILA—but
failed to disclose, or unclearly and
inconspicuously disclosed at the bottom
of the ad in much smaller type, the
required information set forth by the
TILA. Finally, the complaint alleges that
respondent’s leasing advertisements
violated the Consumer Leasing Act
(CLA) and Regulation M by failing to
disclose or to disclose clearly and
conspicuously required terms.
Specifically, respondent’s
advertisements prominently stated the
monthly payment amounts for certain
vehicles—a triggering term under the
CLA—but failed to disclose, or
unclearly and inconspicuously
disclosed at the bottom of the ad in
much smaller type, the required
information set forth by the CLA.
The proposed order is designed to
prevent the respondent from engaging in
similar deceptive practices in the future.
• Definition B. of the order defines
‘‘clearly and conspicuously’’ to mean
that required disclosures must be
difficult to miss (i.e., easily noticeable)
and easily understandable by ordinary
consumers, including that disclosures
must appear in the same language as the
representation requiring the disclosure
is made (e.g. Spanish advertisement →
Spanish disclosure).
• Part I.A.1. provides that respondent
shall not misrepresent the cost of
financing the purchase of an
automobile, including by
misrepresenting the amount or
percentage of the down payment, the
number of payments or period of
repayment, the amount of any payment,
and the repayment obligation over the
full term of the loan, including any
balloon payment.
• Part I.A.2. provides that respondent
shall not misrepresent the cost of
leasing an automobile, including by
misrepresenting the total amount due at
lease inception, the down payment,
amount down, acquisition fee,
capitalized cost reduction, any other
amount required to be paid at lease
inception, and the amounts of all
monthly or other periodic payments.
• Part I.B. provides that respondent
shall not misrepresent any qualification
or restriction on the consumer’s ability
to obtain the represented financing or
leasing terms, including any
qualification or restriction based on the
consumer’s credit score or credit
history.
• Part I.C. provides that respondent
shall not represent any financing or
VerDate Sep<11>2014
20:38 Dec 07, 2017
Jkt 244001
leasing term, unless the representation
is non-misleading, and the
advertisement clearly and
conspicuously discloses all
qualifications or restrictions on the
consumer’s ability to obtain the
represented financing or leasing term,
including any qualifications or
restrictions that respondent’s lender,
lessor, or any other entity may impose
based on a consumer’s credit score or
credit history. Additionally, if a
majority of consumers likely will not be
able to meet a credit score qualification
or restriction stated in the
advertisement, respondent must clearly
and conspicuously disclose that fact.
• Part I.D. provides that respondent
shall not misrepresent the number of
vehicles, makes, or models that are
available for purchase or lease.
• Part I.E. provides that respondent
shall not misrepresent any other
material fact about the price, sale,
financing, or leasing of any automobile.
• Part II of the order addresses the
TILA and Regulation Z allegations by
prohibiting credit sale advertisements
that:
A. State the amount or percentage of
any down payment, the number of
payments or period of repayment, the
amount of any payment, or the amount
of any finance charge, without
disclosing clearly and conspicuously all
of the following terms:
Æ The amount or percentage of the
down payment;
Æ The terms of repayment; and
Æ The annual percentage rate, using
the term ‘‘annual percentage rate’’ or the
abbreviation ‘‘APR.’’ If the annual
percentage rate may be increased after
consummation of the credit transaction,
that fact must also be disclosed; or
B. State a rate of finance charge
without stating the rate as an ‘‘annual
percentage rate’’ or the abbreviation
‘‘APR,’’ using that term; or
C. Fail to comply in any respect with
Regulation Z, 12 CFR part 226, as
amended, and the Truth in Lending Act,
as amended, 15 U.S.C. 1601–1667f.
• Part III of the order addresses the
CLA and Regulation M allegations by
prohibiting lease advertisements that:
A. State the amount of any payment
or that any or no initial payment is
required at lease inception, without
disclosing clearly and conspicuously
the following terms:
Æ That the transaction advertised is a
lease;
Æ the total amount due prior to or at
consummation or by delivery, if
delivery occurs after consummation;
Æ the number, amounts, and timing of
scheduled payments;
PO 00000
Frm 00038
Fmt 4703
Sfmt 4703
Æ whether or not a security deposit is
required; and
Æ that an extra charge may be
imposed at the end of the lease term
where the consumer’s liability (if any) is
based on the difference between the
residual value of the leased property
and its realized value at the end of the
lease term.
B. Fail to comply in any respect with
Regulation M, 12 CFR part 213, as
amended, and the Consumer Leasing
Act, 15 U.S.C. 1667–1667f, as amended.
• Part IV requires respondent to
provide copies of the order to certain
personnel and to obtain
acknowledgments of receipt.
• Part V requires respondent to file
compliance reports with the
Commission, including notices
regarding changes in corporate structure
that might affect compliance obligations
under the order. Part VI requires
respondent to create certain records for
15 years and to retain them for 5 years.
Part VII provides the Commission
certain mechanisms to monitor
respondent’s compliance with the order.
Part VIII is a provision that ‘‘sunsets’’
the order after 20 years, with certain
exceptions.
The purpose of this analysis is to aid
public comment on the proposed order.
It is not intended to constitute an
official interpretation of the complaint
or proposed order, or to modify in any
way the proposed order’s terms.
By direction of the Commission.
Donald S. Clark,
Secretary.
[FR Doc. 2017–26443 Filed 12–7–17; 8:45 am]
BILLING CODE P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifiers: CMS–718–721 and
CMS–10307]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Centers for Medicare &
Medicaid Services.
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
SUMMARY:
E:\FR\FM\08DEN1.SGM
08DEN1
sradovich on DSK3GMQ082PROD with NOTICES
Federal Register / Vol. 82, No. 235 / Friday, December 8, 2017 / Notices
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the burden estimate or any
other aspect of this collection of
information, including the necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions, the accuracy of
the estimated burden, ways to enhance
the quality, utility, and clarity of the
information to be collected; and the use
of automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
DATES: Comments on the collection(s) of
information must be received by the
OMB desk officer by January 8, 2018.
ADDRESSES: When commenting on the
proposed information collections,
please reference the document identifier
or OMB control number. To be assured
consideration, comments and
recommendations must be received by
the OMB desk officer via one of the
following transmissions: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–5806, OR, Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
Web site address at https://
www.cms.gov/Regulations-andGuidance/Legislation/
PaperworkReductionActof1995/PRAListing.html.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
SUPPLEMENTARY INFORMATION: Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
VerDate Sep<11>2014
20:38 Dec 07, 2017
Jkt 244001
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Reinstatement of a previously
approved collection; Title of
Information Collection: Business
Proposal Forms for Quality
Improvement Organizations (QIOs); Use:
The submission of proposal information
by current quality improvement
associations (QIOs) and other bidders,
on the appropriate forms, will satisfy
our need for meaningful, consistent, and
verifiable data with which to evaluate
contract proposals. We use the data
collected on the forms associated with
this information collection request to
negotiate QIO contracts. We will be able
to compare the costs reported by the
QIOs on the cost reports to the proposed
costs noted on the business proposal
forms. Subsequent contract and
modification negotiations will be based
on historic cost data. The business
proposal forms will be one element of
the historical cost data from which we
can analyze future proposed costs. In
addition, the business proposal format
will standardize the cost proposing and
pricing process among all QIOs. With
well-defined cost centers and line items,
proposals can be compared among QIOs
for reasonableness and appropriateness.
Form Number: CMS–718–721 (OMB
control number: 0938–0579); Frequency:
Annually; Affected Public: Business or
other for-profits and Not-for-profit
institutions; Number of Respondents:
20; Total Annual Responses: 20; Total
Annual Hours: 1,000. (For policy
questions regarding this collection
contact Benjamin Bernstein at 410–786–
6570.)
2. Type of Information Collection
Request: Reinstatement with change of a
previous approved information
collection; Title of Information
Collection: Medical Necessity and
Claims Denial Disclosures under
MHPAEA; Use: The Paul Wellstone and
Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008
(MHPAEA) (Pub. L. 110–343) generally
requires that group health plans and
group health insurance issuers offering
mental health or substance use disorder
(MH/SUD) benefits in addition to
medical and surgical (med/surg)
benefits ensure that they do not apply
PO 00000
Frm 00039
Fmt 4703
Sfmt 4703
57985
any more restrictive financial
requirements (e.g., co-pays, deductibles)
and/or treatment limitations (e.g., visit
limits) to MH/SUD benefits than those
requirements and/or limitations applied
to substantially all med/surg benefits.
The Patient Protection and Affordable
Care Act, Public Law 111–148, was
enacted on March 23, 2010, and the
Health Care and Education
Reconciliation Act of 2010, Public Law
111–152, was enacted on March 30,
2010. These statutes are collectively
known as the ‘‘Affordable Care Act.’’
The Affordable Care Act extended
MHPAEA to apply to the individual
health insurance market. Additionally,
the Department of Health and Human
Services (HHS) final regulation
regarding essential health benefits (EHB)
requires health insurance issuers
offering non-grandfathered health
insurance coverage in the individual
and small group markets, through an
Exchange or outside of an Exchange, to
comply with the requirements of the
MHPAEA regulations in order to satisfy
the requirement to cover EHB (45 CFR
147.150 and 156.115).
Medical Necessity Disclosure Under
MHPAEA
MHPAEA section 512(b) specifically
amends the Public Health Service (PHS)
Act to require plan administrators or
health insurance issuers to provide,
upon request, the criteria for medical
necessity determinations made with
respect to MH/SUD benefits to current
or potential participants, beneficiaries,
or contracting providers. The Interim
Final Rules Under the Paul Wellstone
and Pete Domenici Mental Health Parity
and Addiction Equity Act of 2008 (75
FR 5410, February 2, 2010) and the
Final Rules under the Paul Wellstone
and Pete Domenici Mental Health Parity
and Addiction Equity Act of 2008 set
forth rules for providing criteria for
medical necessity determinations. CMS
oversees non-Federal governmental
plans and health insurance issuers.
Claims Denial Disclosure Under
MHPAEA
MHPAEA section 512(b) specifically
amends the PHS Act to require plan
administrators or health insurance
issuers to supply, upon request, the
reason for any denial or reimbursement
of payment for MH/SUD services to the
participant or beneficiary involved in
the case. The Interim Final Rules Under
the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction
Equity Act of 2008 (75 FR 5410,
February 2, 2010) and the Final Rules
under the Paul Wellstone and Pete
Domenici Mental Health Parity and
E:\FR\FM\08DEN1.SGM
08DEN1
57986
Federal Register / Vol. 82, No. 235 / Friday, December 8, 2017 / Notices
Addiction Equity Act of 2008
implement 45 CFR 146.136(d)(2), which
sets forth rules for providing reasons for
claims denial. CMS oversees nonFederal governmental plans and health
insurance issuers, and the regulation
provides a safe harbor such that nonFederal governmental plans (and issuers
offering coverage in connection with
such plans) are deemed to comply with
requirements of paragraph (d)(2) of 45
CFR 146.136 if they provide the reason
for claims denial in a form and manner
consistent with ERISA requirements
found in 29 CFR 2560.503–1. Section
146.136(d)(3) of the final rule clarifies
that PHS Act section 2719 governing
internal claims and appeals and external
review as implemented by 45 CFR
147.136, covers MHPAEA claims
denials and requires that, when a nonquantitative treatment limitation
(NQTL) is the basis for a claims denial,
that a non-grandfathered plan or issuer
must provide the processes, strategies,
evidentiary standard, and other factors
used in developing and applying the
NQTL with respect to med/surg benefits
and MH/SUD benefits.
Disclosure Request Form
Group health plan participants,
beneficiaries, covered individuals in the
individual market, or persons acting on
their behalf, may use this optional
model form to request information from
plans regarding NQTLs that may affect
patients’ MH/SUD benefits or that may
have resulted in their coverage being
denied. Form Number: CMS–10307
(OMB control number: 0938–1080) ;
Frequency: On Occasion; Affected
Public: State, Local, or Tribal
Governments, Private Sector,
Individuals; Number of Respondents:
267,538; Number of Responses:
1,081,929; Total Annual Hours: 43,327.
(For policy questions regarding this
collection, contact Usree
Bandyopadhyay at 410–786–6650.)
Dated: December 5, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2017–26524 Filed 12–7–17; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Agency Recordkeeping/Reporting
Requirements Under Emergency
Review by the Office of Management
and Budget (OMB); Comment Request
Title: Child Care and Development
Fund Plan for States/Territories for FFY
2019–2021(ACF–118).
OMB No.: 0970–0114.
Description: The Child Care and
Development Fund (CCDF) Plan (the
Plan) for States and Territories is
required from each CCDF Lead agency
in accordance with Section 658E of the
Child Care and Development Block
Grant Act of 1990, (CCDBG Act), as
amended, CCDBG Act of 2014 (Pub. Law
113–186), and 42 U.S.C 9858. The Plan
provides ACF and the public with a
description of, and assurance about, the
States’ and Territories’ child care
programs. States must submit Plans to
ACF on or before July 2, 2018 for
approval in order to receive funding on
October 1, 2018 for FY 2019.
The Office of Child Care (OCC) has
revised the FY 2019–2021 CCDF Plan
Preprint to align with the CCDF Final
Rule published on September 30, 2016.
In making the revisions, consideration
was given to minimize the burden of the
collection of information on
respondents. The Plan, submitted via
the ACF–118, is required triennially,
and will remain in effect for three years.
Due to unanticipated events,
including challenges faced by States and
Territories in implementing portions of
the comprehensive and unprecedented
background check requirements, the
OCC has re-examined the
implementation deadline to give States
and Territories an opportunity to apply
for additional time (up to two years, in
one year increments) to meet the most
challenging parts of the background
check requirements as long as specific
milestones are met. These developments
required OCC to delay submission of the
CCDF Plan Preprint for review and
approval by OMB because the process
and criteria for requesting additional
time will be carried out as part of the
Plan submission process. The delay
prevented OCC from completing the
regular Paperwork Reduction Act
clearance process that includes two
Federal Register notices and comment
periods.
Respondents: State and Territory
CCDF Lead Agencies (56)
ANNUAL BURDEN ESTIMATES
Number of
respondents
Instrument
sradovich on DSK3GMQ082PROD with NOTICES
ACF–118 ..........................................................................................................
Estimated Total Annual Burden
Hours: 3,696.
Additional Information:
ACF is requesting that Office of
Management and Budget (OMB) grant a
180-day approval for the FY 2019–2012
CCDF State/Territory Plan Preprint
(ACF–118) under procedures for
emergency processing by January 31,
2018. A copy of this information
collection may be obtained by
contacting Valentina Ntim, Child Care
Program Specialist, at (202) 205–8398.
Email address: valentina.ntim@
acf.hhs.gov
This notice provides for a single 30day comment period for the public to
VerDate Sep<11>2014
20:38 Dec 07, 2017
Jkt 244001
56
submit comments on the revised ACF–
118. Comments and questions about the
information collection described above
should be directed to the following
addresses within 30 days of publication
of this notice: Administration for
Children and Families, Office of
Planning, Research, and Evaluation,
Attn: ACF Reports Clearance Officer,
infocollection@acf.hhs.gov, and Office
of Information and Regulatory Affairs,
Office of Management and Budget,
Paperwork Reduction Project, Desk
PO 00000
Frm 00040
Fmt 4703
Sfmt 9990
Number of
responses per
respondent
Average
burden hours
per response
0.33
Total burden
hours
200
Officer for ACF, Email address:
Stephanie_J_Tatham@omb.eop.gov.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2017–26472 Filed 12–7–17; 8:45 am]
BILLING CODE 4184–43–P
E:\FR\FM\08DEN1.SGM
08DEN1
3,696
]]>Agencies
[Federal Register Volume 82, Number 235 (Friday, December 8, 2017)]
[Notices]
[Pages 57984-57986]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-26524]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-718-721 and CMS-10307]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register
[[Page 57985]]
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, and to allow a second opportunity for public comment on
the notice. Interested persons are invited to send comments regarding
the burden estimate or any other aspect of this collection of
information, including the necessity and utility of the proposed
information collection for the proper performance of the agency's
functions, the accuracy of the estimated burden, ways to enhance the
quality, utility, and clarity of the information to be collected; and
the use of automated collection techniques or other forms of
information technology to minimize the information collection burden.
DATES: Comments on the collection(s) of information must be received by
the OMB desk officer by January 8, 2018.
ADDRESSES: When commenting on the proposed information collections,
please reference the document identifier or OMB control number. To be
assured consideration, comments and recommendations must be received by
the OMB desk officer via one of the following transmissions: OMB,
Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-5806, OR, Email:
[email protected].
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' Web site address at Web site address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to [email protected].
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. The term ``collection of
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and
includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-day notice in the Federal Register
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, before submitting the collection to OMB for approval. To
comply with this requirement, CMS is publishing this notice that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Reinstatement of a
previously approved collection; Title of Information Collection:
Business Proposal Forms for Quality Improvement Organizations (QIOs);
Use: The submission of proposal information by current quality
improvement associations (QIOs) and other bidders, on the appropriate
forms, will satisfy our need for meaningful, consistent, and verifiable
data with which to evaluate contract proposals. We use the data
collected on the forms associated with this information collection
request to negotiate QIO contracts. We will be able to compare the
costs reported by the QIOs on the cost reports to the proposed costs
noted on the business proposal forms. Subsequent contract and
modification negotiations will be based on historic cost data. The
business proposal forms will be one element of the historical cost data
from which we can analyze future proposed costs. In addition, the
business proposal format will standardize the cost proposing and
pricing process among all QIOs. With well-defined cost centers and line
items, proposals can be compared among QIOs for reasonableness and
appropriateness. Form Number: CMS-718-721 (OMB control number: 0938-
0579); Frequency: Annually; Affected Public: Business or other for-
profits and Not-for-profit institutions; Number of Respondents: 20;
Total Annual Responses: 20; Total Annual Hours: 1,000. (For policy
questions regarding this collection contact Benjamin Bernstein at 410-
786-6570.)
2. Type of Information Collection Request: Reinstatement with
change of a previous approved information collection; Title of
Information Collection: Medical Necessity and Claims Denial Disclosures
under MHPAEA; Use: The Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008 (MHPAEA) (Pub. L. 110-343)
generally requires that group health plans and group health insurance
issuers offering mental health or substance use disorder (MH/SUD)
benefits in addition to medical and surgical (med/surg) benefits ensure
that they do not apply any more restrictive financial requirements
(e.g., co-pays, deductibles) and/or treatment limitations (e.g., visit
limits) to MH/SUD benefits than those requirements and/or limitations
applied to substantially all med/surg benefits.
The Patient Protection and Affordable Care Act, Public Law 111-148,
was enacted on March 23, 2010, and the Health Care and Education
Reconciliation Act of 2010, Public Law 111-152, was enacted on March
30, 2010. These statutes are collectively known as the ``Affordable
Care Act.'' The Affordable Care Act extended MHPAEA to apply to the
individual health insurance market. Additionally, the Department of
Health and Human Services (HHS) final regulation regarding essential
health benefits (EHB) requires health insurance issuers offering non-
grandfathered health insurance coverage in the individual and small
group markets, through an Exchange or outside of an Exchange, to comply
with the requirements of the MHPAEA regulations in order to satisfy the
requirement to cover EHB (45 CFR 147.150 and 156.115).
Medical Necessity Disclosure Under MHPAEA
MHPAEA section 512(b) specifically amends the Public Health Service
(PHS) Act to require plan administrators or health insurance issuers to
provide, upon request, the criteria for medical necessity
determinations made with respect to MH/SUD benefits to current or
potential participants, beneficiaries, or contracting providers. The
Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008 (75 FR 5410, February 2,
2010) and the Final Rules under the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 set forth rules
for providing criteria for medical necessity determinations. CMS
oversees non-Federal governmental plans and health insurance issuers.
Claims Denial Disclosure Under MHPAEA
MHPAEA section 512(b) specifically amends the PHS Act to require
plan administrators or health insurance issuers to supply, upon
request, the reason for any denial or reimbursement of payment for MH/
SUD services to the participant or beneficiary involved in the case.
The Interim Final Rules Under the Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (75 FR 5410,
February 2, 2010) and the Final Rules under the Paul Wellstone and Pete
Domenici Mental Health Parity and
[[Page 57986]]
Addiction Equity Act of 2008 implement 45 CFR 146.136(d)(2), which sets
forth rules for providing reasons for claims denial. CMS oversees non-
Federal governmental plans and health insurance issuers, and the
regulation provides a safe harbor such that non-Federal governmental
plans (and issuers offering coverage in connection with such plans) are
deemed to comply with requirements of paragraph (d)(2) of 45 CFR
146.136 if they provide the reason for claims denial in a form and
manner consistent with ERISA requirements found in 29 CFR 2560.503-1.
Section 146.136(d)(3) of the final rule clarifies that PHS Act section
2719 governing internal claims and appeals and external review as
implemented by 45 CFR 147.136, covers MHPAEA claims denials and
requires that, when a non-quantitative treatment limitation (NQTL) is
the basis for a claims denial, that a non-grandfathered plan or issuer
must provide the processes, strategies, evidentiary standard, and other
factors used in developing and applying the NQTL with respect to med/
surg benefits and MH/SUD benefits.
Disclosure Request Form
Group health plan participants, beneficiaries, covered individuals
in the individual market, or persons acting on their behalf, may use
this optional model form to request information from plans regarding
NQTLs that may affect patients' MH/SUD benefits or that may have
resulted in their coverage being denied. Form Number: CMS-10307 (OMB
control number: 0938-1080) ; Frequency: On Occasion; Affected Public:
State, Local, or Tribal Governments, Private Sector, Individuals;
Number of Respondents: 267,538; Number of Responses: 1,081,929; Total
Annual Hours: 43,327. (For policy questions regarding this collection,
contact Usree Bandyopadhyay at 410-786-6650.)
Dated: December 5, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2017-26524 Filed 12-7-17; 8:45 am]
BILLING CODE 4120-01-P
