[Federal Register Volume 78, Number 149 (Friday, August 2, 2013)]
[Notices]
[Pages 47016-47017]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18602]


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OFFICE OF PERSONNEL MANAGEMENT


Submission for Review: Request for External Review

AGENCY: U.S. Office of Personnel Management.

ACTION: 60-Day Notice and request for comments.

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SUMMARY: National Healthcare Operations, Office of Personnel Management 
(OPM), offers the general public and other Federal agencies the 
opportunity to comment on a new information collection request (ICR) 
3206-NEW, Request for External Review. As required by the Paperwork 
Reduction Act of 1995, (Pub. L. 104-13, 44 U.S.C. chapter 35) as 
amended by the Clinger-Cohen Act (Pub. L. 104-106), OPM is soliciting 
comments for this collection. The Office of Management and Budget is 
particularly interested in comments that:
    1. 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;
    2. 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;
    3. Enhance the quality, utility, and clarity of the information to 
be collected; and
    4. 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

[[Page 47017]]

technological collection techniques or other forms of information 
technology, e.g., permitting electronic submissions of responses.

DATES: Comments are encouraged and will be accepted until October 1, 
2013. This process is conducted in accordance with 5 CFR 1320.1.

ADDRESSES: Interested persons are invited to submit written comments on 
the proposed information collection to National Healthcare Operations, 
Office of Personnel Management, 1900 E Street NW., Washington, DC 
20415, Attention: Ed DeHarde, or sent via electronic mail to 
[email protected].

FOR FURTHER INFORMATION CONTACT: A copy of this ICR, with applicable 
supporting documentation, may be obtained by contacting National 
Healthcare Operations, Office of Personnel Management, 1900 E Street 
NW., Washington, DC 20503, Attention: Ed DeHarde, or sent via 
electronic mail to [email protected].

SUPPLEMENTARY INFORMATION: Section 1334 of the Patient Protection and 
Affordable Care Act, Public Law 111-148, as amended by the Health Care 
Education Reconciliation Act, Public Law 111-152 (together, 
``Affordable Care Act''), directed the Office of Personnel Management 
(OPM) to enter into contracts with health insurance issuers to offer 
coverage on Exchanges (also called ``Marketplaces'') throughout the 50 
States and the District of Columbia. OPM issued final regulations for 
the establishment of the Multi-State Plan Program (MSPP) on March 11, 
2013, 78 FR 15560, which outlined an external review process that would 
be available to enrollees in Multi-State Plans (MSPs).
    The regulations state that ``OPM will conduct external review of 
adverse benefit determinations using a process similar to OPM review of 
disputed claims under [the Federal Employees Health Benefits Program] . 
. . .'' A necessary part of conducting external review of adverse 
benefit determinations is accepting requests for external review from 
MSP enrollees who seek external review.
    In general, after an issuer denies a claim, the enrollee whose 
claim is denied may ask the issuer to reconsider through a process 
called an internal appeal. If an issuer upholds a denial on internal 
appeal, the enrollee may seek external review of the denial. External 
review is a process that affords an enrollee in an MSP the right to 
have a denial of a claim appealed to an entity other than his or her 
health insurance issuer. The attached Model Notice of Final Internal 
Adverse Benefit Determination illustrates the content of the notice 
that an MSP issuer must provide to an MSP enrollee after denying a 
claim and upholding such denial upon internal appeal.

Analysis

    Agency: National Healthcare Operations, Office of Personnel 
Management.
    Title: Request for External Review.
    OMB Number: 3206-NEW.
    Frequency: Occasionally.
    Affected Public: Multi-State Plan enrollees.
    Estimated Number of Respondents: 2,933,333.
    Estimated Time per Respondent: 30 minutes.
    Estimated Total Burden Hours: 1,466,666.5.

U.S. Office of Personnel Management.
Elaine Kaplan,
Acting Director.
[FR Doc. 2013-18602 Filed 8-1-13; 8:45 am]
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