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Federal Register / Vol. 86, No. 131 / Tuesday, July 13, 2021 / Rules and Regulations
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balance billing law. In order to estimate the number of self-insured plans that have opted into the balance billing law for New Jersey, DOL has scaled Washingtons estimate by the number of participants with self-insured ERISAcovered plans.210 According to the 2019
Health Insurance Coverage Bulletin, there are respectively, 0.7 million, 2.1
million, and 2.7 million with selfinsured ERISA-covered plans in Nevada, Virginia, and New Jersey.
Additionally, according to the Washingtons Office of Insurance Commissioner, about 0.5 million selfinsured participants have opted into Washingtons balance billing law.211
This results in a total of 6 million participants.212 Thus, DOL estimates that 20, 231, 309, and 57 private selfinsured plans will opt in respectively in Nevada, Virginia, Washington, and New Jersey, resulting in a total of 617 selfinsured plans.213 These plans will incur the one-time burden and cost to include the disclosure in their plan documents in 2022.
DOL estimates that it will take 1 hour for an administrative assistant, with a wage rate of $55.14, to gather information and review information.214
This results in hour burden of 617
hours, with an equivalent cost of $34,023. DOL estimates that it will take 30 minutes for a benefits manager, with a wage rate of $134.21, to gather information and review information.215
This results in hour burden of 309
210 Nevada Department of Health and Human Services Office of Consumer Health Assistance.
Payment for Medically Necessary Emergency Services Provided Out-of-Network 2020 Annual Report. 2020. https dhhs.nv.gov/uploadedFiles/
dhhsnvgov/content/Programs/CHA/
AB469%20LCB%20Annual%20Report%20
2020.pdf.
211 Washingtons Office of Insurance Commissioner. Self-Funded Group Health Plans Participating in the Balance Billing Protection Act.
https www.insurance.wa.gov/self-funded-grouphealth-plans.
212 Employee Benefits Security Administration.
Health Insurance Coverage Bulletin: Abstract of Auxiliary Data for the March 2019 Annual Social and Economic Supplement to the Current Population Survey. 2019. https www.dol.gov/
sites/dolgov/files/EBSA/researchers/data/healthand-welfare/health-insurance-coverage-bulletin2019.pdf.
213 New Jersey: 335 0.5/2.7 = 62 self-insured plans; 62 self-insured plans5 non-federal selfinsured plans = 57 private self-insured plans.
214 For more information on how the Department estimates labor costs see: https www.dol.gov/sites/
dolgov/files/EBSA/laws-and-regulations/rules-andregulations/technical-appendices/labor-cost-inputsused-in-ebsa-opr-ria-and-pra-burden-calculationsjune-2019.pdf.
215 For more information on how the Department estimates labor costs see: https www.dol.gov/sites/
dolgov/files/EBSA/laws-and-regulations/rules-andregulations/technical-appendices/labor-cost-inputsused-in-ebsa-opr-ria-and-pra-burden-calculationsjune-2019.pdf.

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hours, with an equivalent cost of $41,406. In 2022, the total hour burden is 926 hours, with an equivalent cost of $75,430.
The average number of participants in a self-insured ERISA-covered plan that will opt into the four states balance billing laws is 9,724.216 DOL assumes that only printing and material costs are associated with the disclosure requirement, because the notice can be incorporated into existing plan documents. DOL estimates that the disclosure will require one-half of a page, at a cost of $0.05 per page for printing and materials, and 34 percent of plan documents will be delivered electronically at minimal cost.217 Thus, in 2022, the cost to deliver 66 percent of these disclosures in print is estimated to be approximately $321.218
Thus, the 3-year average hour burden is 309 hours, with an equivalent cost of $25,143. The 3-year average cost burden is $107.
5. ICRs Regarding Plan and Issuer Disclosure on Patient Protections Against Balance Billing Section 9820c of the Code, section 720c of ERISA, and section 2799A5c of the PHS Act require plans and issuers to make publicly available, post on a public website of the plan or issuer, and include on each explanation of benefits for an item or service with respect to which the requirements under section 9816 of the Code, section 716 of ERISA, and section 2799A1 of the PHS Act apply, information in plain language on the provisions in these sections, and sections 2799B1 and 2799B2 of the PHS Act, and other applicable state laws on out-of-network balance billing, and information on contacting appropriate state and federal agencies in the case that an individual believes that such a provider or facility has violated the prohibition against balance billing.
As discussed earlier in HHS PRA
section, the total burden for all issuers and TPAs will be 6,153 hours with an equivalent cost of $699,245 in 2021. As HHS, DOL, and the Treasury Department share jurisdiction, it is estimated that 50 percent of the burden will be accounted for by the HHS, 25
percent of the burden will be accounted 216 6,000,000 participants with self-insured ERISA-covered plans / 617 self-insured ERISAcovered plans = 9,724 participants per self-insured ERISA-covered plan.
217 According to data from the National Telecommunications and Information Agency, 34
percent of households in the United States accessed health records or health insurance online. https
www.ntia.doc.gov/blog/2020/more-half-americanhouseholds-used-internet-health-related-activities2019-ntia-data-show.
218 9,724 participants 0.66 $0.05 = $321.

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for by the Treasury Department, and the remaining 25 percent will be accounted for by DOL. HHS will account for approximately 3,077 hours with an equivalent cost of approximately $349,622. DOL and the Treasury Department will each account for approximately 1,539 hours with an equivalent cost of approximately $174,811.
Starting in 2022, the total burden for all issuers and TPAs is estimated to be 558,778 hours with an equivalent cost of $21,714,111. The total printing and materials cost for sending 33,526,677
notices by mail will be $1,676,334
annually. As HHS, DOL, and the Treasury Department share jurisdiction, it is estimated that 50 percent of the burden will be accounted for by the HHS, 25 percent of the burden will be accounted for by the Treasury Department, and the remaining 25
percent will be accounted for by DOL.
Thus, HHS will account for 279,389
hours, with an equivalent cost of $10,857,056, and printing and materials cost of $838,167 starting in 2022. DOL
and the Treasury Department will each account for 139,695 hours with an equivalent cost of $419,084.
Thus, the 3-year average hour burden associated with this requirement for DOL and the Treasury Department is 93,643 hours each with an equivalent cost of $7,354,578. The 3-year average cost burden for DOL and Treasury is $279,389 each.
The summary of burden below encompasses the following ICRs: 1
Information to be Shared about the QPA
26 CFR 54.98166Td, 29 CFR
2590.7166d, 2 Complaints Process for Surprise Medical Bills 26 CFR
54.98167T, 29 CFR 2590.7167, 3
Opt-In State Balance Bill Process 26
CFR 54.98163T, 29 CFR 2590.7163, and 4 Plan and Issuer Disclosure on Patient Protections Against Balance Billing.
Summary of Burden Type of Review: New Collection.
Agency: DOLEBSA, Treasury.
Title: No Surprise Billing.
OMB Numbers: 1210NEW, 1545
NEW.
Affected Public: Businesses or other for-profits, Not-for-profit institutions.
Total Respondents: DOL1,985;
Treasury1,779.
Total Responses: DOL10,368,277;
Treasury10,368,071.
Frequency of Response: Occasionally.
Estimated Total Annual Burden Hours: 927,652 DOL463,980, Treasury463,672.

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