Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10433 Appendix D 1 RI, RA, Banking, Edge Server Data Elements	Form and Instruction	New	Repair queued
Form CMS-10433 Appendix D 1 RI, RA, Banking, Edge Server Data Elements	Form and Instruction	New	Available
Form CMS-10433 Appendix C 3 RatingBusinessRules Template	Form and Instruction	New	Available
Form CMS-10433 Appendix C 2 RateTables Template	Form and Instruction	New	Available
Form CMS-10433 Appendix C 1 Rating Tables and Issuer Business Rules	Form and Instruction	New	Available
Form CMS-10433 Appendix B 3 PrescriptionDrug Template	Form and Instruction	New	Available
Form CMS-10433 PlansBenefitsAddIn	Form and Instruction	New	Repair queued
Form CMS-10433 PlansBenefits	Form and Instruction	New	Available
Form CMS-10433 Appendix B 1 QHP Benefit Elements	Form and Instruction	New	Available
Form CMS-10433 Appendix A 6 Network Adequacy Template	Form and Instruction	New	Available
Form CMS-10433 IssuersNCQA	Form and Instruction	New	Available
Form CMS-10433 IssuerURAC	Form and Instruction	New	Available
Form CMS-10433 Appendix A 4 EssentialCommunityProviders Template	Form and Instruction	New	Available
Form CMS-10433 Appendix A 3 AdministrativeData Template	Form and Instruction	New	Available
Form CMS-10433 Appendix A 2 Program Attestations	Form and Instruction	New	Available
Form CMS-10433 Appendix A 1 Issuer data elements	Form and Instruction	New	Available
Form CMS-10433 Appendix B 4 ServiceArea Template	Form and Instruction	New	Available
7 - QHP PRA Summary of Comment and Response.docx	Supplementary Document	Uploaded 2013-03-07	Available
1- Supporting Statement for Initial Plan Data Collection to Support QHP Cer.pdf	Supporting Statement A	Uploaded 2013-03-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206071	States		New
206070	Reinsurance	Form and Instruction	New	Appendix D 1 RI, RA, Banking, Edge Server Data Elements
206069	Reinsurance and Risk Adjustment	Form and Instruction	New	Appendix D 1 RI, RA, Banking, Edge Server Data Elements
206068	QHP Certification	Form and Instruction	New	Appendix C 3 RatingBusinessRules Template
206068	QHP Certification	Form and Instruction	New	Appendix C 2 RateTables Template
206068	QHP Certification	Form and Instruction	New	Appendix C 1 Rating Tables and Issuer Business Rules
206068	QHP Certification	Form and Instruction	New	Appendix B 3 PrescriptionDrug Template
206068	QHP Certification	Form and Instruction	New	PlansBenefitsAddIn
206068	QHP Certification	Form and Instruction	New	PlansBenefits
206068	QHP Certification	Form and Instruction	New	Appendix B 1 QHP Benefit Elements
206068	QHP Certification	Form and Instruction	New	Appendix A 6 Network Adequacy Template
206068	QHP Certification	Form and Instruction	New	IssuersNCQA
206068	QHP Certification	Form and Instruction	New	IssuerURAC
206068	QHP Certification	Form and Instruction	New	Appendix A 4 EssentialCommunityProviders Template
206068	QHP Certification	Form and Instruction	New	Appendix A 3 AdministrativeData Template
206068	QHP Certification	Form and Instruction	New	Appendix A 2 Program Attestations
206068	QHP Certification	Form and Instruction	New	Appendix A 1 Issuer data elements
206068	QHP Certification	Form and Instruction	New	Appendix B 4 ServiceArea Template

ICR Details

OMB Control No: 0938-1187	ICR Reference No: 201303-0938-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 19096
Title: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/13/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/07/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	3,490	0	0
Time Burden (Hours)	203,469	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: As required by the CMS-9989-F: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers ("Exchange rule"), each Exchange must assume responsibilities related to the certification and offering of Qualified Health Plans ("QHP"). To offer insurance through an Exchange, a health insurance issuer must have its health plans certified as QHPs by the Exchange. A QHP must meet certain minimum certification standards, such as network adequacy, actuarial value standards, and the offering of the essential health benefits (EHB). The Exchange is responsible for ensuring that QHPs meet these minimum certification standards as described in the Exchange rule under 45 CFR 155 and 156, based on the Affordable Care Act, as well as other requirements determined by the Exchange.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1321-1322 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1324, 1341 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1343, 1401-1402 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1411-1412 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1301-1304, 1311-1312 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1301-1304, 1311-1312 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1321-1322 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1324, 1341 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1343, 1401-1402 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 1411-1412 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 40061	07/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 69846	11/21/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
QHP Certification	CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433	Appendix A 1 Issuer data elements ,   Appendix A 2 Program Attestations ,   Appendix A 3 AdministrativeData Template ,   Appendix A 4 EssentialCommunityProviders Template ,   IssuerURAC ,   IssuersNCQA ,   Appendix A 6 Network Adequacy Template ,   Appendix B 1 QHP Benefit Elements ,   PlansBenefits ,   PlansBenefitsAddIn ,   Appendix B 3 PrescriptionDrug Template ,   Appendix B 4 ServiceArea Template ,   Appendix C 1 Rating Tables and Issuer Business Rules ,   Appendix C 2 RateTables Template ,   Appendix C 3 RatingBusinessRules Template
Reinsurance	CMS-10433	Appendix D 1 RI, RA, Banking, Edge Server Data Elements
Reinsurance and Risk Adjustment	CMS-10433	Appendix D 1 RI, RA, Banking, Edge Server Data Elements
States

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,490	0	3,490	0	0	0
Annual Time Burden (Hours)	203,469	0	203,469	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $2,888,783

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/07/2013

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