Basic Health Program Report for Health Insurance Exchange Premium

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10510 Basic Health Plan State Report for Health Insurance Exchange Premiums	Form and Instruction	New	Available
CMS-10510 - Supporting Statement Part B [rev 12-02-2013 by OSORA PRA].doc	Supporting Statement B	Uploaded 2013-12-03	Available
Emergency Justification to Howard Shelanski.pdf	Supplementary Document	Uploaded 2013-12-03	Available
BHP CMS-10510_-_Supporting_Statement_Part_A eds td clean 01062014.doc	Supporting Statement A	Uploaded 2014-01-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209843	Basic Health Plan State Report for Health Insurance Exchange Premiums	Form and Instruction	New

ICR Details

OMB Control No: 0938-1218	ICR Reference No: 201312-0938-015
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21056
Title: Basic Health Program Report for Health Insurance Exchange Premium
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/06/2014
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/06/2014
	Date Received in OIRA: 12/23/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2014	6 Months From Approved
Responses	17	0	0
Time Burden (Hours)	68	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is requesting that an information collection request to support the development of federal payment rates for the Basic Health Program (BHP) be processed under the emergency clearance process associated with Paperwork Reduction Act of 1995 (PRA), specifically 5 CFR 1320.13(a)(2)(i). In accordance with Section 1331 of ACA, the BHP is federally funded by determining the amount of payments that the federal government would have made through premium tax credits (PTCs) and cost sharing reductions (CSRs) for people enrolled in BHP had they instead been enrolled in an Exchange. In order to calculate these amounts for each state, CMS needs the reference premiums for the second lowest cost silver plans (SLCSPs) in each geographic area in a state, as SLCSPs are a basic unit in the calculation of PTCs and CSRs under the Exchanges. Relatedly, the reference premiums for these SLCSPs are critical components in the BHP payment methodology in order to estimate what PTCs and CSRs would have been paid. Similarly, CMS also needs to collect reference premiums for the lowest cost bronze plans to appropriately account for CSR calculations for American Indians and Alaskan Natives. CMS recently determined that it does not have sufficient data from State Based Exchanges (SBEs) to determine the reference premiums for their SLCSPs and lowest cost bronze plans. Reference premiums are foundational inputs into the BHP payment methodology.

Emergency Justfication: The emergency justification is attached to this package.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1331 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 152 1331 Name of Law: Health Care and Education Reconciliation Act of 2010
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1331 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1331 Name of Law: Health Care and Education Reconciliation Act of 2010

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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:
	78 FR 77469	12/23/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 77469	12/23/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Basic Health Plan State Report for Health Insurance Exchange Premiums	CMS-10510	BHP State Report for Health Insurance Exchange Premiums

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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	17	0	17	0	0	0
Annual Time Burden (Hours)	68	0	68	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 collection.

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Annual Cost to Federal Government: $1,305

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 12/23/2013

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