CMS-10416 - Supporting Statement_508C

SUPPORTING STATEMENT FOR THE
INFORMATION COLLECTION REQUIREMENTS “BLUEPRINT FOR
APPROVAL OF AFFORDABLE HEALTH INSURANCE
MARKETPLACES”
(OMB CONTROL NUMBER 0938-1172)”
A.

Background

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act
(P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010
(P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable
Care Act (ACA). The Affordable Care Act creates new competitive private health insurance
markets – through competitive Marketplaces, called Affordable Insurance Exchanges or
“Exchanges– that will provide millions of Americans and small businesses with access to
affordable coverage and the same insurance choices members of Congress will have.
Marketplaces will help individuals and small employers shop for, select, and enroll in high
quality, affordable private health plans that fit their needs at competitive prices. The Marketplace
IT systems will support simple and seamless identification of individuals who qualify for
coverage through the Marketplace, tax credits, cost-sharing reductions, Medicaid, and CHIP
programs. By providing a place for one-stop shopping, Marketplaces will make purchasing
health insurance easier and more understandable and will put greater control and more choice in
the hands of individuals and small businesses.
The law gives states (including U.S. territories and the District of Columbia) the opportunity to
establish State-based Marketplaces, subject to certification (or “Approval”) that the State-based
Marketplace meets Federal standards and will be able to offer health care coverage for the
following plan year, beginning January 1, 2014. States may operate the functions of a
Marketplace according to one of three forms: State-based Marketplace (SBM), State Partnership
Marketplace (SPM), and State-based Small Health Options Plan (SHOP) Marketplace. To
document their Marketplace’s compliance with the ACA, each state must submit a Blueprint
Application. States that do not apply for one of these options will resume their current status as a
Federally-facilitated Marketplace (FFM) or State Partnership Marketplace and will not be
required to submit an application. Currently, 17 states have completed a Blueprint Application
to operate a SBM, 7 states have completed an application to operate a SPM, and one has
completed an application to operate a SHOP Marketplace. The remaining 26 have elected to rely
on the Federally-facilitated Marketplace (FFM). States that seek HHS Approval and have not
been previously approved to operate a State-based Marketplace, State-based SHOP Marketplace,
or a State Partnership Marketplace for coverage years beginning after January 1, 2014 (e.g.,
January 1, 2015, January 1, 2016) must submit a Blueprint Application to demonstrate their
compliance with the ACA.

B.

Justification

1. Need and Legal Basis
The Affordable Care Act, Section 1311(b)(1) gives states the opportunity to establish State-based
Exchanges (also known as “Marketplaces”), subject to approval that the State-based Marketplace
meets Federal standards and will be ready to offer health care coverage on January 1, 2014. The
deadline for Exchange approval is January 1, 2013. Section 1321(c) of the Affordable Care Act
directs the Secretary of Health and Human Services to facilitate the establishment of an
Exchange in a state that does not achieve approval or conditional by the January 1, 2013
deadline. The Exchange Final Rule (45 CFR § 155-157 Establishment of Exchanges and
Qualified Health Plans) includes requirements for establishing an Exchange that meets all the
legal and operational requirements.
As part of the Marketplace approval process, it is expected that Marketplaces will attest to
completion of, and demonstrate compliance with, operational requirements through a)
submission of a Marketplace Blueprint (referred to as “Certification Application” for purposes of
60-day public comment) and b) demonstration of operational readiness. The Marketplace
Blueprint is organized by Marketplace activities and includes requirements for an operational
Marketplace. In completing the Marketplace Blueprint, states are required to submit a
compilation of attestations, descriptions of processes, and reference files such as state testing
summaries and results of the Marketplace’s execution of CMS-provided test scenarios. To
further ensure operational readiness of a Marketplace, CMS may conduct onsite system walkthroughs as part of its approval process.
In order to ensure a state can operate a successful and compliant Marketplace, it is critical that
states provide CMS with a complete and thorough Marketplace Blueprint and demonstrate
operational readiness. CMS is aware of the burden that the Marketplace Blueprint and
operational readiness assessments place on states and will work to streamline all reporting and
assessments required from states to ensure an efficient and effective Marketplace approval
process.

2. Information Users
The information collected from states will be used by CMS, IRS, SSA and other Federal
agencies to determine if a state can implement a complete and fully operational Marketplace and
what technical assistance and integrative builds must be built.

3. Use of Information Technology
The Marketplace Blueprint data collection tool will be available online, which will permit
electronic submission of responses.

4. Duplication of Efforts

The information CMS requires in order to certify a State Marketplace is similar to the
information being currently collected as part of the Establishment Review Process, which is
associated with Planning and Establishment Grant reporting. The HHS Center for Consumer
Information and Insurance Oversight (CCIIO) has worked in collaboration with the Center for
Medicaid and CHIP Services (CMCS) and the Office of Information Services (OIS) to develop
the Establishment Review Process that supports states with their Marketplace design. While the
Establishment Review Process is intended to be a glide path to Marketplace Approval, the
approval process is independent of the Establishment Reviews. To ensure data collection
requirements associated with the Marketplace Blueprint are streamlined, HHS will utilize, where
possible, information collected during the Establishment Review Process to make Marketplace
Approval determinations.

5. Small Businesses
This collection does not impact small businesses or other small entities.

6. Less Frequent Collection
This collection cannot be conducted less frequent. The Marketplace Approval process requires a
one-time submission of the completed application tool in order for CMS to assess a
Marketplace’s compliance with ACA requirements and associated regulations. As referenced in
response to #4 (Duplication of Efforts), CMS will work to minimize any duplicative efforts,
while ensuring a Marketplace complies with the relevant legislative and regulatory requirements.

7. Special Circumstances
No special circumstances apply.

8. Federal Register/Outside Consultation
As required by the Paperwork Reduction act of 1995, the Centers for Consumer Information and
Insurance Oversight (CCIIO) published a 60-day Federal Register Notice (FRN) to provide
interested parties the opportunity to comment on the collections of information required by the
Marketplace Blueprint tool. FRN appeared on August 16, 2013, on page 50060 -50062 (3 pages) of
the Federal Register.

9. Payments/Gifts to Respondents
There will be no payments or gifts to respondents.

10.

Confidentiality

Not applicable

11.

Sensitive Questions

There will be no sensitive questions asked.

12.

Burden Estimates (Hours & Wages)

While it was estimated in the original clearance that each state (including District of Columbia
and U.S. territories) would complete and submit a Marketplace Blueprint, some states have
elected to rely on the FFMs to achieve compliance with the ACA and were not required to
submit an application. However, some states are still considering establishing a Marketplace and
may submit applications in the future. Also some states may elect to modify the format of their
Marketplace and be required to update their Blueprint accordingly.
The calculation for the overall burden includes both those states that have already completed
their applications (25) and best estimates for the number and types of exchanges that could be
potentially be requested in the future (6). As a result, 31 potential respondents were used to
calculate the burden estimates. CMS used the Bureau of Labor Statistics for standard wages in
order to calculate the burden costs1.
Estimated Annualized Burden Table

Forms
Exchange
Blueprint
Total

Type of
Respondent

Number of
Respondents

Number of
Responses
per
Respondent

State Agency

31

1

Total
Estimated
Estimated
Burden hours
Burden
per Response
Hours
179.1

5,552.1

179.1

5,552.1

Hours and Costs Table

Type of Respondent

Senior-level manager to
oversee application
Senior-level manager to
conduct most writing

1

Number of
Respondents

Number of
Responses per
Respondent

31

1

31

1

Average
Burden
Hours

Wage
per Hour

Burden Costs

3.3

$56.48

$5,777.90

3.5

$56.48

$6,128.08

We calculate total hourly wage based on the mean hourly wage, 34.3% of compensation from benefits, and fringe
rate. We calculate total annual salary by multiplying total wage by a full-time, year-round working year of 2,080
hours. Source: May 2009 National Industry-Specific Occupational Employment and Wage Estimates - State
Government htttp://www.bls.gov/oes/current/naics4_999200.htm

31

1

17.5

$41.23

$22,367.28

31

1

4

$56.48

$7,003.52

31

1

19.6

$41.23

$25,051.35

31

1

3.6

$56.48

$6,303.17

31

1

19.6

$41.23

$25,051.35

31

1

3.1

$56.48

$5,427.73

31

1

1.3

$41.23

$1,661.57

31

1

17

$64.98

$34,244.46

31

1

18.4

$49.65

$28,320.36

31

1

18.1

$37.78

$21,198.36

Administrative assistant

31

1

16.1

$24.67

$12,312.80

Lawyer

31

1

19.4

$60.55

$36,414.77

31

1

2.7

$44.60

$3,733.02

Agency head (1)

31

1

3

$76.47

$7,111.71

Agency head (2)

31

1

3

$76.47

$7,111.71

Agency head (3)

31

1

3

$76.47

$7,111.71

31

1

3

$56.48

$5,252.64

Mid-level policy analyst to
support writing
Senior-level manager with
insurance expertise
Mid-level policy analyst
with insurance expertise
Senior-level manager
from Medicaid agency
Mid-level policy analyst
from Medicaid agency
Senior-level manager with
health policy expertise
Mid-level policy analyst
with health policy
expertise
Senior-level manager with
systems architecture
expertise
Mid-level analyst with
systems architecture
expertise
Administrative budget
analyst

Budget analyst from
outside core team

Official in Governor's
office
Total

179.1

$267,583.48

13.

Capital Costs

Not applicable

14.

Cost to Federal Government

Not applicable

15.

Changes to Burden

Based on the changing nature of the states’ approaches to meeting the requirements of the ACA
and changes in delivery format, there has been a significant reduction to the overall burden. It
has been reduced by 6,260.8 hours and $267,583.48. CMS has translated the application from its
original paper-based format to an on-line tool that allows the states to enter the information
efficiently and without redundancy. CMS has also converted many of the information
requirements on the application from full explanations, requiring significant levels of effort to
produce to a more streamlined “attestations” and uploading of supporting documents developed
for other purposes. CMS has also revised and clarified the descriptions of various Marketplace
activities to provide more concise guidance to the states.

Type of
respondent
Annual
responses
Annual hour
burden
Annual cost
burden

16.

Total
Requested

Change
Due to
New
Statute

Change
Due to
Agency
Discretion

Change
Due to
Agency
Estimate

Change
Due to
Violation

Currently
Approved

31.0

-25

56

5,552.1

-6,260.8

11,816

$267,583.48

-311,013.01

$578,596.48

Publication/Tabulation Dates

The results of this collection will not be published.

17.

Expiration Date

Exemption not required

18.

Certification Statement

There are no exceptions to the certification statement identified in Item 19, “Certification for
Paperwork Reduction Act Submissions,” on OMB Form 83-I.