Emergency Justification

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Center for Consumer Information & Insurance Oversight
200 Independence Avenue SW
Washington, DC 2020I

DATE:

October 31, 2014

TO:

Howard Shelanski
Administrator, OIRA

CENTERS FOR MEDICARE & MEDICAID SERVICES

CENTER FOR CONSUMER INFORMATION
& INSURANCE OVERSIGHT

enner

FROM:

r

SUBJECT:

Request for Emergency Clearance of Revisions to the Information Collection
Requirements Contained in the Cooperative Agreements to Support Establishment of
State-Operated Health Insurance Under the Paperwork Reduction Act

Emergency Justification
The Centers for Medicare & Medicaid Services (CMS) is requesting revisions to the "Grants to States for
the planning and establishment of Exchanges" information collection request (ICR) to be processed
under the emergency clearance process in accordance with 5 CFR 1320.13(a)(2)(i). Public harm is
reasonably likely to ensue if the normal clearance procedures are followed. Existing collections gather
information from the grant awardee to ensure the CMS is able to conduct their statutory oversight
responsibilities. The revision is necessary to obtain more accurate and consistent enrollment data during
the upcoming Open Enrollment Period which begins November 15, 2014. The immediate need for this
revision is due to the State-Based Marketplaces (SBM) maturing business processes and the requirement
for more precise reporting of comparison data between the first and second years of ACA
implementation. Of particular concern is the need to capture certain demographic data and information
on new versus re-enrolled individuals in accordance with uniform definitions so as not to produce
misleading results. A delay in finalizing this ICR will result in key data being unavailable to CMS during
the 2014 Open Enrollment Period. CMS will not be able to use the data to provide technical and policy
mid-course corrections to the State Exchanges during the Open Enrollment Period.

Background:
Section 1311 of the Affordable Care Act provides for grants to States for the planning and establishment
of Marketplaces. Given the innovative nature of Marketplaces and the statutorily-prescribed relationship
between the Secretary and States in their development and operation, it has been critical that the Secretary
work closely with States to provide necessary guidance and technical assistance to ensure that States can
meet the prescribed timelines, federal requirements, and goals of the statute. These grants are funded
through the Health Insurance Marketplaces Cooperative Agreement to Support Establishment of the
Affordable Care Act's Health Insurance Exchanges (Funding Opportunity Number: IE-HBE-12-001). A
critical part of this guidance and assistance is the collection of precise information to measure the
performance of the individual exchanges.

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CMS has determined the need for additional information during the 2015 open enrollment periods from
the 14 operational SBMs (including Washington DC) to enhance the agency's understanding of the
demographic makeup of the citizens enrolling in the various health plans as well as the affordability of
those plans. This additional information will also allow CMS to provide increased public visibility into
the effectiveness, viability, and impact of the Marketplaces. They are essential for ensuring basic
transparency in the performance of Marketplaces and allow consistent cross-state comparisons of the
impacts of varying approaches to Marketplace implementation.
The revised data collection instrument has been developed in coordination with the states, based on an
understanding of their current data collection efforts and capabilities. The tool will enable us to: 1)
distinguish new enrollees from renewals; 2) capture language preference (Spanish, other language, or no
preference) to assist in targetting potentially underserved individuals; 3) obtain a better understanding of
enrollment activity by certain demographic breakdowns to better target our activities through more
refined cross-tabulations of data by age and gender, by age and Metal Level, and by financial assistance
status (with/without) and Metal Level; 4) distinguish Special Enrollment Period activity for the 2014
coverage year during the period that overlaps with the first 2.5 months of Open Enrollment [November
IS-December 31] in order to avoid contamination of 2015 data, to assess the extent of Special Enrollment
activity during the last phase of 2014 activity; 5) identify stand-alone dental plans to better measure the
extent to which individuals are enrolling in these products in order to provide input into ASPE' s monthly
report to the public; 6) codify providing enrollment data for all issuers in the individual marketplaces, if
available, compared to the template that asks only for the top three in the individual marketplaces [These
data, if available, have been provided to us as a write-in to the previous template on a voluntary basis.].

Timeline
November 5, 2014
Target publication date for emergency 7-day Federal Register (FR) notice.
Draft PRA package posted to CMS PRA web site
PRA package formally submitted to OMB
November 12, 2014
End of 7 -day public comment period
November 12, 2014
Start of OMB review period
November 14, 2014
Requested date of OMB approval

CMSPOC

Dena Puskin
Phone: 301-492-4342

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