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

Forms and Documents

Document Name	Status
Form CMS-10433 Reinsurance and Risk Adjustment Form and Instruction	Modified
Form CMS-10433 QHP Certification Form	Modified
CMS-10433 - Supporting Statement QHP 4162015.pdf Supporting Statement A	2015-05-07

IC Document Collections

IC ID	Document Title	Status
206071	States	Unchanged
206070	Reinsurance Instruction	Unchanged
206069	Reinsurance and Risk Adjustment Form and Instruction	Modified
206068	QHP Certification Form	Modified

ICR Details

OMB Control No: 0938-1187	ICR Reference No: 201505-0938-004
Status: Historical Active	Previous ICR Reference No: 201409-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 21422
Title: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/30/2015
	Date Received in OIRA: 05/07/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved
Responses	27,225	0	0
Time Burden (Hours)	317,875	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 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
   PL: Pub.L. 111 - 148 1321-1322 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

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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:
	80 FR 7607	02/11/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23555	04/28/2015
Did the Agency receive public comments on this ICR? No

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

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	Data Template Administrative ,   Medical Essential Community Providers ,   Dental Essential Community Provider ,   URAC Application ,   NCQA Template ,   AAAHC ,   Network Adequacy ,   Program Attestations ,   Accreditation Attestations ,   Plan and Benefit ,   Prescription Drugs Template ,   Service Area ,   Network ID ,   Rates Table ,   Business Rules
Reinsurance and Risk Adjustment	CMS-10433	Appendix D - Banking and Edge Server
Reinsurance
States

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ICR Summary 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	27,225	0	0	0	0	27,225
Annual Time Burden (Hours)	317,875	0	0	0	600	317,275
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: HHS proposed an emergency modification of this data collection for the DDC information collection in Appendix D. This information collection was also published in the Federal Register for public comment on July 30, 2014. We estimate that this modification would result in an additional burden of approximately 600 hours and $46,200 for all 2,400 risk adjustment covered and reinsurance eligible issuers.

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Annual Cost to Federal Government: $0

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: 05/07/2015

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