Risk Corridors Data Validation for the 2014 Benefit Year (CMS-10582)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10582 Response_to_Public_Comments (9-4-15).doc	Supplementary Document	Uploaded 2015-09-04	Available
CMS-10582 EMERGENCY KP Comment Letter Risk Corridors PRA 09 2015.pdf	Supplementary Document	Uploaded 2015-09-04	Available
CMS-10582 - EMERGENCY AHIP BCBSA risk corridor comment letter (final) 9-3-15.pdf	Supplementary Document	Uploaded 2015-09-04	Available
CMS-10582 - RC Letter Discrepancy #2 WAD.docx	Supplementary Document	Uploaded 2015-09-01	Available
CMS-10582 - RC Letter Discrepancy #1 NAD.docx	Supplementary Document	Uploaded 2015-09-01	Available
CMS-10582_Supporting_Statement_Part_A_OMB comments (CCIIO clean 9-4-15).docx	Supporting Statement A	Uploaded 2015-09-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218064	MLR Risk Corridors Submission Checklist and the Risk Corridors Data Discrepancy Worksheet	Instruction	New

ICR Details

OMB Control No: 0938-1283	ICR Reference No: 201508-0938-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Risk Corridors Data Validation for the 2014 Benefit Year (CMS-10582)
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: 09/04/2015
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/05/2015
	Date Received in OIRA: 09/01/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	6 Months From Approved
Responses	250	0	0
Time Burden (Hours)	14,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: While conducting program integrity reviews of submitted data for the 2014 benefit year, CMS has identified a number of material differences in the 2014 benefit year submissions that issuers made for MLR and risk corridors on July 31, 2015, compared with other data available to CMS, including data submitted through the EDGE servers. CMS also identified a number of common errors that may lead to submissions that do not comply with CMS regulations and guidance. In order to investigate these material differences and operate the MLR and risk corridors program accurately and effectively, CMS seeks to quantify the impact of claims and premium differences by collecting information on the dollar value of, and written explanations of, these differences. This information is not included in the risk corridors data validation ICR that is currently approved under OMB Control Number 0938-1155. "Standards Related to Reinsurance, Risk Corridors, Risk Adjustment, and Payment Appeals", which only estimates the burden for QHP issuers to review and validate their risk corridors data. Without additional information, CMS will be unable to verify the accuracy of the submission and validate the data needed to operate the MLR or risk corridors programs.

Emergency Justfication: CMS has set forth data validation procedures for the risk corridors program at 45 CFR 153.530-540. While conducting program integrity reviews of submitted data for the 2014 benefit year, CMS has identified a number of material differences in the 2014 benefit year submissions that issuers made for MLR and risk corridors on July 31, 2015, compared with other data available to CMS, including data submitted through the EDGE servers. CMS also identified a number of common errors that may lead to submissions that do not comply with CMS regulations and guidance. In order to investigate these material differences and operate the MLR and risk corridors program accurately and effectively, CMS seeks to quantify the impact of claims and premium differences by collecting information on the dollar value of, and written explanations of, these differences. This information is not included in the risk corridors data validation ICR that is currently approved under OMB Control Number (OCN) 0938-1155. “Standards Related to Reinsurance, Risk Corridors, Risk Adjustment, and Payment Appeals”, which only estimates the burden for QHP issuers to review and validate their risk corridors data. Without additional information, CMS will be unable to verify the accuracy of the submission and validate the data needed to operate the MLR or risk corridors programs. Therefore, CMS is requesting emergency clearance of this ICR by the Office of Management and Budget by September 4, 2015. Verifying the accuracy of the MLR and risk corridors data is critical to CMS’s mission of ensuring the integrity of these programs. If data is not validated, public harm could result because premium uncertainty in the individual and small group health insurance markets would increase, and rebates to consumers could be inaccurate. CMS is requesting a revision to the ICR under emergency procedure in order to provide for the timely implementation of risk corridors payments and charges. A delay in these payments and charges could influence issuers’ ability to comply with the regulatory deadline for MLR rebates set forth at 45 CFR 158.240(d), rate setting and other regulatory decisions by Departments of Insurance and Exchanges, and the statutory accounting treatment of risk corridors receivables.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1342 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1342 Name of Law: Patient Protection and 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:
	80 FR 52478	08/31/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 52478	08/31/2015
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
MLR Risk Corridors Submission Checklist and the Risk Corridors Data Discrepancy Worksheet

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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	250	0	0	250	0	0
Annual Time Burden (Hours)	14,500	0	0	14,500	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: $1,200,000

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: 09/01/2015

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