Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10433 Reinsurance and Risk Adjustment Bank Server	Form and Instruction	Modified	Available
Form CMS-10433 Reinsurance Program and Risk Adjustment Program	Form and Instruction	Modified	Available
Form CMS-10433 QHP Certification Instrument Screenshots	Form and Instruction	Modified	Available
Form CMs-10433 Business Rules Template	Form and Instruction	Modified	Available
Form CMS-10433 Service Area Template	Form and Instruction	Modified	Available
Form CMS-10433 Rate Table Template	Form and Instruction	Modified	Available
Form CMS-10433 Prescriptions Drug Formulary Template	Form and Instruction	Modified	Available
Form CMS-10433 Plans and Benefits Template	Form and Instruction	Modified	Available
Form CMS-10433 Network ID Template	Form and Instruction	Modified	Available
Form CMS-10433 NCQA Template	Form and Instruction	Modified	Repair queued
Form CMS-10433 Network Adequacy Template	Form and Instruction	Modified	Available
Form CMS-10433 Administrative Data Template	Form and Instruction	Modified	Available
CMS-10433 - QHP 30-day Comment Response.docx	Supplementary Document	Uploaded 2016-02-17	Available
CMS-10433 - Appendix N QHP Certification 60-Day Comment Summary Responses 11-3-15.pdf	Supplementary Document	Uploaded 2015-11-27	Available
CMS-10433 - QHP PRA Supporting Statement A.PDF	Supporting Statement A	Uploaded 2015-11-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206071	States		Modified
206070	Reinsurance	Instruction	Unchanged
206069	Reinsurance and Risk Adjustment	Form and Instruction	Modified	Reinsurance and Risk Adjustment Bank Server
206068	QHP Certification	Form and Instruction	Modified	Reinsurance Program and Risk Adjustment Program
206068	QHP Certification	Form and Instruction	Modified	QHP Certification Instrument Screenshots
206068	QHP Certification	Form and Instruction	Modified	Business Rules Template
206068	QHP Certification	Form and Instruction	Modified	Service Area Template
206068	QHP Certification	Form and Instruction	Modified	Rate Table Template
206068	QHP Certification	Form and Instruction	Modified	Prescriptions Drug Formulary Template
206068	QHP Certification	Form and Instruction	Modified	Plans and Benefits Template
206068	QHP Certification	Form and Instruction	Modified	Network ID Template
206068	QHP Certification	Form and Instruction	Modified	NCQA Template
206068	QHP Certification	Form and Instruction	Modified	Network Adequacy Template
206068	QHP Certification	Form and Instruction	Modified	Administrative Data Template

ICR Details

OMB Control No: 0938-1187	ICR Reference No: 201511-0938-013
Status: Historical Active	Previous ICR Reference No: 201505-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 21422
Title: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/24/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/27/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	06/30/2018
Responses	26,951	0	27,225
Time Burden (Hours)	235,153	0	317,875
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 45979	08/03/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 72066	11/18/2015
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

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	Administrative Data Template ,   Network Adequacy Template ,   NCQA Template ,   Network ID Template ,   Plans and Benefits Template ,   Prescriptions Drug Formulary Template ,   Rate Table Template ,   Service Area Template ,   Business Rules Template ,   QHP Certification Instrument Screenshots ,   Reinsurance Program and Risk Adjustment Program
Reinsurance
Reinsurance and Risk Adjustment	CMS-10433	Reinsurance and Risk Adjustment Bank Server
States

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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	26,951	27,225	0	0	-274	0
Annual Time Burden (Hours)	235,153	317,875	0	0	-82,722	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: Since finalizing this PRA package and receiving an OMB control number, CMS has updated the burden oF QHP, SADP, non-QHP, and State issuers in our calculations. Currently, this data collection is approved for 317,875 hours. With this ICR, the total annualized hour burden is approximately 235,153 hours. The change in burden is due to the lack of start-up hours that were a part of the previously approved clearance as well as adjustments to the data collection instruments.

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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: 11/27/2015

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