Provider Network Coverage Data Collection (CMS-10594)

Forms and Documents

Document Name	Status
CMS-10594- Supporting Statement Provider Network Coverage FR.pdf Supporting Statement A	2016-04-13

IC Document Collections

IC ID	Document Title	Status
219312	Provider Network Coverage - Notice to Enrollees	Modified
219311	Provider Network Coverage - Provider Discontinuation	Unchanged

ICR Details

OMB Control No: 0938-1302	ICR Reference No: 201604-0938-006
Status: Historical Active	Previous ICR Reference No: 201512-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Provider Network Coverage Data Collection (CMS-10594)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/04/2016
	Date Received in OIRA: 04/14/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved
Responses	320,650	0	0
Time Burden (Hours)	21,709	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Proposed §156.230(e)(1) would require that QHP issuers make a good faith effort to provide written notice of discontinuation of a provider 30 days prior to the effective date of the change or otherwise as soon as practicable, to enrollees who are patients seen on a regular basis by the provider or who receive primary care from the provider whose contract is discontinuing. This is a third-party disclosure requirement. CMS is not proposing to collect this notice from QHP issuers in FFMs, therefore we are not specifying ways in which we will use the data. The purpose of this notice is to provide consumers information on when their providers will no longer be available in-network in their QHP. In proposed 156.230(f)(2), we require QHP issuers to provide a notice to enrollees of the possibility of out-of-network charges from an out-of-network provider in an in-network setting at least 10 calendar days prior to the service being provided to avoid counting the out-of-network costs against to the annual limitation on cost sharing.

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Authorizing Statute(s): PL: Pub.L. 111 - 156 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: US Code: 45 USC 156.230 Name of Law: 156.230

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS57	Final or interim final rulemaking	81 FR 12203	03/08/2016

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Provider Network Coverage - Provider Discontinuation
Provider Network Coverage - Notice to Enrollees

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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	320,650	0	320,650	0	0	0
Annual Time Burden (Hours)	21,709	0	21,709	0	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 collection of information.

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Annual Cost to Federal Government:

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: 04/14/2016

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