Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10454 Disclosure of State Rating Requirements	Form and Instruction	Modified	Available
CMS-10454 - Non-substantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-11-21	Available
CMS-10454 Supporting Statement - Part A final rev (2).pdf	Supporting Statement A	Uploaded 2013-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208568	Disclosure of State Rating Requirements	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1258	ICR Reference No: 201611-0938-012
Status: Historical Active	Previous ICR Reference No: 201309-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 20436
Title: Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2016
	Date Received in OIRA: 11/29/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	11/30/2017	11/30/2017
Responses	432	0	432
Time Burden (Hours)	2,084	0	2,084
Cost Burden (Dollars)	0	0	0

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Abstract: The final rule "Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review" implements sections 2701, 2702, and 2703 of the Public Health Service Act (PHS Act), as added and amended by the Affordable Care Act, and sections 1302(e) and 1312(c) of the Affordable Care Act. The rule directs that states submit to CMS certain information about state rating and risk pooling requirements for their individual and small group markets, as applicable. Specifically, states will inform CMS of age rating ratios that are narrower than 3:1 for adults; tobacco use rating ratios that are narrower than 1.5:1; a state-established uniform age curve; geographic rating areas; whether premiums in the small group market are required to be based on average enrollee amounts; and, in states with pure community rating, uniform family tier structures and corresponding multipliers. In addition, states that elect to merge their individual and small group market risk pools into a combined pool will notify CMS of such election. This information will allow CMS to determine whether state-specific rules apply or Federal default rules apply. It will also support the accuracy of the federal risk adjustment methodology.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1201 Name of Law: Amendment to the Public Health Service Act
   PL: Pub.L. 111 - 148 1562 Name of Law: Conforming amendments
   PL: Pub.L. 111 - 148 1312 Name of Law: Consumer Choice
   US Code: 42 USC 300 Name of Law: Fair Health Insurance Premiums
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR40	Final or interim final rulemaking	78 FR 13406	02/17/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 13406	02/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 13406	02/17/2013
Did the Agency receive public comments on this ICR? Yes

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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
Disclosure of State Rating Requirements	CMS-10454	State Rating Requirements Disclosure Form

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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	432	432	0	0	0	0
Annual Time Burden (Hours)	2,084	2,084	0	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:

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Annual Cost to Federal Government: $13,824

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: 11/29/2016

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