CMS -10320 - Supporting Statement 30-day 717

Supporting Statement for Paperwork Reduction Act Submission: Health Care
Reform Insurance Web Portal and Supporting Authority Contained in Sections
1103 and 10102 of The Patient Protection and Affordability Care Act, Pub. L.
111-148 (2010) [CMS-10320/OMB Control Number: 0938-1086]

A. Background

In accordance with Sections 1103 and 10102 of The Patient Protection and Affordability Care Act,
Pub. L. 111-148 (2010) (Affordable Care Act) the U.S. Department of Health and Human Services
(HHS) is tasked with developing and implementing an Internet website portal to assist consumers
with identifying affordable and comprehensive health insurance coverage options that are available
in their State. Consistent with minimizing burden and providing consistency in data collection, the
Centers for Medicare & Medicaid Services (CMS) updates its HealthCare.gov collection
requirements as regulatory developments occur. There have been no developments since the last
approved collection that require changes to the Paperwork Reduction Act (PRA) package.
The Departments of Health and Human Services, Labor and the Treasury (the Departments)
published a final regulation implementing the Section 2715 consumer disclosure provisions of the
ACA. (77 Fed. Reg. 8668 (Feb. 14, 2012), codified at 45 CFR 147.200). These final regulations set
forth the requirements for group health plans (plans) and health insurance issuers (issuers) to
provide the Summary of Benefits and Coverage (SBC) and the uniform glossary of medical and
insurance terms. Under these regulations, plans and issuers must provide in the SBC information
about covered services, cost sharing, limitations and exceptions of the coverage, coverage
examples, and other disclosures. The final regulation also clarifies the timing and format for
providing these documents.
CCIIO is requesting approval to implement this provision for the collection of information to assist
consumers in making educated decisions on their health care options. This collection was initially
approved under Office of Management and Budget (OMB) control number 0938-1086. Various
elements discussed within this package have already been through comment periods and have
been authorized for collection under OMB control number 0938-1157. These elements are included
here so that the public can identify how the efforts are integrated and get a consistent view of the
collection.
The reinsurance and risk adjustment programs outlined by the Affordable Care Act, detailed in the
Standards for Reinsurance, Risk Corridors, and Risk Adjustment Rule (77 FR 17220, March 23, 2012),
have general information reporting requirements that apply to qualified health plans (QHPs)
offered through the Exchanges and to non-Exchange plans in the outside market. For the
reinsurance program, administrative information will be used to identify all entities – health
insurance issuers and self-insured group health plans- required to contribute to the reinsurance
program. In addition, non-Exchange plan information such as plan type and location will be used to
identify non-grandfathered individual market plans inside and outside the exchange eligible for
reinsurance payments. For the risk adjustment program, administrative information will be used to
identify all non-grandfathered small group and individual market plans inside and outside the

exchange eligible for the program. Risk adjustment also requires select data such as rating area,
rating factors and actuarial value (AV) level, to perform calculation of payments and charges.
Non-Exchange Plan Information Collection: Reinsurance and Risk Adjustment
Section 1341 of the Affordable Care Act provides that each state will establish a transitional
reinsurance program to help stabilize premiums for coverage in the individual market from 2014
through 2016. Section 1343 provides that each state will establish a permanent program of risk
adjustment for all non-grandfathered plans in the individual and small group markets. If a state
chooses not to actively participate in reinsurance and/or risk adjustment, CMS will be responsible
for implementation. The requirements for issuers with plan offerings outside of the Exchanges are
codified at 45 CFR Part 153.
Reinsurance Reporting Requirements for Non-Exchange Plans
The transitional reinsurance program will reduce the uncertainty of insurance risk in the individual
market by making payments for high-cost enrollees in non- grandfathered individual market plans.
Health insurance issuers and self-insured group plans are required to remit contributions on behalf
of enrollees in major medical coverage, and thus are collectively referred to as “contributing
entities.” Self-insured group health plans may remit their reinsurance contributions through a third
party administrator or an administrative services only contractor. Non-grandfathered individual
market plans are eligible to request and receive reinsurance payments.
CMS will collect all contributions under the uniform reinsurance contribution rate, regardless of
whether a state is operating a reinsurance program. CMS will operate reinsurance payment
functions for a state when the state defers operation of the program to CMS.
In order to effectively identify and contact “contributing entities” and third party administrators,
(and administrative services only contractors) administrative information, such as name, location,
and contact for company, is needed. In addition, in order to identify eligible plans for reinsurance
payments, plan-level information is needed for non-grandfathered, non-Exchange plan offerings in
the individual market as well as QHPs.
Additionally, states operating the transitional reinsurance program will be required to register in
HIOS in order for HHS to distribute reinsurance payments to the state. The state will then allocate
those reinsurance payments to the issuers in their state.
Risk Adjustment Reporting Requirements for Non-Exchange Plans
The permanent risk adjustment program provides payments to health insurance issuers that
disproportionately attract high-risk populations (such as those with chronic conditions), thereby
reducing the incentives for issuers to avoid higher-risk enrollees. Under this program, funds are
transferred within a risk pool within a market within a state from issuers with lower risk enrollees to
issuers with higher risk enrollees.

A “risk adjustment covered plan” includes most health insurance plans offered in the individual or
small group market. The exceptions are grandfathered health plans, group health insurance
coverage described in 45 CFR 146.145(c), individual health insurance coverage described in 45 CFR
148.220, and any other plan determined not to be a risk adjustment covered plan in the applicable
Federally-certified risk adjustment methodology. States, or CMS on behalf of a state, will require
basic identifying information about all risk adjustment covered plans, whether or not they are
QHPs.

B. Justification

1. Need and Legal Basis

This information is mandated by Sections 1103 and 10102 of the Affordable Care Act. A copy of this
mandate is provided in Appendix B. Additionally, the collection covers information required in
Sections 1302 and 2715 of the Affordable Care Act regarding transparency and the provision of SBC.

2. Information Users

Once all of the information is collected from the States, State health benefits high risk pools, and
insurance issuers (hereon referred to as issuers), this information is processed by contractors for
display on the HealthCare.gov website. The information that is provided helps the general public
make educated decisions about their choice in organizations providing private health care
insurance. Information collected quarterly from insurance issuers is used to populate the Plan
Finder application to show individuals their options, to provide some profile information, and to
coordinate the data collection with Oversight collections to reduce the burden on issuers and the
Federal Government. Collecting information consistent with the SBC standards allows consumers to
access this information in a consistent manner.

3. Use of Information Technology

CCIIO has created a system where insurance issuers and their States log into the web portal using a
custom user ID and password validation. The States were asked to provide information on issuers in
their State and various websites (see Appendix E). The issuers have been downloading a basic
information template to enter data then upload into the portal. Information to be collected on
issuers and products can be found in Appendix C. Additionally, for purposes of this collection, we
will collect information consistent with both QHPs and the Federally-facilitated Exchange within one
consolidated template. The requirements and data elements of this collection can be found in OMB
Control No. 0938-1157. Information to be collected can be found in the following Appendices:
Plans and Benefits and Service Area Templates can be found in Appendices B1 and B3; Rating Tables
and Issuer Business Rules data can be found in Appendices C1 and C2; Pricing and Benefits data can
be found in Appendix D.
CCIIO will be using drop down menus and error checks wherever possible to minimize burden on
plans and issuers. Once the data is submitted, the plans and issuers can later log in to update
information they provided instead of having to re-upload all plan/product information.

4. Duplication of Efforts

CMS will make every effort to reduce the burden on issuers and reuse the information that is
collected under the various provisions of the Affordable Care Act. As such, data obtained under
other authorized collections that implement provisions of the Affordable Care Act will be utilized to
meet some Exchange requirements, for example Rate Increase Disclosure and Review Requirements
(45 CFR Part 154),OMB Control Number CMS – 10379. Additionally, the implementation of the
Affordable Care Act section 2715 requirement’s for specific standards for reporting information to
consumers, we have aligned our data collection with the structure for a SBC as recommended by
the National Association of Insurance Commissioners (NAIC).

5. Small Business

Small Businesses are not significantly affected by this collection.

6. Less Frequent Collection

CCIIO has been operating with an approximately 45 day refresh schedule to obtain changes in plan
benefits and pricing as well as comprehensive lists of products approved within a State for sale to
the public. In the event that an issuer enhances its existing plans, proposes new plans, or
deactivates plans, the organization would be required to update the information in the web portal
using the edit function or uploading an updated template within an open window period. In
response to the desire to decrease burden as much as possible, CMS has adjusted the collection
period to quarterly. Through the use of effective dates and periodic windows of opportunity for
changes, CMS anticipates that we can decrease the overall burden for the data collection
significantly.

7. Special Circumstances

Dependent on the frequency with which an issuer enhances, eliminates, or adds options to their
products, additional submissions may be necessary.
Information that is to be collected from State health benefits high risk pools (Appendix F) has been
collected from the National Association of State Comprehensive Health Insurance Plans (NASCHIP)
at this time. Administrators have been voluntarily entering changes as they develop, so no general
call for the collection of data from these groups is currently contemplated. Information from State
Insurance Commissioners was collected in 2010, and no current plans exist to continue that
collection during the period covered by this document. CMS reserves the right to continue to
request this information, however, as the nature of these markets is highly changeable.

8. Federal Register/Outside Consultation

The 60-day Federal Register published on April 5, 2017 (FR 2017-09170). A 30-day Notice
will public in the Federal Register on ________________.

CMS received 2 comments during the 60-day comment period. CMS response to comments
are included in Appendix G. No outside consultation was sought.

9. Payments/Gifts to Respondents

There are no payments/gifts to respondents.

10. Confidentiality

To the extent provided by law, we will maintain respondent privacy with respect to the information
being collected. HealthCare.gov collects issuer opinions regarding confidentiality of any new data
elements for review by the Freedom of Information Act (FOIA) office at CMS. Certain fields have
been determined as confidential on the basis of this review and are redacted from public files.

11. Sensitive Questions

There are no sensitive questions included in this collection effort.

12. Burden Estimates (Hours & Wages)

The estimated hour burden on issuers for the PlanFinder data collection in the first year is
estimated as 29,733 total burden hours, or 119 hours per organization. This estimate is based on an
assumed average of 450 individual plan issuers and 700 small group plan issuers (750 total, as some
issuers offer both individual and small group plans) per each of the four quarterly collections. It
includes 30 hours per organization for training and communication. Additionally, for each of the
issuers it includes 11 hours of preparation time, one hour of login and upload time, two hours of
troubleshooting and data review, and one half hour for attestation per organization per quarterly
refresh.

Insurance Issuers:
Issuers

Submissions Hours Total

30

22,500 1x 22,500

Per
Total Cost
Hour
Wage
Rate 1
$63.26 $1,423,350

450

11

4950

4

19800

$63.26

$1,252,548

Submission
PreparationIndividual

700

11

7700

4

30800

$63.26

$1,948,408

Submission
PreparationSmall Group

750

Xs Annual
Hours

Explanation

Training and
Communication

To derive average costs, we used date from the Bureau of Labor Statistics’ May 2015 National Occupational
Employment. Hourly wage rates include the costs of fringe benefits (calculated at 100 percent of salary) and the
adjusted hourly wage. https://www.bls.gov/oes/current/oes_nat.htm#31-0000

1

450

1

450

4

1800

$63.26

$113,868

700

1

700

4

2800

$63.26

$177,128

450

2

900

4

3600

$63.26

$227,736

700

2

1400

4

5600

$63.26

$354,256

450
700

0.5
0.5

225
350

4
4

900
1400

$63.26

$56,934
$63.26 $88,564
Total $5,642,792

Data EntryIndividual
Data Entry- Small
Group
TroubleshootIndividual
TroubleshootSmall Group
Attest- Individual
Attest-Small Grp.

State Burden
The estimated hour burden on the States for the PlanFinder data is informed by the fact that they
have already submitted the data once and only need to update their submissions. The overall hours
estimate is 525, or 10.5 per Department of Insurance. This is premised on 2 hours of training and
communication, 8 hours for data collection, and one half hour for submission.

States Submissions Hours Total Xs
50
50
50

2
8
0.5

100
400
25

1
1
1

Annual
Hours
100
400
25
525

Per
Hour
$63.26
$63.26
$63.26
$63.26

Total Cost

Explanation

$6326
$25,304
$1581.50
$33,211.50

Training
Data Collection
Submission

13. Capital Costs

There is no capital costs needed for this collection effort.

14. Cost to Federal Government

The initial burden to the Federal Government for the development and implementation of the
collection of basic, pricing, and benefits information of issuers on the web portal is $15,161,494.

The calculations for CCIIO employees’ hourly salary was obtained from the OPM website:
http://www.opm.gov/oca/10tables/html/dcb_h.asp.

Software Development and Hosting
Managing and Coordinating Contracts

$15,000,000

3 GS – 13: 3 x $42.66 x 416 $53,240.00
Analysis and QA
4 GS – 13:4 x $42.66 x 416
$70,986.00
Overhead Costs
84,978.72 * 30% $37,267.80
Total Cost to Government

$15,161,494

15. Changes to Burden

There are no changes to burden hour. Costs burden per respondent has increased due to
updated 2016 BLS wage data information.

16. Publication/Tabulation Dates

The collection of detailed information from issuers to post on Finder.healthcare.gov is anticipated
under this request for collection in August 2017.

17. Expiration Date

The expiration date and OMB control number will be displayed on each instrument.