Under sections 1401, 1411, and 1412 of the Affordable Care Act and 45 CFR part 155 subpart D, an Exchange makes an advance determination of tax credit eligibility for individuals who enroll in QHP coverage through the Exchange and seek financial assistance. Using information available at the time of enrollment, the Exchange determines whether the individual meets the income and other requirements for advance payments and the amount of the advance payments that can be used to pay premiums. Advance payments are made periodically under section 1412 of the Affordable Care Act to the issuer of the QHP in which the individual enrolls. Section 1402 of the Affordable Care Act provides for the reduction of cost sharing for certain individuals enrolled in a QHP through an Exchange, and section 1412 of the Affordable Care Act provides for the advance payment of these reductions to issuers. The statute directs issuers to reduce cost sharing for essential health benefits for individuals with household incomes between 100 and 400 percent of the Federal poverty level (FPL) who are enrolled in a silver level QHP through an individual market Exchange and are eligible for advance payments of the premium tax credit. Health insurance issuers will manually enter enrollment and payment data into a Microsoft Excel-based spreadsheet, and submit the information to HHS. The data collection will be used by HHS to make payments or collect charges from issuers under the following programs: advance payments of the premium tax credit, advanced cost-sharing reductions, and Marketplace user fees. HHS will use the information collected to make payments and collect charges in January 2014 and for a number of months thereafter, as may be required based on HHS's operational progress.
PL: Pub.L. 111 - 148 1401 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 148 1402 Name of Law: Patient Protection and Affordable Care Act
The burden hours have decreased by -83,420 hours (94,373 hours to 10,953 hours). In January 2016, HHS implemented an automated payment approach, called policy-based payments (PBPs) to determine an issuerâs advance payment using enrollment and payment data in the Federally- FFE. As of April 2016, all FFE and SBE-FP issuers have fully transitioned to the PBP process. SBE issuers continue to use the manual payment process and will be transitioning to the PBP process in 2018 and 2019. In 2014, we estimated 575 issuers would be required to use a manual methodology to transmit enrollment and payment data, but since we have fully transitioned all FFE and SBE-FP issuers to the automated payment approach (PBPs), we now estimate that only 75 issuers would be required to use the manual methodology to transmit information via a manual system. Additionally, issuers will not be required to establish new systems to complete their enrollment and payment forms because their systems have already been established and the forms are not changing.
$3,561
No
No
No
Yes
No
No
Uncollected
Jamaa Hill 301 492-4190
Reginfo record details
No
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:
(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;
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.
Form CMS-10515 Monthly Data Submission Accuracy Certification Form
CMS-10515 - Supporting Statement 2018 OMB - Final.docx
Testing & Development