Essential Health Benefits Benchmark Plans (CMS-10448)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10488 EHB Substitution	Form and Instruction	New	Available
Form CMS-10488 EHB Reporting	Form and Instruction	Modified	Available
Form CMS-10488 Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection	Form	Removed	Available
CMS-10448_ Crosswalk of changes.pdf	Supplementary Document	Uploaded 2018-04-16	Available
CMS-10448 _ EHB Supporting Statement.pdf	Supporting Statement A	Uploaded 2018-04-16	Available
CMS-10448_ Appendix F Comment Tracker.docx	Supplementary Document	Uploaded 2018-04-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231104	EHB Substitution	Form and Instruction	New
229047	EHB Reporting	Form and Instruction	Modified
203740	EHB Dental Plan Issuers		Unchanged
203739	Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection	Form	Removed

ICR Details

OMB Control No: 0938-1174	ICR Reference No: 201804-0938-010
Status: Active	Previous ICR Reference No: 201710-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10448
Title: Essential Health Benefits Benchmark Plans (CMS-10448)
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: 06/04/2018
	Date Received in OIRA: 04/18/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	09/30/2018
Responses	580	0	226
Time Burden (Hours)	561	0	165
Cost Burden (Dollars)	0	0	0

---

Abstract: The Affordable Care Act requires that all qualified health plans (QHPs) offered in the Exchanges provide the essential health benefits (EHB) and be accredited by an accrediting entity that is recognized by the Secretary of Health and Human Services. In order to establish EHB benchmark plans in each State, CMS will collect data from potential default benchmark plan issuers in each State and from States that select their own benchmark. CMS also intends to ask all States for a voluntary submission of their State mandated benefits. This data collection will include: administrative data necessary to identify the plan, all health benefits offered by the plans and associated limits, drug coverage, network type, and plan level enrollment. Finally, we plan to collect submissions from dental plan issuers on whether they intend to apply for certification to participate in the Exchanges as stand-alone plans.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1201, 1301, 1302, 1311, 1321 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: US Code: 42 USC 156.111 Name of Law: Essential health benefits requirements

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT12	Final or interim final rulemaking	83 FR 16930	04/17/2018

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
EHB Dental Plan Issuers
Essential Health Benefits Benchmark Plans and Accrediting Entities Data Collection	CMS-10488	Data Collection Instructions
EHB Reporting	CMS-10448, CMS-10488, CMS-10448, CMS-10448	EHB Confirmation Template ,   EHB Benchmark Plan Certification ,   Benchmark Plans Prescription Template ,   Summary of Benefits Template
EHB Substitution	CMS-10488	Substitution Notification

---

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	580	226	15	-51	390	0
Annual Time Burden (Hours)	561	165	402	-77	71	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: In response to 60-day comments (see Appendix F) and to align with the policy finalized in Final 2019 Payment Notice, certain modifications were made to the collection instruments in the Appendices. Burden estimates associated with §156.112(e)(2) increased from 16 hours to 18 hours for the actuary to complete the actuarial certification and associated report. The change was made in recognition of the extension of the generosity standard and in recognition that the definition of typical employer plan may require the actuary to determine whether the typical employer plan meets minimum value requirements as finalized in the Final 2019 Payment Notice. Lastly, the estimated number of States that need to respond to §156.112(e)(2) increased from 7 to 10 due to revisions in §156.111(b)(2)(i) and (ii). The overall burden hours increased by 395 hours (from 165 hours to 560 hours). However, the existing ICR assumed burden for 226 respondents and this ICR estimates an overall decrease to 190 respondents per year due to certain issuers and States no longer being required to respond to the information collection. The total costs for §156.111(e) per year is estimated to increase $25,605.20 (from $8,094 to $33,699.20) and the stand-alone dental plan data collection is estimated as $5,941 total costs per a year. The burden related to SADP issuers has risen due to increased fringe and overhead costs. The burden for §156.115(b)(2)(ii) of $165.10 is new to this ICR.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  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:

(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: 04/18/2018

---