Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations (CMS-10361)

Forms and Documents

Document Name	Status
CMS-10361 MLR State Adjustments PRA Package Supporting Statement - 30day.docx Supporting Statement A	2018-05-16

IC Document Collections

IC ID	Document Title	Status
195389	Record Retention Requirement	Removed
195248	Waiver Application	Unchanged

ICR Details

OMB Control No: 0938-1114	ICR Reference No: 201805-0938-009
Status: Active	Previous ICR Reference No: 201711-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations (CMS-10361)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/14/2018
	Date Received in OIRA: 05/23/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved	08/31/2014
Responses	22	0	442
Time Burden (Hours)	3,080	0	442
Cost Burden (Dollars)	0	0	0

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Abstract: Section 2718 of the Public Health Service Act (PHS Act) and its implementing regulation at 45 CFR Part 158 requires health insurance issuers (issuers) offering group or individual health insurance coverage to provide rebates to enrollees in any State where an issuer does not meet the medical loss ratio (MLR) standard specified by section 2718 for the applicable market (individual, small group, or large group). Section 2718(d) of the PHS Act provides that the Secretary may adjust the MLR standard in the individual market. Title 45 CFR Part 158 sets forth the framework for a State to request such an adjustment and the process and criteria for the Secretary to determine whether to grant a State’s request. Subpart C of 45 CFR Part 158 specifies the information that the State must provide to support its request, and the criteria that HHS may consider in making a determination. HHS must obtain such information in order to ascertain whether an adjustment to the MLR standard would have a reasonable likelihood of helping stabilize the individual market in the requesting State.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1001(e) Name of Law: BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.
  

Citations for New Statutory Requirements: US Code: 45 USC 158.350 Name of Law: Subsequent requests for adjustment to the medical loss ratio.

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

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Waiver Application
Record Retention Requirement

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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	22	442	-420	0	0	0
Annual Time Burden (Hours)	3,080	442	2,638	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: In the HHS Notice of Benefit and Payment Parameters for 2019 final rule, HHS has reduced the burden on respondents by eliminating collection of some data elements that were included in the previously approved ICR and streamlining the requirements for other data elements. It is estimated that there will be a net reduction in total burden from 3,700 to 3,080.

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Annual Cost to Federal Government: $38,544

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

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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: 05/23/2018

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