Provider Network Coverage Data Collection (CMS-10594)

ICR 201908-0938-012

OMB: 0938-1302

Federal Form Document

Forms and Documents
Supporting Statement A
IC Document Collections
ICR Details
0938-1302 201908-0938-012
Active 201604-0938-006
HHS/CMS 10594
Provider Network Coverage Data Collection (CMS-10594)
Revision of a currently approved collection   No
Approved without change 01/03/2020
Retrieve Notice of Action (NOA) 08/28/2019
  Inventory as of this Action Requested Previously Approved
01/31/2023 36 Months From Approved 01/31/2020
262,161 0 320,650
17,810 0 21,709
0 0 0

Proposed §156.230(e)(1) would require that QHP issuers make a good faith effort to provide written notice of discontinuation of a provider 30 days prior to the effective date of the change or otherwise as soon as practicable, to enrollees who are patients seen on a regular basis by the provider or who receive primary care from the provider whose contract is discontinuing. This is a third-party disclosure requirement. CMS is not proposing to collect this notice from QHP issuers in FFMs, therefore we are not specifying ways in which we will use the data. The purpose of this notice is to provide consumers information on when their providers will no longer be available in-network in their QHP. In proposed 156.230(f)(2), we require QHP issuers to provide a notice to enrollees of the possibility of out-of-network charges from an out-of-network provider in an in-network setting at least 10 calendar days prior to the service being provided to avoid counting the out-of-network costs against to the annual limitation on cost sharing.

PL: Pub.L. 111 - 156 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
US Code: 45 USC 156.230 Name of Law: 156.230

Not associated with rulemaking

  84 FR 30123 06/26/2019
84 FR 45154 08/28/2019

IC Title Form No. Form Name
Provider Network Coverage - Provider Discontinuation
Provider Network Coverage - Notice to Enrollees

  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 262,161 320,650 0 0 -58,489 0
Annual Time Burden (Hours) 17,810 21,709 0 0 -3,899 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
The number of burden hours have been reduced from 21,334 to 17,439, a total reduction of 3,895 burden hours. The burden hour reduction is due to the decrease in the number of respondents.

Jamaa Hill 301 492-4190


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.

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