Patient Protection and
Affordable Care Act; Exchange Functions: Eligibility for Exemptions
(CMS-10466)
Revision of a currently approved collection
No
Regular
03/25/2020
Requested
Previously Approved
36 Months From Approved
01/31/2021
45,066
2,000,072
15,381
555,752
0
600,000
On March 23, 2010, the President
signed into law H.R. 3590, the Patient Protection and Affordable
Care Act, Public Law 111-148, as amended by the Health Care and
Education Reconciliation Act of 2010, Pub. L. 111-152, collectively
referred to as “The Affordable Care Act.” The Affordable Care Act
expands access to health insurance for individuals and employees of
small businesses through the establishment of new Affordable
Insurance Exchanges (Exchanges), including the Small Business
Health Options Program (SHOP). The Health Benefits Exchanges
established by the Affordable Care Act facilitate the enrollment of
qualified individuals into Qualified Health Plans (QHPs). Section
1501(b) of the Affordable Care Act added section 5000A of the
Internal Revenue Code (the Code) to a new chapter 48 of subtitle of
the Code effective for months beginning after December 31, 2013.
Section 5000A of the Code requires that nonexempt individuals
either maintain minimum essential coverage or make a shared
responsibility payment, includes standards for the calculation of
the shared responsibility payment, describes categories of
individuals who may qualify for an exemption from the shared
responsibility payment, and provides the definition of minimum
essential coverage. Section 1311(d)(4)(H) of the Affordable Care
Act specifies that the Exchange will, subject to section 1411 of
the Affordable Care Act, grant certifications of exemption from the
shared responsibility payment specified in section 5000A of the
Code. Section 1411(a)(4) of the Affordable Care Act provides that
the Secretary of Health and Human Services (the Secretary) will
establish a program for determining whether a certification of
exemption from the shared responsibility requirement and penalty
will be issued by an Exchange under section 1311(d)(4)(H). Section
1321 of the Affordable Care Act discusses state flexibility in the
operation and enforcement of Exchanges and related requirements.
Section 1321(a) provides broad authority for the Secretary to
establish standards and regulations to implement the statutory
requirements related to Exchanges and other components of title I
of the Affordable Care Act as amended by the Health Care and
Education Reconciliation Act of 2010. CMS is publishing the
criteria needed to determine eligibility for certifications of
exemption and updated applications for exemptions as processed by
the Marketplace. CMS developed this PRA package as part of an
effort to solicit feedback from key stakeholders.
We have updated the information
request based on the number of applications received during the
first five years of the program. The most significant burden hour
reduction is due to the number of applicants to both the Exchange
and the IRS being reduced from 2 million to 45,000 individual
requests for exemptions from the Exchange each year beginning in
the 2020 tax year. Additionally, the estimated number of
state-based Exchanges who use HHS exemption services has decreased
from 12 to 11. CMS has further reduced burden due to a decrease in
the types of exemptions processed by the FFE. As of 2017, a
hardship exemption due to cancellation of individual coverage
(hardship 13) is no longer available. In 2016 these accounted for
approximately 4,600 individual requests for an exemption which was
reduced by 3,950 requests in 2018 for a total of approximately 650
individual requests. We estimate that in 2020 there will be
approximately 300 request for hardships due to cancellation of
individual coverage and although an exemption for hardship 13 is no
longer available CMS must process the exemption application and
send a denial notice to the consumer. Overall this means we expect
the burden to be reduced by approximately 4,300 individual requests
since 2016. Additionally, we estimate that the cost to edit the
exemption applications will be significantly less than the
estimated cost of developing the exemption application because the
changes are minimal burden has been reduced from 12,268 hours to
440 hours. Additional reduction of burden is due to the tax reform
legislation enacted in December 2017
(https://www.congress.gov/115/plaws/publ97/PLAW-115publ97.pdf)
which reduced the individual shared responsibility payment to $0
for months beginning after December 31, 2018. Starting in 2019
individuals only need to seek a hardship exemption, including
affordability, for purposes of obtaining catastrophic coverage.
Therefore, CMS no longer processes exemption requests for Religious
Sect exemptions after December 31, 2018.
$6,534
No
No
No
Yes
No
No
No
Jamaa Hill 301 492-4190
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-10466 Exemption Applications - Eligibility for Exemptions
cms-10466 - Supporting Statement (1).docx
Agreements