Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions (CMS-10466)
Revision of a currently approved collection
No
Regular
03/25/2020
table that charts list comparision
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 âThe Affordable Care Act.â 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
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-10466 Exemption Applications - Eligibility for Exemptions
cms-10466 - Supporting Statement (1).docx
Agreements