Essential Health Benefits Benchmark Plans (CMS-10448)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10448 State Certification Annual Report (SBRs)	Form and Instruction	Modified	Repair queued
Form CMS-10448 State Annual Report	Form and Instruction	Modified	Repair queued
Form CMS-10448 Reporting - State Mandates	Form and Instruction	Modified	Repair queued
Form CMS-10448 State Documentation Requirements	Form and Instruction	Modified	Repair queued
Form CMS-10448 EHB Substitution	Form and Instruction	Modified	Repair queued
Form CMS-10488 Substitution Notification	Form and Instruction	Modified	Repair queued
Form CMS-10448 Summary of Benefits Template	Form and Instruction	Modified	Repair queued
Form CMS-10448 Benchmark Plans Prescription Template	Form and Instruction	Modified	Repair queued
Form CMS-10448 EHB Benchmark Plan Certification	Form and Instruction	Modified	Repair queued
Form CMS-10448 EHB Reporting	Form and Instruction	Modified	Repair queued
Form CMS-10488 EHB Confirmation Template	Form and Instruction	Modified	Repair queued
CMS-10448 - EHB Supporting Statement - Final.docx	Supporting Statement A	Uploaded 2020-06-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241291	Reporting - State Mandates	Form and Instruction	Modified	State Certification Annual Report (SBRs)
241291	Reporting - State Mandates	Form and Instruction	Modified	State Annual Report
241291	Reporting - State Mandates	Form and Instruction	Modified
231104	EHB Substitution	Form and Instruction	Modified	State Documentation Requirements
231104	EHB Substitution	Form and Instruction	Modified
231104	EHB Substitution	Form and Instruction	Modified	Substitution Notification
229047	EHB Reporting	Form and Instruction	Modified	Summary of Benefits Template
229047	EHB Reporting	Form and Instruction	Modified	Benchmark Plans Prescription Template
229047	EHB Reporting	Form and Instruction	Modified	EHB Benchmark Plan Certification
229047	EHB Reporting	Form and Instruction	Modified
229047	EHB Reporting	Form and Instruction	Modified	EHB Confirmation Template
203740	EHB Dental Plan Issuers		Modified

ICR Details

OMB Control No: 0938-1174	ICR Reference No: 202006-0938-008
Status: Historical Active	Previous ICR Reference No: 202003-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
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: 02/25/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/11/2020
Terms of Clearance: In CMS' next revision, extension, or reinstatement request, CMS shall ensure that this collection complies with 5 CFR 1320.8(b)(3) and a submit a copy of all then-effective public guidance issued by CMS on completing this collection (if any) with the package.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2024	36 Months From Approved	06/30/2021
Responses	231	0	580
Time Burden (Hours)	157	0	561
Cost Burden (Dollars)	0	0	0

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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.

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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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT98	Final or interim final rulemaking	85 FR 29164	05/14/2020

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
EHB Dental Plan Issuers
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-10448, CMS-10488	Substitution Notification ,   State Documentation Requirements
Reporting - State Mandates	CMS-10448, CMS-10448	State Annual Report ,   State Certification Annual Report (SBRs)

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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	231	580	41	0	-390	0
Annual Time Burden (Hours)	157	561	19	0	-423	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: New annual reporting of state mandate requirements were finalized in the 2021 Payment Notice (increase of 19 hours). However, the previous iteration of the ICR contained an arithmetic error which incorrectly inflated burden hours by 423 hours. The burden is now being revised to reflect the accurate burden hour total of 157 hours.

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Annual Cost to Federal Government: $9,839

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? No

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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: 06/11/2020

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