Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10454 State Rating Requirements Disclosure Form	Form and Instruction	Modified	Repair queued
Form CMS-10454 Disclosure of State Rating Requirements	Form and Instruction	Modified	Repair queued
CMS-10454 Supporting Statementf - Part A -.docx	Supporting Statement A	Uploaded 2021-03-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208568	Disclosure of State Rating Requirements	Form and Instruction	Modified	State Rating Requirements Disclosure Form
208568	Disclosure of State Rating Requirements	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1258	ICR Reference No: 202103-0938-016
Status: Historical Active	Previous ICR Reference No: 201802-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Disclosure of State Rating Requirements and Individual Market Special Enrollment Notice (CMS-10454)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/10/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/18/2021
Terms of Clearance: Please update the burden estimate on the form when the expiration date is updated to be consistent with the burden calculation in this approval and submit the revised form as a non-substantive change.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	08/31/2021
Responses	3	0	423
Time Burden (Hours)	17	0	2,338
Cost Burden (Dollars)	0	0	0

---

Abstract: The final rule "Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review" implements sections 2701, 2702, and 2703 of the Public Health Service Act (PHS Act), as added and amended by the Affordable Care Act, and sections 1302(e) and 1312(c) of the Affordable Care Act. The rule directs that states submit to CMS certain information about state rating and risk pooling requirements for their individual and small group markets, as applicable. Specifically, states will inform CMS of age rating ratios that are narrower than 3:1 for adults; tobacco use rating ratios that are narrower than 1.5:1; a state-established uniform age curve; geographic rating areas; whether premiums in the small group market are required to be based on average enrollee amounts; and, in states with pure community rating, uniform family tier structures and corresponding multipliers. In addition, states that elect to merge their individual and small group market risk pools into a combined pool will notify CMS of such election. This information will allow CMS to determine whether state-specific rules apply or Federal default rules apply. It will also support the accuracy of the federal risk adjustment methodology.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 1201 Name of Law: Amendment to the Public Health Service Act
   US Code: 42 USC 300 Name of Law: Fair Health Insurance Premiums
   PL: Pub.L. 111 - 148 1562 Name of Law: Conforming amendments
   PL: Pub.L. 111 - 148 1312 Name of Law: Consumer Choice
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 73720	11/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 9349	02/12/2021
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Disclosure of State Rating Requirements	CMS-10454	State Rating Requirements Disclosure Form

---

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	3	423	0	0	-420	0
Annual Time Burden (Hours)	17	2,338	0	0	-2,321	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: Total burden for reporting decreased by 2,321 hours (from 2,338 hours to 17 hours) because states will only incur the burden of reporting changes to their rating factors.

---

Annual Cost to Federal Government: $242,632

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

---

Common Form ICR:  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:

(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: 03/18/2021

---