Transparency in Pricing Information (CMS-10715)

Forms and Documents

Document Name	Status
Form CMS-10715: Appendi Allowed Amount File Form and Instruction	Modified
Form CMS-10715: Appendi In-Network Rate File Form and Instruction	Modified
Form CMS-10715: Appendi Internet-based Self-Service Tool Form and Instruction	Modified
CMS-10715-Transparency in Coverage_Supporting Statement.docx Supporting Statement A	2021-10-25
CMS-10715 - PRA Comments Responses.docx Supplementary Document	2021-10-15

IC Document Collections

IC ID	Document Title	Status
249776	Customer Service Representatives Training	New
249775	Prescription Drug File Other-Data Elements	New
238760	Allowed Amount File Form and Instruction	Modified
238759	In-Network Rate File Form and Instruction	Modified
238758	Requests for Mailed Disclosures Instruction	Modified
238757	Internet-based Self-Service Tool Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1372	ICR Reference No: 202110-0938-009
Status: Received in OIRA	Previous ICR Reference No: 201912-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO (10715)
Title: Transparency in Pricing Information (CMS-10715)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/25/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	74,462	0
Time Burden (Hours)	28,618,546	0
Cost Burden (Dollars)	0	0

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Abstract: The information collection requirements contained in the proposed rule titled “Transparency in Coverage,” published November 27, 2019 (84 FR 65464), would require group health plans and health insurance issuers offering coverage in the individual and group markets to disclose to a participant, beneficiary, or enrollee (or an authorized representative on behalf of such individual), the estimated cost-sharing liability for covered items or services from a particular provider or providers, thereby allowing a participant, beneficiary, or enrollee to obtain an accurate estimate and understanding of their potential out-of-pocket expenses and to effectively shop for covered items and services. Group health plans and health insurance issuers would be required to make such information available through a self-service tool on an internet website. The self-service tool must provide the information through real-time responses and allow users to search for cost-sharing information for covered items and services. The self-service tool must also allow users to input information necessary to learn the out-of-network allowed amount for a covered item or service and have the capability to refine and reorder results. Group health plans and health insurance issuers would also be required to make this information available as a disclosure in written form. Both the self-service tool and the paper disclosure would be required to include several disclaimer statements relevant to information provided through the disclosure and could be provided by using a model notice developed by the Departments. Additionally, group health plans and health insurance issuers would be subject requirements to disclose in-network provider negotiated rates and historical payment data for allowed amounts for covered items and services furnished by out-of-network providers through two digital files in a machine-readable format to be specified by the Departments. The Negotiated Rate file and the Allowed Amount file must be posted publicly on an internet website.

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Authorizing Statute(s): US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in coverage
   US Code: 45 USC 156.220 Name of Law: Transparency in coverage
   PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act
US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in coverage
US Code: 45 USC 156.220 Name of Law: Transparency in coverage

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 86567	12/30/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 57151	10/14/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Allowed Amount File	CMS-10715: Appendix 2, CMS-10715: Appendix 3	APPENDIX 2: In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Customer Service Representatives Training
In-Network Rate File	CMS-10715: Appendix 2, CMS-10715: Appendix 3	APPENDIX 2: In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Internet-based Self-Service Tool	CMS-10715: Appendix 2, CMS-10715: Appendix 3	APPENDIX 2: In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Prescription Drug File
Requests for Mailed Disclosures

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ICR Summary of Burden

	Total Request	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	74,462	0	0	0	0	74,462
Annual Time Burden (Hours)	28,618,546	0	0	0	0	28,618,546
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:

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Annual Cost to Federal Government: $0

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: 10/25/2021

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