Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-10468)

ICR 202205-0938-005

OMB: 0938-1207

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2022-05-09
ICR Details
0938-1207 202205-0938-005
Received in OIRA 202201-0938-012
HHS/CMS CCIIO
Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-10468)
Revision of a currently approved collection   No
Regular 05/09/2022
  Requested Previously Approved
36 Months From Approved 02/29/2024
1,140 276
25,614 101,623
2,955,530 1,424,634

The Patient Protection and Affordable Care Act, Public Law 111-148, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act, Public Law 111-152, enacted on March 30, 2010 (collectively, “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 Exchanges, which became operational on January 1, 2014, enhanced competition in the health insurance market, expanded access to affordable health insurance for millions of Americans, and provided consumers with a place to easily compare and shop for health insurance coverage. Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment (CMS-2334-F) address: (1) standards related to notices, (2) procedures for the verification of enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer-sponsored plan; and (3) other eligibility and enrollment provisions to provide detail necessary for state implementation. The submission seeks OMB approval of the information collection requirements Sections 1311(b) and 1321(b) of the Affordable Care Act provide that each state has the opportunity to establish an Exchange that (1) facilitates the purchase of insurance coverage by qualified individuals through QHPs; (2) assists qualified employers in the enrollment of their employees in QHPs; and (3) meets other standards specified in the Affordable Care Act. Section 1311(k) of the Affordable Care Act specifies that Exchanges may not establish rules that conflict with or prevent the application of regulations promulgated by the Secretary. Section 1311(d) of the Affordable Care Act describes the minimum functions of an Exchange, including the certification of QHPs.

PL: Pub.L. 111 - 148 1311 Name of Law: Affordable choices of health benefit plans.
  
US Code: 45 USC 155.315 Name of Law: Verification process related to eligibility for enrollment in a QHP through the Exchange
US Code: 45 USC 155.320 Name of Law: Verification process related to eligibility for insurance affordability programs

0938-AU65 Final or interim final rulemaking 87 FR 27208 05/06/2022

No

  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 1,140 276 0 0 864 0
Annual Time Burden (Hours) 25,614 101,623 0 0 -76,009 0
Annual Cost Burden (Dollars) 2,955,530 1,424,634 0 0 1,530,896 0
No
No
There is a total burden hour decrease of -76,009, from 101,623 to 25,614 hours due to a calculation error in the last information collection submission. However, the number of respondents increased from 13 to 18 State-based Exchanges who operate their own State-based Exchanges. We do not expect this change to impact State-based Exchanges beyond the current burden associated with the Special Enrollment Verification process.

$0
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.
05/09/2022


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