CMS-10666 Non-Exchange Entities Supporting Statementt

Supporting Statement for Information Collection Requirements
for Non-Exchange Entities (CMS-10666/OMB control number: 0938-NEW)
A. Background
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”), expanded access to health insurance for
individuals and employees of small businesses through the establishment of new Affordable
Insurance Exchanges (Exchanges), also called Marketplaces, including the Small Business Health
Options Program (SHOP). The Exchanges, which became operational on January 1, 2014,
enhance competition in the health insurance market, expand access to affordable health insurance
for millions of Americans, and provide consumers with a place to easily compare and shop for
health insurance coverage.
Section 1312(e) of the Affordable Care Act directs the Secretary of the Department of Health and
Human Services (HHS) to establish procedures under which a State may permit agents and
brokers to enroll qualified individuals and employers into qualified health plans (QHPs) offered
through an Exchange and to enable these agents and brokers to assist individuals in applying for
advance payments of the premium tax credit and cost-sharing reductions.
The HHS Notice of Benefit and Payment Parameters for 2017; Final Rule (2017 Payment
Notice) finalized the definition of standardized options as well as one set of standardized
options at § 155.20. It also codified the authority for HHS to differentially display
standardized options on consumer-facing plan comparison and shopping tools, such as those
on HealthCare.gov, at § 155.205(b)(1).
The HHS Notice of Benefit and Payment Parameters for 2018; Final Rule (2018 Payment
Notice) finalized several updated sets of standardized options at § 155.20. In accordance with
section 1312(e) of the Affordable Care Act, the 2018 Payment Notice also finalized
requirements for web-brokers and issuers that use the Classic Direct Enrollment (Classic DE)
and Enhanced Direct Enrollment (EDE) pathways to differentially display standardized
options in a manner consistent with that adopted by HHS for display on HealthCare.gov, at §§
155.220(c)(3)(i)(H) and 156.265(b)(3)(iv), respectively. It also finalized that a web-broker or
issuer that utilizes the Classic DE and EDE pathways could submit a request to deviate from
the differential display of standardized options on HealthCare.gov with approval from HHS at
§§ 155.220(c)(3)(i)(H) and 156.265(b)(3)(iv), respectively.
The original information collection request (ICR) that provided the authority for HHS to
collect the information necessary for these requests to deviate was titled Non-Exchange
Entities (0938-1329) and was approved on 5/23/2017. The original ICR was discontinued on
3/4/2020 due to the concurrent discontinuation of standardized options in the HHS Notice of
Benefit and Payment Parameters for 2019; Final Rule (2019 Payment Notice).
This ICR serves as the formal request for a reinstated data collection clearance associated
with the HHS Notice of Benefit and Payment Parameters for 2023 Proposed Rule (2023
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Proposed Payment Notice) regarding the authority to allow HHS to collect the necessary
information to enable web-brokers and issuers using the Classic DE and EDE pathways to submit a
request to deviate from the manner in which standardized options are differentially displayed on
HealthCare.gov, if they so choose.
B.

Justification

1.

Need and Legal Basis

Section 1312(e) of the Affordable Care Act directs the Secretary of HHS to establish
procedures under which a State may permit agents and brokers to enroll qualified individuals
and employers into QHPs offered through an Exchange and to enable these agents and brokers
to assist individuals in applying for advance payments of the premium tax credit and cost
sharing reductions.
In the 2018 Payment Notice, at §§ 155.220(c)(3)(i)(H) and 156.265(b)(3)(iv), HHS codified
the authority to require web-brokers and issuers that use the Classic DE and EDE pathways to
differentially display standardized options in a manner consistent with that adopted by HHS
for display on HealthCare.gov in order to promote consistent messaging across all enrollment
platforms, including those of web-brokers and direct enrollment issuers.
In the 2018 Payment Notice, HHS noted that it anticipated that the differential display of
standardized options would not require significant modification of web-broker and issuer
platforms but that such display would provide an important service for consumers seeking to
enroll in a standardized option. However, HHS noted that system constraints may prevent
web-brokers and issuers from precisely mirroring the differential display of standardized
options on HealthCare.gov.
For this reason, in the 2018 Payment Notice, HHS noted it would not require the manner of
differentiation of standardized plans on non-Exchange web sites to be identical to that
adopted on HealthCare.gov. Instead, HHS noted that the display must have the same level of
differentiation and clarity as is provided on HealthCare.gov. To allow web-brokers and
issuers using the DE and EDE pathways additional flexibility, HHS allowed these entities to
submit a request to deviate from the manner in which standardized options are differentially
displayed on HealthCare.gov. HHS stated that these requests would be reviewed based on
whether the same level of differentiation and clarity is being provided under the requested
deviation as is provided on HealthCare.gov.
The current ICR provides the authority for HHS to request information from these entities to
submit a request to deviate from the manner in which standardized options are differentially
displayed on HealthCare.gov, if these entities so choose. This flexibility will ensure that webbrokers and issuers using the DE and EDE pathways can continue to enroll qualified
consumers into QHPs offered through the Exchanges without disruption.
2.

Information Users
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This ICR will provide HHS the authority necessary to request information from web-brokers
and QHP issuers using the Classic DE and EDE pathways to request to deviate from the
manner in which standardized options are differentially displayed on HealthCare.gov, if they so
choose.
3.

Use of Information Technology

HHS anticipates that a majority of the systems, notices, and information collection required will
be automated. A majority of the information that is required by the collection of information
will be submitted electronically. HHS staff will analyze or review the data in the same manner
by which it was submitted and communicate with States, health insurance issuers, and other
entities using e-mail, telephone, or other electronic means.
4.

Duplication of Efforts

This information collection does not duplicate any other Federal effort.
5.

Small Businesses

This information collection will not have a significant impact on small business.
6.

Less Frequent Collection

If information is collected on a less frequent basis, HHS will be unable to allow web-brokers and
QHP issuers using a DE or an EDE pathway to request to deviate from the manner in which
standardized options are differentially displayed on HealthCare.gov, which could impede the
enrollment of qualified individuals into QHPs through these enrollment pathways. Therefore, this
information must be collected on an annual basis to allow these web-brokers and issuers to
submit a request to deviate, if they so choose.
7.

Special Circumstances

There are no anticipated special circumstances.
8.

Federal Register/Outside Consultation

This ICR was posted as part of the Payment Notice rule published in the Federal Register on
12/28/2021 (Vol. 87, No. 3, Pg. 584-728) for the public to submit written comment as part of a
first-round public comment period. No comments were received that pertained to this ICR.
This ICR will be published as part of the Payment Notice rule in the Federal Register on
May 6, 2022.
No additional outside consultation was sought.

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9.

Payments/Gifts to Respondents

No payments and/or gifts will be provided to respondents.
10. Confidentiality
To the extent of the applicable law and HHS policies, we will maintain respondent privacy
with respect to the information collected. Nothing in the information collection should be
interpreted as preventing a State from being allowed to disclose its own data.
11. Sensitive Questions
There are no sensitive questions included in this information collection effort.
12. Burden Estimates (Hours & Wages)
We used the web site (https://www.bls.gov/oes/current/oes_stru.htm) of the Bureau of
Labor Statistics (BLS) to estimate the burden for this collection. The mean hourly wage for
a web and digital interface designer is $45.90, plus a 100% fringe benefit rate of $45.90, for
an adjusted hourly wage of $91.80 per hour. The mean hourly wage for a compliance
officer is $36.45, plus a 100% fringe benefit rate of $36.45, for an adjusted hourly wage of
$72.90 per hour.
Table 1. Adjusted Hourly Wages Used in Burden Estimates
Occupational Title

Occupational
Code

Mean Hourly
Wage ($/hour)

Adjusted
Hourly Wage
($/hour)

$45.90

Fringe Benefits
& Overhead
(100%)
($/hour)
$45.90

Web and Digital
Interface Designer
Compliance Officer

15-1255
13-1041

$36.45

$36.45

$72.90

$91.80

Burden for Web-Brokers and QHP Issuers to Differentially Display Standardized
Options on HealthCare.gov
The 2023 Payment Notice proposes to resume enforcement of the standardized options
differential display requirements at §§ 155.220(c)(3)(i)(H) and 156.265(b)(3)(iv). As such, webbrokers and QHP issuers that utilize the Classic DE and EDE pathways would be required to
differentially display standardized options consistent with the approach adopted by HHS for
display on HealthCare.gov, unless HHS approves a deviation.
Similar to the approach that was taken in the 2018 Payment Notice, HHS does not anticipate that
the differential display of standardized options would require significant modification of webbroker and issuer platforms but that such display would provide an important service for
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consumers seeking to enroll in a standardized option.
We estimate a total of 110 web-brokers and QHP issuers participating in the FFEs and SBEFPs would be required to comply with these requirements. We estimate that it would take a
web and digital interface designer two hours annually, at an average hourly cost of $91.80 per
hour, to implement these changes, at a total annual cost of $183.60 per respondent. We
therefore estimate a total annual burden of 220 hours at a total annual cost of $20,196 for all
applicable web-brokers and QHP issuers.
Pursuant to § 155.220 and § 156.265, the 2023 Payment Notice proposes to resume enforcement
of the standardized options differential display requirements.
Table 2. Burden for Web-Brokers and Issuers Utilizing Classic DE/EDE Pathways to
Differentially Display Standardized Options Consistent with the Display on
HealthCare.gov
Total Burden Total Burden
Cost Per
Costs (All
Respondent Respondents)

Year

Number of
Respondents

Hours Per
Respondent

Total Burden
Hours

2023

110

2

220

$183.60

$20,196

2024

110

2

220

$183.60

$20,196

2025

110

2

220

$183.60

$20,196

Burden for Web-Brokers and QHP Issuers Requesting to Deviate from the
Standardized Options Displayed on HealthCare.gov
However, HHS is aware that system constraints may prevent web-brokers and issuers from
precisely mirroring the differential display of standardized options on HealthCare.gov. For
this reason, HHS would not require the differential display of standardized plans on nonExchange web sites to be identical to that of HealthCare.gov. Instead, HHS would require that
the display must have the same level of differentiation and clarity as is provided on
HealthCare.gov.
To allow web-brokers and issuers using the Classic DE and EDE pathways additional
flexibility, HHS would allow these entities to submit a request to deviate from the manner in
which standardized options are differentially displayed on HealthCare.gov. These requests
would be reviewed based on whether the same level of differentiation and clarity is being
provided under the requested deviation as is provided on HealthCare.gov.
Of the 110 total entities, we estimate that 55 web-brokers and QHP issuers would submit a
request to deviate from the manner in which standardized options are differentially displayed
on HealthCare.gov. We estimate it would take a compliance officer (at a rate of $72.90 per
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hour) approximately one hour annually to complete and submit the request to deviate. We
therefore estimate an annual cost burden of $72.90 per applicable direct enrollment
respondent. This amounts to an annual burden of 55 hours at a total annual cost of $4,009.50
for all web-brokers and QHP issuers submitting a request to deviate from the manner in which
standardized options are differentially displayed on HealthCare.gov.
Pursuant to § 155.220 and § 156.265, the 2023 Payment Notice proposes to resume enforcement
of the standardized options differential display requirements.
Table 3. Burden for Web-Brokers and QHP Issuers Utilizing Classic DE/EDE Pathways
Submitting a Request to Deviate from the Manner in which Standardized Options are
Displayed on HealthCare.gov
Total Burden Total Burden
Cost Per
Costs (All
Respondent Respondents)

Year

Number of
Respondents

Hours Per
Respondent

Total Burden
Hours

2023

55

1

55

$72.90

$4,009.50

2024

55

1

55

$72.90

$4,009.50

2025

55

1

55

$72.90

$4,009.50

Table 4. Summary of Annual Total Burden
Table Number: Name

CFR Section

Table 2. Burden for Web-Brokers
and Issuers Utilizing Classic
45 CFR §§
DE/EDE Pathways to
155.220(c)(3)(i)(H)
Differentially Display
Standardized Options Consistent and 156.265(b)(3)(iv)
with the Display on
HealthCare.gov
Table 3. Burden for Web-Brokers
and QHP Issuers Utilizing Classic
DE/EDE Pathways Submitting a
45 CFR §§
Request to Deviate from the
155.220(c)(3)(i)(H)
Manner in which Standardized
and 156.265(b)(3)(iv)
Options are Displayed on
HealthCare.gov
Total

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Total Annual Total Annual
Burden Hours Burden Costs

220

$20,196

55

$4,009.50

275

$24,205.50

13. Capital Costs
There are no anticipated capital costs associated with these information collections.
14. Cost to Federal Government
We estimate that the operations and maintenance costs for the data collection tool and the data
collection support to have a total cost to the federal government of $1,258.55 per year. The
calculations for CCIIO employees’ hourly salary was obtained from the OPM website: SALARY
TABLE 2022-GS (opm.gov)

Table 5. Administrative Burden Costs for the Federal Government Associated with the
Data Collection
Task
Operations, maintenance, and data collection support
2 GS-13 (step 7): 2 x $46.70x 10 hours
Managerial review and oversight
1 GS-15 (step 7): $64.91 x 5 hours
Total Costs to Government

Estimated Cost
$934.00
$324.55
$1258.55

15. Changes to Burden
The burden estimate in the previously discontinued collection did not include an estimate for
allowing web-brokers and QHP issuers utilizing the Classic DE and EDE pathways to submit a
request to deviate from the manner in which standardized options are differentially displayed on
HealthCare.gov, so this aspect of the burden estimate is slightly higher in the current collection.
Altogether, the total annual burden hour estimate increased from 220 hours to 275 hours, a total
increase of 55 hours.

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16. Publication/Tabulation Dates
There are no plans to publish the outcome of the data collection.
17. Expiration Date
The expiration date and OMB control number will appear on the first page of the instrument in
the top, right corner.

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