Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10492 Notice of Availability of Separate Contraception Payments from Fully Insured Issuers	Form and Instruction	Modified	Available
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified	Repair queued
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services	Form and Instruction	Modified	Available
Form CMS-10492 Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment	Form and Instruction	Modified	Available
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Available
Form CMS-10492 Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services	Form and Instruction	Modified	Available
Form CMS-10492 Issuers Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment	Form and Instruction	Modified	Available
Form CMS-10492 Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Repair queued
CMS-10492 - User Fee Adjustment Supporting Statement - 2223.docx	Supporting Statement A	Uploaded 2023-02-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
258236	Data Submission and Maintenance of Records for Individual Contraceptive Arrangement		New
258183	Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers	Instruction	New
217425	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified	Notice of Availability of Separate Contraception Payments from Fully Insured Issuers
217425	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	Form and Instruction	Modified
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified	Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
217424	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	Form and Instruction	Modified
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified	Issuers Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment
217422	Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1285	ICR Reference No: 202302-0938-001
Status: Historical Inactive	Previous ICR Reference No: 202208-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment (CMS-10492)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 04/03/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/02/2023
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2025	36 Months From Approved	09/30/2025
Responses	325	0	325
Time Burden (Hours)	1,450	0	1,450
Cost Burden (Dollars)	0	0	0

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Abstract: CMS will use the data collections from participating issuers and third party administrators to verify the total dollar amount for such payments for contraceptive services provided under this accommodation for the purpose of determining a participating issuer's user fee adjustment. The attestation that the payments for contraceptive services were made in compliance with 26 CFR 54.9815-2713A(b)(2) or 29 CFR 2590.715-2713A(b)(2) will help ensure that the user fee adjustment is being utilized to provide contraceptive services for the self-insured plans in accordance with the previously noted accommodation.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2713 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 2713 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU94	Proposed rulemaking	88 FR 7236	02/02/2023

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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: 5

table that charts list of burden

IC Title	Form No.	Form Name
Collection of User Fee Adjustment Information from FFE (or SBE-FP) Participating Issuers
Data Submission and Maintenance of Records for Individual Contraceptive Arrangement
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Fully Insured Issuers)	CMS-10492	Notice of Availability of Separate Contraception Payments from Fully Insured Issuers
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (Issuer)	CMS-10492, CMS-10492	Issuers' Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment ,   Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services
Data Submission for the Federally-facilitated Exchange User Fee Adjustment (TPAs)	CMS-10492, CMS-10492	Issuers Data Submission Requirements to Receive the Federally-facilitated Exchange User Fee Adjustment ,   Third Party Administrators' Submission Requirements for Claims Cost Reimbursement of Certain Preventative Services

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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: Burden hours increased as a result of 2023 rulemaking which proposes to allow an eligible individual to voluntarily, and independently of any actions by the objecting entity, elect an individual contraceptive arrangement. In addition, participating providers of contraceptive services would be required, as a condition of participation in the proposed individual contraceptive arrangement, to maintain documentation for 10 years. Therefore, burden has been adjusted accordingly from 1,450 hours to 380,850 hours, a total of 379,400 hours.

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Annual Cost to Federal Government: $9,187

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: 02/02/2023

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