Information Collection for Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs (CMS-10558)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10558 Schema Screenshots	Form and Instruction	Modified	Available
Form CMS-10558 QHP Network and Formulary - Developer Documentation	Form and Instruction	Modified	Repair queued
CMS-10558 - Supporting Statement .docx	Supporting Statement A	Uploaded 2024-03-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217257	QHP Network and Formulary - Developer Documentation	Form and Instruction	Modified	Schema Screenshots
217257	QHP Network and Formulary - Developer Documentation	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1284	ICR Reference No: 202403-0938-014
Status: Active	Previous ICR Reference No: 202011-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: 10558
Title: Information Collection for Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs (CMS-10558)
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 with change	Conclusion Date: 08/09/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/27/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	36 Months From Approved	08/31/2024
Responses	5,208	0	4,512
Time Burden (Hours)	39,126	0	31,484
Cost Burden (Dollars)	3,474,257	0	0

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Abstract: On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act (P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable Care Act. The Affordable Care Act implements various policies that will make health insurance coverage more accessible to consumers. Under 45 CFR 156.122(d)(1)(2) and 156.230(c) in the rule Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016 (CMS-9944-P), new standards for qualified health plan (QHP) issuers are established for the submission of provider and formulary data in a machine- readable format to the Department of Health and Human Services (HHS) and for posting on issuer web sites.

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Authorizing Statute(s): PL: Pub.L. 111 - 156 122, 230 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: None

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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:
	88 FR 75597	11/03/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 21254	03/27/2024
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
QHP Network and Formulary - Developer Documentation	CMS-10558	Schema Screenshots

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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	5,208	4,512	0	0	696	0
Annual Time Burden (Hours)	39,126	31,484	0	0	7,642	0
Annual Cost Burden (Dollars)	3,474,257	0	0	0	3,474,257	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: Burden hours increased by 7,642 hours (from 31,484 hours to 39,126 hours). This change is mainly due to more issuers (376 in the previously approved package compared to 434 in this current request) participating in the health insurance Exchanges. In addition, because the burden is calculated separately for the 219 QHP issuers and 215 SADP issuers on the Exchanges, the increased burden reflects greater growth in QHP issuers (175 in the previously approved package compared to 219 in this current request, an increase of 25 percent) compared with SADP issuers (201 in the previously approved package compared to 215 in this current request, an increase of 7 percent). Because SADP issuers are not required to make updated formulary information available to consumers and to CMS, we estimate that SADP issuers will require no pharmacist burden hours and will require half the burden hours estimated for QHPs for the remaining labor categories (per respondent). As a result of including more total issuers in the calculations, and proportionally higher numbers of QHP issuers, specifically, whose organizations will bear a higher reporting burden, the total three-year cost has increased from $2,780,537.46 to $3,474,187.52.

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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: 03/27/2024

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