Non-Standardized Plan Option Limit Exception Justification Form (CMS-10878)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10878 Non-Standardized Plan Option Limit Exceptions	Form and Instruction	Modified	Available
Form CMS-10878 Non-Standardized Plan Option Limit Exceptions	Form and Instruction	Modified	Repair queued
CMS-10878 - Supporting Statement FR.docx	Supporting Statement A	Uploaded 2024-04-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
263675	Non-Standardized Plan Option Limit Exceptions	Form and Instruction	Modified	Non-Standardized Plan Option Limit Exceptions
263675	Non-Standardized Plan Option Limit Exceptions	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1461	ICR Reference No: 202404-0938-012
Status: Active	Previous ICR Reference No: 202311-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Non-Standardized Plan Option Limit Exception Justification Form (CMS-10878)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/09/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/18/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved
Responses	50	0	0
Time Burden (Hours)	850	0	0
Cost Burden (Dollars)	95,182	0	0

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Abstract: Section 1311(c)(1) of the ACA directs the Secretary to establish criteria for the certification of health plans as qualified health plans (QHPs). Section 1321(a)(1)(B) of the ACA directs the Secretary to issue regulations that set standards for meeting the requirements of title I of the ACA for, among other things, the offering of QHPs through such Exchanges. In the HHS Notice of Benefit and Payment Parameters for 2024 Final Rule (2024 Payment Notice Final Rule), HHS exercised its authority under Sections 1311(c)(1) and 1321(a)(1)(B) of the ACA to limit the number of non-standardized plan options that issuers of QHPs can offer through Exchanges on the Federal platform, including both through Federally-facilitated Exchanges (FFEs) and State-Based Exchanges on the Federal platform (SBE-FPs), to four non-standardized plan options per product network type (as described in the definition of “product” at 45 C.F.R. 144.103), metal level (excluding catastrophic plans), inclusion of dental and/or vision benefit coverage, and service area for plan year (PY) 2024, and two for PY 2025 and subsequent plan years. This information collection request (ICR) serves as the formal request for a new information collection clearance associated with the HHS Notice of Benefit and Payment Parameters for 2025 Proposed Rule (2025 Payment Notice Proposed Rule) regarding the authority to allow HHS to collect the necessary information to enable QHP issuers to seek to be excepted from the non-standardized plan option limit of two per product network type, metal level, inclusion of dental and/or vision benefit coverage, and service area for PY 2025 and subsequent years, if they so choose.

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Authorizing Statute(s): US Code: 45 USC 156.202 Name of Law: Health Insurance Issuer Standards under the Affordable Care Act
   PL: Pub.L. 111 - 148 1311(c)(1) Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 148 1321(a)(1)(b) Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311(c)(1) Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 148 1321(a)(1)(b) Name of Law: Patient Protection and Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV22	Final or interim final rulemaking	89 FR 26218	04/15/2024

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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: 1

table that charts list of burden

IC Title	Form No.	Form Name
Non-Standardized Plan Option Limit Exceptions	CMS-10878	Non-Standardized Plan Option Limit Exceptions

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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	50	0	50	0	0	0
Annual Time Burden (Hours)	850	0	850	0	0	0
Annual Cost Burden (Dollars)	95,182	0	95,182	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: There are no changes to burden as this is a new information collection.

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Annual Cost to Federal Government: $15,405

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: 04/18/2024

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