Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10803 Appendix A	Form and Instruction	Modified	Available
Form CMS-10803 Essential Community Provider and Network Adequacy Data Requirements	Form and Instruction	Modified	Repair queued
CMS-10803 - AWT-SSS-Tech-Guide-QHP-FFE-508.pdf	Supplementary Document	Uploaded 2024-12-16	Repair queued
CMS-10803 - ECP-NA_Supporting Statement.docx	Supporting Statement A	Uploaded 2024-12-16	Repair queued
CMS-10803_ECP-NA_Supporting Statementf.docx	Supporting Statement A	Uploaded 2024-08-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
266278	QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection		Modified
251109	Essential Community Provider and Network Adequacy Data Requirements	Form and Instruction	Modified	Appendix A
251109	Essential Community Provider and Network Adequacy Data Requirements	Form and Instruction	Modified
251109	Essential Community Provider and Network Adequacy Data Requirements	Other-Screenshots	Modified

ICR Details

OMB Control No: 0938-1415	ICR Reference No: 202408-0938-010
Status: Active	Previous ICR Reference No: 202403-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/17/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/09/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved	08/31/2025
Responses	536	0	485
Time Burden (Hours)	249,410	0	5,380
Cost Burden (Dollars)	316,583	0	0

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Abstract: In accordance with section 1311(c)(1)(C) of the Affordable Care Act (ACA), Qualified Health Plan (QHP) issuers, including Stand-alone Dental Plan (SADP) issuers, are required to ensure access to a sufficient number and geographic distribution of essential community providers (ECPs), where available, that serve predominantly low-income, medically-underserved individuals. Under 45 Code of Federal Regulations (CFR) 156.235, the Secretary of HHS has established criteria for inclusion of a sufficient number and geographic distribution of ECPs, where available, in an issuer’s network to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in their service areas. To satisfy this ECP requirement, medical QHP and SADP issuers must submit an Essential Community Provider/Network Adequacy (ECP/NA) template as part of their QHP application, in which they must list the ECPs with whom they have contracted. In the Issuer Module, issuers will also have to attest to meeting each element of the ECP standard. In accordance with section 1311(c)(1)(B) of the ACA, QHP issuers, including SADP issuers, are required to ensure a sufficient choice of providers (in a manner consistent with the applicable provisions under section 2702(c) of the Public Health Service Act). Under CFR 156.230, QHPs that use a provider network must ensure that the network is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible without unreasonable delay. This information collection request (ICR) serves as a formal request for a new clearance associated with the Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2023 Proposed Rule (2023 Payment Notice). This ICR details the burden associated with collecting and reviewing essential community provider and network adequacy data.

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Authorizing Statute(s): US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards Under The Affordable Care Act, Including Standards Related To Exch
   PL: Pub.L. 111 - 156 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: US Code: 45 USC 156.230 Name of Law: Network adequacy standards
US Code: 45 USC 156.235 Name of Law: Essential community providers

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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: 2

table that charts list of burden

IC Title	Form No.	Form Name
Essential Community Provider and Network Adequacy Data Requirements	CMS-10803	Appendix A
QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection

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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	536	485	0	0	51	0
Annual Time Burden (Hours)	249,410	5,380	0	0	244,030	0
Annual Cost Burden (Dollars)	316,583	0	0	0	316,583	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 is an overall increase in the financial burden for this ICR because of the substantive addition of the activities associated with medical QHP issuers in FFEs needing to contract with a third party to administer secret shopper provider surveys to a statistically valid sample of network providers to assess compliance with appointment wait time standards. As a result, the total burden hours increased from 5,380 hours to 249,410 hours, which is an increase of 244,030 hours. The estimated annual costs increased from $392,202 to $17,544,032, which is an increase of $17,151,830. There was also an increase in labor because of the appointment wait time secret shopper data collection and addition of the labor categories Business Operation Specialist and General and Operations Manager.

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Annual Cost to Federal Government: $1,655,820

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: 08/09/2024

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