Transparency in Pricing Information (CMS-10715)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10715 Transparency in Coverage	Form and Instruction	New	Available
Form CMS-10715 Contraceptive Disclosure	Form and Instruction	New	Repair queued
Form CMS-10715 Transparency in Coverage	Form and Instruction	Modified	Repair queued
Form CMS-10715 Customer Service Representatives Training	Form and Instruction	Modified	Repair queued
Form CMS-10715 APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements	Form and Instruction	Modified	Available
Form CMS-10715 APPENDIX 2: In-network Rate Machine-Readable File Data Elements	Form and Instruction	Modified	Available
Form CMS-10715 Allowed Amount File	Form and Instruction	Modified	Available
Form CMS-10715 APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements	Form and Instruction	Modified	Repair queued
Form CMS-10715 APPENDIX 2: In-network Rate Machine-Readable File Data Elements	Form and Instruction	Modified	Repair queued
Form CMS-10715 In-Network Rate File	Form and Instruction	Modified	Repair queued
Form CMS-10715 APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements	Form and Instruction	Modified	Available
Form CMS-10715 In-network Rate Machine-Readable File Data Elements	Form and Instruction	Modified	Available
Form CMS-10715 Internet-based Self-Service Tool	Form and Instruction	Modified	Repair queued
CMS 10715 Transparency in Coverage Supporting Statement CL.docx	Supporting Statement A	Uploaded 2024-10-30	Available
CMS 10715 Transparency in Coverage Supporting Statement CL.docx	Supporting Statement A	Uploaded 2024-10-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271985	Contraceptive Disclosure	Form and Instruction	New	Transparency in Coverage
271985	Contraceptive Disclosure	Form and Instruction	New
249984	Customer Service Representatives Training	Form and Instruction	Modified	Transparency in Coverage
249984	Customer Service Representatives Training	Form and Instruction	Modified
249983	Prescription Drug File	Other-Data Elements	Modified
249967	Allowed Amount File	Form and Instruction	Modified	APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
249967	Allowed Amount File	Form and Instruction	Modified	APPENDIX 2: In-network Rate Machine-Readable File Data Elements
249967	Allowed Amount File	Form and Instruction	Modified
249944	In-Network Rate File	Form and Instruction	Modified	APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
249944	In-Network Rate File	Form and Instruction	Modified	APPENDIX 2: In-network Rate Machine-Readable File Data Elements
249944	In-Network Rate File	Form and Instruction	Modified
249943	Requests for Mailed Disclosures	Other-Instruction	Modified
249942	Internet-based Self-Service Tool	Form and Instruction	Modified	APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
249942	Internet-based Self-Service Tool	Form and Instruction	Modified	In-network Rate Machine-Readable File Data Elements
249942	Internet-based Self-Service Tool	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1429	ICR Reference No: 202410-0938-023
Status: Historical Inactive	Previous ICR Reference No: 202410-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Transparency in Pricing Information (CMS-10715)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/07/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/30/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	10/31/2027
Responses	74,462	0	74,462
Time Burden (Hours)	28,618,546	0	28,618,546
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection requirements contained in the proposed rule titled “Transparency in Coverage,” published November 27, 2019 (84 FR 65464), would require group health plans and health insurance issuers offering coverage in the individual and group markets to disclose to a participant, beneficiary, or enrollee (or an authorized representative on behalf of such individual), the estimated cost-sharing liability for covered items or services from a particular provider or providers, thereby allowing a participant, beneficiary, or enrollee to obtain an accurate estimate and understanding of their potential out-of-pocket expenses and to effectively shop for covered items and services. Group health plans and health insurance issuers would be required to make such information available through a self-service tool on an internet website. The self-service tool must provide the information through real-time responses and allow users to search for cost-sharing information for covered items and services. The self-service tool must also allow users to input information necessary to learn the out-of-network allowed amount for a covered item or service and have the capability to refine and reorder results. Group health plans and health insurance issuers would also be required to make this information available as a disclosure in written form. Both the self-service tool and the paper disclosure would be required to include several disclaimer statements relevant to information provided through the disclosure and could be provided by using a model notice developed by the Departments. Additionally, group health plans and health insurance issuers would be subject requirements to disclose in-network provider negotiated rates and historical payment data for allowed amounts for covered items and services furnished by out-of-network providers through two digital files in a machine-readable format to be specified by the Departments. The Negotiated Rate file and the Allowed Amount file must be posted publicly on an internet website.

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Authorizing Statute(s): US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in Coverage
   US Code: 45 USC 156.220 Name of Law: Transparency in Coverage
   PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in Coverage
US Code: 45 USC 156.220 Name of Law: Transparency in Coverage

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV57	Proposed rulemaking	89 FR 85750	10/28/2024

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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: 7

table that charts list of burden

IC Title	Form No.	Form Name
Allowed Amount File	CMS-10715, CMS-10715	APPENDIX 2: In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Contraceptive Disclosure	CMS-10715	Transparency in Coverage
Customer Service Representatives Training	CMS-10715	Transparency in Coverage
In-Network Rate File	CMS-10715, CMS-10715	APPENDIX 2: In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Internet-based Self-Service Tool	CMS-10715, CMS-10715	In-network Rate Machine-Readable File Data Elements ,   APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements
Prescription Drug File
Requests for Mailed Disclosures

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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: The overall burden has decreased from 28,618,546 to 7,591,925 hours, resulting in a total burden reduction of 21,026,621 hours. Consequently, the associated cost has decreased from $1,036,852,972 to $28,618,546, resulting in a reduction of $1,008,234,426. Although the introduction of the proposed rule to incorporate the contraceptive disclosure into the existing internet-based self-service tool led to a slight increase in burden, the significant reduction in the overall burden is primarily due to removal of first- and second-year one-time burden for issuers and TPAs to develop and implement their internet-based self-service tool, which were incurred in 2022 and 2023. Additionally, the overall reduction in burden is partially due to the updated count of issuers and TPAs, resulting in a decreased total number of these entities. In addition to these changes in burden, CMS has updated the CFR citations in this Transparency in Coverage Supporting Statement’s ICR section headings to correct errors in the prior version of the Transparency in Coverage Supporting Statement. The citation in the section heading for the ICRs Regarding Requirements for Disclosures to Participants, Beneficiaries, or Enrollees was updated from 45 CFR 147.210(b) to 45 CFR 147.211(b). The citation in the section heading for ICRs Regarding Requirements for Public Disclosure of In-network Rates, Historical Allowed Amount Data for Covered Items and Services from Out-of-Network Providers and Prescription Drug Pricing Information was updated from 45 CFR 147.21 to 45 CFR 147.212.

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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:  Yes

Description/Changes for Common Form Usage:  The purpose of this submission is to revise the information collection request currently approved under 0938-1429 as a Sponsoring Common Form.

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 10/30/2024

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