Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment (CMS-10401)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10401 - Supporting Statement.docx	Supporting Statement A	Uploaded 2025-06-24	Repair queued
CMS-10401 Supporting Statement_2024 UpdateNPRM.docx	Supporting Statement A	Uploaded 2025-01-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254458	Claim In-Network or Out-of-Network Indicator		Modified
254457	Respond to the final distributed data report	Other-Data Elements	Modified
211708	Supplemental Diagnosis	Other-Data Elements	Modified
211707	Risk adjustment distributed data collection	Other-Data Elements	Modified
208837	Upload of Risk Adjustment and Reinsurance Data for Masked Enrollee Identification Number	Other-Data Elements	Modified

ICR Details

OMB Control No: 0938-1155	ICR Reference No: 202412-0938-011
Status: Active	Previous ICR Reference No: 202308-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment (CMS-10401)
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: 06/26/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/15/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2028	36 Months From Approved	06/30/2025
Responses	3,250	0	3,250
Time Burden (Hours)	4,167,536	0	4,154,150
Cost Burden (Dollars)	0	0	0

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Abstract: The reinsurance program, risk corridors program, and risk adjustment program support the effective functioning of the American Health Benefit Exchanges ("Exchanges"), which will become operational by January 1, 2014. The program also mitigate the negative impacts of adverse selection and market uncertainty.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1321; 1341; 1342; 1343 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: US Code: 45 USC 153 Name of Law: STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV61	Final or interim final rulemaking	90 FR 4424	01/15/2025

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 82308	10/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 4424	01/15/2025
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
Claim In-Network or Out-of-Network Indicator
Respond to the final distributed data report
Risk adjustment distributed data collection
Supplemental Diagnosis
Upload of Risk Adjustment and Reinsurance Data for Masked Enrollee Identification Number

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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	3,250	3,250	0	0	0	0
Annual Time Burden (Hours)	4,167,536	4,154,150	0	0	13,386	0
Annual Cost Burden (Dollars)	0	0	0	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: This revision includes a slight increase in burden from approximately 4,154,150 hours to 4,167,519 hours. This is due to the removal of a one-time burden incurred in a previous benefit year that is no longer applicable. This burden is associated with the collection of new data elements and the build costs associated with adding fields for those data elements in the EDGE server data submission process. These burden estimates include the burden impacts of the policies finalized in the 2026 Payment Notice such as the policies finalized to adjust the HHS-RADV IVA sampling and SVA methodologies. These burden estimates also include revised burden estimates associated with the RADC process and the RA and HHS-RADV discrepancy related processes.

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Annual Cost to Federal Government: $73,420,050

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: 01/15/2025

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