Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

Forms and Documents

Document Name	Status
Form CMS-10433 Risk Adjustment Form and Instruction	Modified
Form CMS-10433 QHP Certification Form and Instruction	Modified
CMS-10433 QHP Cert Supporting Statement v2.docx Supporting Statement A	2019-06-28

IC Document Collections

IC ID	Document Title	Status
235127	Stand-Alone Dental Issuers: QHP Certification	New
206071	States	Modified
206070	Reinsurance Instruction	Removed
206069	Risk Adjustment Form and Instruction	Modified
206068	QHP Certification Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1187	ICR Reference No: 201902-0938-012
Status: Active	Previous ICR Reference No: 201511-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10433
Title: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)
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: 06/28/2019
	Date Received in OIRA: 02/28/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	2,892	0	26,951
Time Burden (Hours)	68,666	0	235,153
Cost Burden (Dollars)	0	0	0

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Abstract: As required by the CMS-9989-F: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers ("Exchange rule"), each Exchange must assume responsibilities related to the certification and offering of Qualified Health Plans ("QHP"). To offer insurance through an Exchange, a health insurance issuer must have its health plans certified as QHPs by the Exchange. A QHP must meet certain minimum certification standards, such as network adequacy, actuarial value standards, and the offering of the essential health benefits (EHB). The Exchange is responsible for ensuring that QHPs meet these minimum certification standards as described in the Exchange rule under 45 CFR 155 and 156, based on the Affordable Care Act, as well as other requirements determined by the Exchange.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1301-1304, 1311-1312 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1343, 1401-1402 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1411-1412 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1321-1322 Name of Law: Affordable Care Act
   PL: Pub.L. 111 - 148 1324, 1341 Name of Law: 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:
	83 FR 53474	10/23/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 6789	02/28/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
QHP Certification	CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMS-10433, CMs-10433, CMS-10433, CMS-10433, CMS-10433	Administrative Data Template ,   Network Adequacy Template ,   Plan Benefits Template ,   Network ID Template ,   Plans and Benefits Template ,   Prescriptions Drug Formulary Template ,   Rate Table Template ,   Service Area Template ,   Business Rules Template ,   QHP Certification Instrument Screenshots ,   Reinsurance Program and Risk Adjustment Program
Risk Adjustment	CMS-10433	Reinsurance and Risk Adjustment Bank Server
States
Reinsurance
Stand-Alone Dental Issuers: QHP Certification

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ICR Summary 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	2,892	26,951	0	-23,800	-259	0
Annual Time Burden (Hours)	68,666	235,153	0	-119,000	-47,487	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The reduction in burden is primarily due to the removal of provisions related to the reinsurance program. This removal reduced the number of burden hours by 119,000 hours and respondents by 23,800 entities. The burden on issuers for the QHP certification is reduced from 450 to 200 issuers and a decrease in the number of state-based exchanges using the federal platform and partnership states from 51 to 22 states. Therefore, the current ICR burden is for 26,951 respondents and the proposed ICR estimates 2,892 respondents.The estimated burden hours for this data collection is currently approved for 235,153 hours. With this ICR, the estimated annualized burden hours are 68,666 hours. This is a reduction of 166,487 burden hours compared to the previously approved clearance. There is an increase of 80 hours (+270 respondents) as a result of adding burden associated with stand-alone dental issuers. While the stand-alone dental issuer burden is not a new data collection require, the burden was not accounted for during the last approval.

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Annual Cost to Federal Government: $227,166

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? Uncollected

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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: 02/28/2019

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