Establishment of an Exchange by a State and Qualified Health Plans (CMS-10593)

Forms and Documents

Document Name	Status
CMS-10593 - FInal Supporting Statement A.docx Supporting Statement A	2020-10-12

IC Document Collections

IC ID	Document Title	Status
244024	Quality Reporting Standards for Exchanges (§155.1400 through §155.1405)	New
244021	Exchange Functions: Certification of Qualified Health Plans (§155.1000 through §155.1080)	New
244020	Exchange Functions: Small Business Health Options Program (SHOP)	New
244018	Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability	New
220545	General Functions of an Exchange	Modified
220476	Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans	Modified

ICR Details

OMB Control No: 0938-1312	ICR Reference No: 202009-0938-016
Status: Received in OIRA	Previous ICR Reference No: 201603-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Establishment of an Exchange by a State and Qualified Health Plans (CMS-10593)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/13/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	132	0
Time Burden (Hours)	51,485	0
Cost Burden (Dollars)	0	0

---

Abstract: As directed by the rule Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers (77 FR 18310) (Exchange rule), each Exchange will assume responsibilities related to the certification and offering of Qualified Health Plans (QHPs). 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, inclusion of Essential Community Providers (ECPs), and non-discrimination. 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 standards determined by the Exchange. The reporting requirements and data collection in the Exchange rule address Federal requirements that various entities must meet with respect to the establishment and operation of an Exchange; minimum requirements that health insurance issuers must meet with respect to participation in a State based or Federally-facilitated Exchange; and requirements that employers must meet with respect to participation in the SHOP and compliance with other provisions of the Affordable Care Act.

---

Authorizing Statute(s): US Code: 45 USC 156.285(d)(1) Name of Law: HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCH
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10701	02/25/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 60798	09/28/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability
Exchange Functions: Small Business Health Options Program (SHOP)
Exchange Functions: Certification of Qualified Health Plans (§155.1000 through §155.1080)
Quality Reporting Standards for Exchanges (§155.1400 through §155.1405)
General Functions of an Exchange
Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans

---

ICR Summary of Burden

	Total Request	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	132	0	0	0	-277	409
Annual Time Burden (Hours)	51,485	0	0	0	-4,972	56,457
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: OMB previously approved this information collection in August 2016, with a total of 56,457 burden hours. This revision removes burden estimates for activities that are now The Quality Rating System requirement for SBEs to display QRS data on the SBE website were added to this collection, for which all SBEs are responsible. We estimate that 20 SBEs will take approximately 33 hours annually for the time and effort to display the QRS data they will already be collecting, for a total of 660 hours. Additionally, this revision removes burden estimates for activities that are now covered by other ICRs and certain SHOP provisions that are no longer requirements of Exchanges. As a result, the total burden hours have been reduced to from 56,457 to 51,485.

---

Annual Cost to Federal Government: $358,973

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

---

Common Form ICR:  No

---

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: 10/13/2020

---