CMS is requesting that an information collection request to support the development of federal payment rates for the Basic Health Program (BHP) be processed under the emergency clearance process associated with Paperwork Reduction Act of 1995 (PRA), specifically 5 CFR 1320.13(a)(2)(i). In accordance with Section 1331 of ACA, the BHP is federally funded by determining the amount of payments that the federal government would have made through premium tax credits (PTCs) and cost sharing reductions (CSRs) for people enrolled in BHP had they instead been enrolled in an Exchange. In order to calculate these amounts for each state, CMS needs the reference premiums for the second lowest cost silver plans (SLCSPs) in each geographic area in a state, as SLCSPs are a basic unit in the calculation of PTCs and CSRs under the Exchanges. Relatedly, the reference premiums for these SLCSPs are critical components in the BHP payment methodology in order to estimate what PTCs and CSRs would have been paid. Similarly, CMS also needs to collect reference premiums for the lowest cost bronze plans to appropriately account for CSR calculations for American Indians and Alaskan Natives. CMS recently determined that it does not have sufficient data from State Based Exchanges (SBEs) to determine the reference premiums for their SLCSPs and lowest cost bronze plans. Reference premiums are foundational inputs into the BHP payment methodology.
PL: Pub.L. 111 - 148 1331 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1331 Name of Law: Health Care and Education Reconciliation Act of 2010
In this 2023 iteration, we propose changes that relate to updates to BHP proposed in CMS-1784-P and includes a revision of prior State burden estimates related to the State’s Blueprint submission at § 600.125. Additionally, this request revises the operation of a BHP. We propose at §600.145(a), a State must implement its BHP in accordance with (1) the approved and full certified State BHP Blueprint; or (2) the approved suspension application. We propose at § 600.145(f)(2) the State operating a BHP must perform eligibility and health services appeals as specified in § 600.335. We propose at § 600.330(f), BHP eligibility notices must be written in plain language.
Finally, this creates a new information collection request for suspension of a BHP. We propose at §600.140(b) if a State decides to suspend its BHP or requests a suspension extension, a State must submit to the Secretary a suspension application or suspension extension application. The State must submit the annual report required by §600.170(a)(2) and annually remit to HHS any interest that has accrued on the balance of the BHP trust fund during the suspension period. We propose that the State must submit a transition plan to HHS that describes how the State will reinstate its BHP or terminate the program.
Overall, the rule would add 604 hours.
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:
(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;
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.
Form CMS-10510 Basic Health Program Supporting Regulations
CMS-10510 - Supporting Statement A (CMS-1784-P version 9).docx
Basic Health Program Supporting Regulations