Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)

Forms and Documents

Document Name	Status
Form CMS-10803 Essential Community Provider and Network Adequacy Data Requirements Form and Instruction	Modified
C_ECP-NA 60-Day Comment Response_508.pdf Supplementary Document	2022-06-07
CMS-10803_ECP-NA_Supporting Statement_03.23.24.docx Supporting Statement A	2024-03-23

IC Document Collections

IC ID	Document Title	Status
266278	QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection	New
251109	Essential Community Provider and Network Adequacy Data Requirements Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1415	ICR Reference No: 202403-0938-012
Status: Historical Inactive	Previous ICR Reference No: 202206-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 07/09/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/25/2024
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2025	36 Months From Approved	08/31/2025
Responses	485	0	485
Time Burden (Hours)	5,380	0	5,380
Cost Burden (Dollars)	0	0	0

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Abstract: In accordance with section 1311(c)(1)(C) of the Affordable Care Act (ACA), Qualified Health Plan (QHP) issuers, including Stand-alone Dental Plan (SADP) issuers, are required to ensure access to a sufficient number and geographic distribution of essential community providers (ECPs), where available, that serve predominantly low-income, medically-underserved individuals. Under 45 Code of Federal Regulations (CFR) 156.235, the Secretary of HHS has established criteria for inclusion of a sufficient number and geographic distribution of ECPs, where available, in an issuer’s network to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in their service areas. To satisfy this ECP requirement, medical QHP and SADP issuers must submit an Essential Community Provider/Network Adequacy (ECP/NA) template as part of their QHP application, in which they must list the ECPs with whom they have contracted. In the Issuer Module, issuers will also have to attest to meeting each element of the ECP standard. In accordance with section 1311(c)(1)(B) of the ACA, QHP issuers, including SADP issuers, are required to ensure a sufficient choice of providers (in a manner consistent with the applicable provisions under section 2702(c) of the Public Health Service Act). Under CFR 156.230, QHPs that use a provider network must ensure that the network is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible without unreasonable delay. This information collection request (ICR) serves as a formal request for a new clearance associated with the Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2023 Proposed Rule (2023 Payment Notice). This ICR details the burden associated with collecting and reviewing essential community provider and network adequacy data.

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Authorizing Statute(s): US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards Under The Affordable Care Act, Including Standards Related To Exch
   PL: Pub.L. 111 - 156 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: US Code: 45 USC 156.230 Name of Law: Network adequacy standards
US Code: 45 USC 156.235 Name of Law: Essential community providers

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV22	Proposed rulemaking	88 FR 82510	11/24/2023

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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: 2

IC Title	Form No.	Form Name
Essential Community Provider and Network Adequacy Data Requirements	CMS-10803	Appendix A
QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection

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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: There is an overall increase in the burden due to the substantive addition of the activities associated with medical QHP issuers in FFEs required to contract with a third party to administer secret shopper provider surveys to a statistically valid sample of network providers to assess compliance with appointment wait time standards. As a result, the total burden hours increased from 5,380 hours to 249,410 hours, which is an increase of 244,030 hours.

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Annual Cost to Federal Government: $1,655,820

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: 03/25/2024

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