Program Integrity:Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rule II (CMS-10516)

Forms and Documents

Document Name	Status
CMS-10516 Supporting Statement Track Change.docx Supporting Statement A	2024-09-26

IC Document Collections

IC ID	Document Title	Status
249493	QHP Issuers for Change of Ownership	Unchanged
248247	Administrative Review of Sanctions in a Federally-facilitated Exchange - QHP Issuers	Unchanged
248244	Clarifying Information - QHP Issuers	Unchanged
248242	Onsite Review - QHP Issuers	Unchanged
248241	ICR related to Compliance Reviews	Modified
248240	QHP Issuers to Make Records Available for HHS Inspection	Unchanged
209939	Oversight and Standards for Issuers of Qualified Health Plans in the Federally-facilitated Exchange (§156.705 to §156.715)	Modified

ICR Details

OMB Control No: 0938-1277	ICR Reference No: 202409-0938-025
Status: Received in OIRA	Previous ICR Reference No: 202107-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Program Integrity:Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rule II (CMS-10516)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/26/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2024
Responses	466	433
Time Burden (Hours)	42,771	40,455
Cost Burden (Dollars)	0	0

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Abstract: On June 19, 2013, HHS published the proposed rule CMS-9957-P: Program Integrity: Exchanges, SHOP, Premium Stabilization Programs, and Market Standards (78 FR 37302) (Program Integrity Proposed Rule). Among other things, the Program Integrity Proposed Rule sets forth financial integrity provisions and protections against fraud and abuse. The third party disclosure requirements and data collections proposed in the Program Integrity Proposed Rule support the oversight of premium stabilization programs (transitional reinsurance, risk corridors and risk adjustments), State Exchanges, and qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs). The remaining provisions involve program integrity as it relates to the Exchanges, SHOP, and Eligibility Appeals. This final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges, and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

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Authorizing Statute(s): PL: Pub.L. 111 - 144 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 144 1311 Name of Law: Affordable Care Act

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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:
	89 FR 54824	07/02/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 77865	09/24/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Oversight and Standards for Issuers of Qualified Health Plans in the Federally-facilitated Exchange (§156.705 to §156.715)
Administrative Review of Sanctions in a Federally-facilitated Exchange - QHP Issuers
Clarifying Information - QHP Issuers
ICR related to Compliance Reviews
Onsite Review - QHP Issuers
QHP Issuers for Change of Ownership
QHP Issuers to Make Records Available for HHS Inspection

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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	466	433	0	0	33	0
Annual Time Burden (Hours)	42,771	40,455	0	0	2,316	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: There is an overall increase in the financial burden from the 2021 PRA package because of an increase in the number of QHP issuers from 433 to 457, an increase of 24 issuers. The total burden hours increased from 40,455 hours to 42,771, an increase of 2,316 hours. The estimated annual cost increased from $4,219,357.10 to $4,400,124.80, an increase of $180,767.70. All prior iterations of wage data was based on mean values and the current iteration is based on median values.

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Annual Cost to Federal Government: $306,800

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: 09/26/2024

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