Program Integrity and Additional State Information Collections

Forms and Documents

Document Name	Status
CMS-10490 - Appendix G -Discrepancy Report.pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix F_Data_Elements_Part 156 Subpart J.pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix D - AV Continuance Tables Template.pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix C Habilitative Services_Elements_3-14-13 (2).pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix E_Data_Elements_Part 156 Subpart I CY.pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix B Data Elements_Part 155 Subpart M 6.28.13.pdf Supplementary Document	2013-07-01
CMS-10490 - Appendix A_Data_Elements for Part 155 Subpart C.PDF Supplementary Document	2013-07-01
CMS-10490 - CMS-9957 PI NPRM Supporting Statement - Part A.pdf Supporting Statement A	2013-07-03

IC Document Collections

IC ID	Document Title	Status
208543	45 CFR 156.1230	New
208542	45 CFR 156.1210	New
208540	45 CFR 156.1230	New
208539	45 CFR 156.1210	New
208538	45 CFR 156.1010	New
208537	45 CFR 156.901-156.963	New
208536	45 CFR 156.715	New
208535	45 CFR 156.715	New
208534	45 CFR 156.715	New
208533	45 CFR 156.705	New
208532	45 CFR 156.705	New
208531	45 CFR 156.480	New
208530	45 CFR 156.480	New
208529	45 CFR 156.480	New
208528	45 CFR 156.330	New
208527	45 CFR 156.135	New
208526	45 CFR 156.115	New
208525	45 CFR 155.1210	New
208524	45 CFR 155.1200	New
208523	45 CFR 155.1200	New
208522	45 CFR 155.1200	New
208521	45 CFR 155.1200	New
208520	45 CFR 155.1200	New
208519	45 CFR 155.310	New
208518	45 CFR 155.220	New
208517	45 CFR 153.405(h) and 45 CFR 153.41(c)	New
208516	45 CFR 153.405(h) and 45 CFR 153.41(c)	New

ICR Details

OMB Control No: 0938-1213	ICR Reference No: 201307-0938-016
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 19895
Title: Program Integrity and Additional State Information Collections
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 09/09/2013
	Date Received in OIRA: 07/23/2013
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		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The program integrity data collections and third-party disclosure requirements will assist HHS in determining Exchange compliance with Federal standards. The data collection and third-party disclosure requirements will also assist HHS in monitoring QHP issuers in FFEs for compliance with Federal QHP issuer standards. The data collected by health insurance issuers and Exchanges will help to inform HHS, Exchanges, and health insurance issuers as to the participation of individuals, employers, and employees in the individual Exchange, the SHOP, and the premium stabilization programs. The State specific data will be used by HHS to determine if States' claims data meets requirements established in 45 CFR 156.135(d) and (e) and can be approved by HHS to support the use of the AV calculator. Ultimately, issuers in States that submit State-specific data will use this data in AV calculations.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1302 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1302 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR82	Proposed rulemaking	78 FR 37032	06/19/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 27

IC Title	Form No.	Form Name
45 CFR 153.405(h) and 45 CFR 153.41(c)
45 CFR 153.405(h) and 45 CFR 153.41(c)
45 CFR 155.220
45 CFR 155.310
45 CFR 155.1200
45 CFR 155.1200
45 CFR 155.1200
45 CFR 155.1200
45 CFR 155.1200
45 CFR 155.1210
45 CFR 156.115
45 CFR 156.135
45 CFR 156.330
45 CFR 156.480
45 CFR 156.480
45 CFR 156.480
45 CFR 156.705
45 CFR 156.705
45 CFR 156.715
45 CFR 156.1010
45 CFR 156.1210
45 CFR 156.1230
45 CFR 156.1210
45 CFR 156.1230
45 CFR 156.715
45 CFR 156.715
45 CFR 156.901-156.963

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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: This is a new collection.

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Annual Cost to Federal Government: $272,850

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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: 07/23/2013

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