Payment Collections Operations Contingency Plan

Forms and Documents

Document Name	Status
Form CMS-10515 Monthly Data Submission Accuracy Certification Form Form and Instruction	New
Form CMS-10515 Monthly Data Reports Form and Instruction	New
Form CMS-10515 Payment Collections Operations Contingency Plan Form and Instruction	New
Signed - Emergency PRA - Payment Collections Operations Contingency Plan.pdf Supplementary Document	2013-12-18
OMBEdits_PaymentCollectionsOperations_ContingencyPlan_Supporting_Stateme....docx Supporting Statement A	2013-12-23

IC Document Collections

IC ID	Document Title	Status
209881	Testing & Development	New
209729	Monthly Data Submission Accuracy Certification Form Form and Instruction	New
209728	Monthly Data Reports Form and Instruction	New
209727	Payment Collections Operations Contingency Plan Form and Instruction	New

ICR Details

OMB Control No: 0938-1217	ICR Reference No: 201312-0938-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21137
Title: Payment Collections Operations Contingency Plan
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/30/2014
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/24/2013
	Date Received in OIRA: 12/18/2013
Terms of Clearance: The testing portion of this collection was conducted before OMB approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	6 Months From Approved
Responses	7,875	0	0
Time Burden (Hours)	52,375	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS will collect enrollment and payment information using a spreadsheet. This is an interim process.

Emergency Justfication: The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection request to support the Payment Collections Operations Contingency Plan be processed under the emergency clearance process associated with 5 CFR 1320.13(a)(2)(i) and the Paperwork Reduction Act of 1995 (PRA). Public harm is reasonably likely to occur if the normal, non-emergency clearance procedures are followed. CMS seeks an emergency PRA collection to collect enrollment and payment data from health insurance issuers. This collection would be effectuated via a Microsoft Excel-based spreadsheet because the IT systems designed for this function are not yet complete. If CMS is unable to collect this information in a timely fashion, issuers participating in the Marketplaces will not be able to receive advance payments of the premium tax credit and cost-sharing reductions for enrollees who qualify for financial assistance. The vehicle for this collection of enrollment and payment information is new, and issuers will manually enter data into spreadsheets and submit this information to CMS. Not only is the vehicle for enrollment and payment data new, but also we would not be collecting this data under normal operations and therefore we did not seek a PRA for this collection. Specifically, CMS will collect enrollment by QHP issuer and estimated payment amounts for enrollees in those plans. CMS will use this information to aggregate payments to issuers operating under the same Tax Identification Numbers. CMS had intended to present this information to issuers via an electronic "834" enrollment report generated from Marketplace data; however, because the information systems designed for this process are not yet complete, issuers will now enter and estimate amounts based on their own data, and will then submit this information to CMS. o Data submitted via the template will include: - QHP issuer and plan identification information - aggregate premium amounts - aggregate APTC and advance CSR payment amounts - aggregate enrollment group and enrollee counts Background - Under sections 1401, 1411, and 1412 of the Affordable Care Act and 45 CFR part 155 subpart D, an Exchange makes an advance determination of tax credit eligibility for individuals who enroll in QHP coverage through the Exchange and seek financial assistance. Using information available at the time of enrollment, the Exchange determines whether the individual meets the income and other requirements for advance payments and the amount of the advance payments that can be used to pay premiums. Advance payments are made periodically under section 1412 of the Affordable Care Act to the issuer of the QHP in which the individual enrolls. Section 1402 of the Affordable Care Act provides for the reduction of cost sharing for certain individuals enrolled in a QHP through an Exchange, and section 1412 of the Affordable Care Act provides for the advance payment of these reductions to issuers. The statute directs issuers to reduce cost sharing for essential health benefits for individuals with household incomes between 100 and 400 percent of the Federal poverty level (FPL) who are enrolled in a silver level QHP through an individual market Exchange and are eligible for advance payments of the premium tax credit.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1402 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 148 1401 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1401 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 148 1402 Name of Law: Patient Protection and 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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Testing & Development
Payment Collections Operations Contingency Plan	CMS-10515	SBM Isser Payment Report
Monthly Data Reports	CMS-10515	Copy of Enrollment and Payment Data Template
Monthly Data Submission Accuracy Certification Form	CMS-10515	Enrollment and Payment Data Template Submission Accuracy Certification Form

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ICR Summary of Burden

	Total Approved	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	7,875	0	7,875	0	0	0
Annual Time Burden (Hours)	52,375	0	52,375	0	0	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: This a new information collection.

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Annual Cost to Federal Government: $0

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: 12/18/2013

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