CMS-10320 - Supporting Statement 30day App A 2014docx

Supporting Statement For Paperwork Reduction Act Submission: Health Care
Reform Insurance Web Portal and Supporting Authority Contained in Sections
1103 and 10102 of The Patient Protection and Affordability Care Act, Pub. L.
111-148 (2010) [CMS-10320]
A. Background
In accordance with Sections 1103 and 10102 of The Patient Protection and Affordability Care Act,
Pub. L. 111-148 (2010) (Affordable Care Act) the U.S. Department of Health and Human Services
(HHS) is tasked with developing and implementing an Internet website portal to assist consumers
with identifying affordable and comprehensive health insurance coverage options that are available
in their State. Consistent with minimizing burden and providing consistency in data collection, the
Centers for Medicare & Medicaid Services (CMS) updates its HealthCare.gov collection
requirements as regulatory developments occur. There have been two developments since the last
approved collection that require changes to the Paperwork Reduction Act (PRA) package.
The Departments of Health and Human Services, Labor and the Treasury (the Departments)
published a final regulation implementing the Section 2715 consumer disclosure provisions of the
ACA. (77 Fed. Reg. 8668 (Feb. 14, 2012), codified at 45 CFR 147.200). These final regulations set
forth the requirements for group health plans (plans) and health insurance issuers (issuers) to
provide the Summary of Benefits and Coverage (SBC) and the uniform glossary of medical and
insurance terms. Under these regulations, plans and issuers must provide in the SBC information
about covered services, cost sharing, limitations and exceptions of the coverage, coverage
examples, and other disclosures. The final regulation also clarifies the timing and format for
providing these documents.
CCIIO is requesting approval to implement this provision for the collection of information to assist
consumers in making educated decisions on their health care options. This collection was initially
approved under Office of Management and Budget (OMB) control number 0938-1086. Various
elements discussed within this package have already been through comment periods and have
been authorized for collection under OMB control number 0938-1146. These elements are included
here so that the public can identify how the efforts are integrated and get a consistent view of the
collection.
The reinsurance and risk adjustment programs outlined by the Affordable Care Act, detailed in the
Standards for Reinsurance, Risk Corridors, and Risk Adjustment Rule (77 FR 17220, March 23, 2012),
have general information reporting requirements that apply to qualified health plans (QHPs)
offered through the Exchanges and to non-Exchange plans in the outside market. For the
reinsurance program, administrative information will be used to identify all entities – health
insurance issuers and self-insured group health plans- required to contribute to the reinsurance
program. In addition, non-Exchange plan information such as plan type and location will be used to
identify non-grandfathered individual market plans inside and outside the exchange eligible for
reinsurance payments. For the risk adjustment program, administrative information will be used to
identify all non-grandfathered small group and individual market plans inside and outside the
exchange eligible for the program. Risk adjustment also requires select data such as rating area,
rating factors and actuarial value (AV) level, to perform calculation of payments and charges.

Non-Exchange Plan Information Collection: Reinsurance and Risk Adjustment
Section 1341 of the Affordable Care Act provides that each state will establish a transitional
reinsurance program to help stabilize premiums for coverage in the individual market from 2014
through 2016. Section 1343 provides that each state will establish a permanent program of risk
adjustment for all non-grandfathered plans in the individual and small group markets. If a state
chooses not to actively participate in reinsurance and/or risk adjustment, CMS will be responsible
for implementation. The requirements for issuers with plan offerings outside of the Exchanges are
codified at 45 CFR Part 153.
Reinsurance Reporting Requirements for Non-Exchange Plans
The transitional reinsurance program will reduce the uncertainty of insurance risk in the individual
market by making payments for high-cost enrollees in non- grandfathered individual market plans.
Health insurance issuers and self-insured group plans are required to remit contributions on behalf
of enrollees in major medical coverage, and thus are collectively referred to as “contributing
entities.” Self-insured group health plans may remit their reinsurance contributions through a third
party administrator or an administrative services only contractor. Non-grandfathered individual
market plans are eligible to request and receive reinsurance payments.
CMS will collect all contributions under the uniform reinsurance contribution rate, regardless of
whether a state is operating a reinsurance program. CMS will operate reinsurance payment
functions for a state when the state defers operation of the program to CMS.
In order to effectively identify and contact “contributing entities” and third party administrators,
(and administrative services only contractors) administrative information, such as name, location,
and contact for company, is needed. In addition, in order to identify eligible plans for reinsurance
payments, plan-level information is needed for non-grandfathered, non-Exchange plan offerings in
the individual market as well as QHPs.
Additionally, states operating the transitional reinsurance program will be required to register in
HIOS in order for HHS to distribute reinsurance payments to the state. The state will then allocate
those reinsurance payments to the issuers in their state.
Risk Adjustment Reporting Requirements for Non-Exchange Plans
The permanent risk adjustment program provides payments to health insurance issuers that
disproportionately attract high-risk populations (such as those with chronic conditions), thereby
reducing the incentives for issuers to avoid higher-risk enrollees. Under this program, funds are
transferred within a risk pool within a market within a state from issuers with lower risk enrollees to
issuers with higher risk enrollees.
A “risk adjustment covered plan” includes most health insurance plans offered in the individual or
small group market. The exceptions are grandfathered health plans, group health insurance
coverage described in 45 CFR 146.145(c), individual health insurance coverage described in 45 CFR
148.220, and any other plan determined not to be a risk adjustment covered plan in the applicable
Federally-certified risk adjustment methodology. States, or CMS on behalf of a state, will require

basic identifying information about all risk adjustment covered plans, whether or not they are
QHPs.

B. Justification
1. Need and Legal Basis
This information is mandated by Sections 1103 and 10102 of the Affordable Care Act. A copy of this
mandate is provided in Appendix B. Additionally, the collection covers information required in
Sections 1302 and 2715 of the Affordable Care Act regarding transparency and the provision of SBC.

2. Information Users
Once all of the information is collected from the States, State health benefits high risk pools, and
insurance issuers (hereon referred to as issuers), this information is processed by contractors for
display on the HealthCare.gov website. The information that is provided helps the general public
make educated decisions about their choice in organizations providing private health care
insurance. Information collected quarterly from insurance issuers is used to populate the Plan
Finder application to show individuals their options, to provide some profile information, and to
coordinate the data collection with Oversight collections to reduce the burden on issuers and the
Federal Government. Collecting information consistent with the SBC standards allows consumers to
access this information in a consistent manner.

3. Use of Information Technology
CCIIO has created a system where insurance issuers and their States log into the web portal using a
custom user ID and password validation. The States were asked to provide information on issuers in
their State and various websites (see Appendix E). The issuers have been downloading a basic
information template to enter data then upload into the portal. Information to be collected on
issuers and products can be found in Appendix C. Additionally, for purposes of this collection, we
will collect information consistent with both QHPs and the Federally-facilitated Exchange within one
consolidated template. The requirements and data elements of this collection can be found in OMB
Control No. 0938-1156. Information to be collected can be found in the following Appendices:
Plans and Benefits and Service Area Templates can be found in Appendices B1 and B3; Rating Tables
and Issuer Business Rules data can be found in Appendices C1 and C2; Pricing and Benefits data can
be found in Appendix D.
CCIIO will be using drop down menus and error checks wherever possible to minimize burden on
plans and issuers. Once the data is submitted, the plans and issuers can later log in to update
information they provided instead of having to re-upload all plan/product information.

4. Duplication of Efforts
CMS will make every effort to reduce the burden on issuers and reuse the information that is
collected under the various provisions of the Affordable Care Act. As such, data obtained under
other authorized collections that implement provisions of the Affordable Care Act will be utilized to
meet some Exchange requirements, for example Rate Increase Disclosure and Review
Requirements (45 CFR Part 154),OMB Control Number CMS – 10379. Additionally, the

implementation of the Affordable Care Act section 2715 requirement’s for specific standards for
reporting information to consumers, we have aligned our data collection with the structure for a
SBC as recommended by the National Association of Insurance Commissioners (NAIC).

5. Small Business
Small Businesses are not significantly affected by this collection.

6. Less Frequent Collection
CCIIO has been operating with an approximately 45 day refresh schedule to obtain changes in plan
benefits and pricing as well as comprehensive lists of products approved within a State for sale to
the public. In the event that an issuer enhances its existing plans, proposes new plans, or
deactivates plans, the organization would be required to update the information in the web portal
using the edit function or uploading an updated template within an open window period.
In response to the desire to decrease burden as much as possible, CMS has adjusted the collection
period to quarterly. Through the use of effective dates and periodic windows of opportunity for
changes, CMS anticipates that we can decrease the overall burden for the data collection
significantly.

7. Special Circumstances
Dependent on the frequency with which an issuer enhances, eliminates, or adds options to their
products, additional submissions may be necessary.
Information that is to be collected from State health benefits high risk pools (Appendix F) has been
collected from the National Association of State Comprehensive Health Insurance Plans (NASCHIP)
at this time. Administrators have been voluntarily entering changes as they develop, so no general
call for the collection of data from these groups is currently contemplated. Information from State
Insurance Commissioners was collected in 2010, and no current plans exist to continue that
collection during the period covered by this document. CMS reserves the right to continue to
request this information, however, as the nature of these markets is highly changeable.

8. Federal Register/Outside Consultation
CMS received 1 public comment regarding the notice of the Health Care Reform Insurance Web Portal
and Supporting Authority Contained in Sections 1103 and 10102 of the Patient Protection and
Affordability Care Act, Pub. L.11-148. The PRA package published in the Federal Register on January 31,
2014 (78 FR 6197) with comments due by April 1, 2014.

The PRA package contains the requirements to minimize the burden on issuers The comment CMS
received is summarized immediately below. Most of the concerns addressed the templates and data
being collected pertaining to the Affordable Care Act’s premium stabilization programs, the authority to
collect the confidentially of the data, and the burden of the collection is such that it should be delayed
until late 2014. The summary below sets our response
. Comments on the 2014 Issuer Data Collection
Accessibility and Use of Plan Finder on Healthcare.gov
CMS is committed to implementing a consolidated data collection effort which minimizes the overall
burden on insurers. As a result, the Plan Finder collection does incorporate needs of other efforts when
it seems least burdensome to incorporate those needs. While the timing and design of the Plan Finder
collection specified in the Information Request do take into consideration the requirements of the
Affordable Care Act’s premium stabilization programs, the primary goal and principle design is to
provide consumers with information on their affordable care options as required under Section 1103 of
the Act.
The Plan Finder web site has not been updated to reflect the new market rules adopted in January 2014.
The templates specified for adoption include rate collection rules consistent with the 2014 market rules,
as opposed to the earlier templates which did not. The benefits template captures essential health
benefit (EHB) defined categories which the prior templates did not. Changes to the coverage area
template are also required due to the interaction of coverage areas and rating areas having changed
with the 2014 market rules.
CMS agrees with the commenter that CMS needs to provide comprehensive information to consumers
on their Health Insurance options which is accurate. The changes proposed allow for the capture of the
appropriate level of information which consumers use to make decisions, and does so in a manner
consistent with how the data is reported and displayed on the federally facilitated marketplace (FFM).
The commenter’s recommendations for the web site will be taken into consideration, but it should be
noted that creating an integrated site will be very difficult without consistent reporting of the data.
The commenter also requests more information on how small group premiums will be presented to
consumers. Web site design has not been finalized, but CMS will engage industry representatives in
presenting the proposed approaches.
Confidentiality
The commenter expresses concerns regarding the ability to designate that certain collected fields are
considered proprietary. The Plan Finder collection will include a template by which issuers can designate
such belief, and provide explanation. This is consistent with prior collections, and no data will be
released via FOIA request or Pro-active release prior to those comments being reviewed, initial
determinations made, and response notifications sent.
The commenter raises specific concerns regarding base rates and rating factors associated with the
premium stabilization requirements. The data collection instruments will be consistent with the QHP
rate tables and business rules associated with policy construction, and not expanded to those factors
collected in unified rate review or the edge servers.
Alternative Ways to Collect 3Rs Information

In general, we agree with the commenter that premium stabilization information be obtained via the
edge server design. CMS does not intend to expand the Plan Finder collection to cover claims, detailed
enrollment, or paid premiums. These elements are not covered under the information request.
The connection between the PlanFinder collection and premium stabilization is less than perceived by
the commenter, and the concerns raised will be included in future considerations by CMS. However,
system design of the premium stabilization efforts does require a frame of reference for what plans are
currently being offered, as well as information on claims and premiums of what has been sold. The
PlanFinder collection is the only collection by the Federal government which has collected the full range
of plans offered to consumers off of the facilitated marketplaces. CMS intends to use this data solely for
purposes of cross referencing and validation.
Risk Corridors
As the commenter notes, federal risk corridors require identifying equivalent products to those offered
on the exchange. As they also note, the designated equivalents were not captured for the 2014 QHP
submission. Additionally, while issuers may be able to indicate that they believe a separate plan is
equivalent to a given QHP for 2015, oversight and review of such indications requires detailed benefit
and cost sharing information which would be obtained via the PlanFinder collection. We understand the
commenter’s concern regarding changes to the 2014 templates, and the redesigned PlanFinder
collection allows for review of this data for 2014 as well as for future years.
While the commenter notes that final determinations do not need to be made until summer of 2015,
CMS again notes that this is insufficient to meet the consumers’ needs being addressed by the
PlanFinder. Duplicative collections seem more onerous than modifying the collection. The specific
requirements associated with the risk corridors are appreciated, and it is intended that use of a
collection design consistent with that used to report QHPs would minimize any additional burden during
final submission in 2015.
Regulatory Authority
The commenter suggests that CMS should not extend the data collection beyond what is required to
support the PlanFinder and questions our regulatory authority to do so. It is important to note that the
commenter never addresses any specific elements as being outside the requirements of Section 1103 of
the Patient Protection and Affordable Care Act (Pub.L. 111-148), however. The clear application of the
requirement for benefits, cost sharing and pricing information to plans in the individual and small group
markets is further specified in 45 CFR Part 159. By limiting the changes to the specific templates
covering where plans are available, what their benefits and cost shares are, and how pricing is
determined, CMS believes the collection is fully authorized under Section 1103. Since most of this data is
also required for oversight of Premium stabilization and a substantial portion is responsive to the
Summary of Benefits and Coverage, we argue that we have authority under Sections 1302, 2715 and
10102.

The changes summarized by the information request bring the data collection into alignment with the
collection of QHPs, thus allowing direct comparisons between plans on the facilitated marketplace and
those which are not. It is difficult to understand how CMS would meet the specified desire for
comprehensive information without these changes. We recognize that the use of particular data
elements for more than one purpose could create some confusion regarding under what authority the
data is being collected. CMS will attempt to clearly indicate the authority under which elements are
collected moving forward.
Recommendations and Timing
In addition to the general concerns regarding the premium stabilization efforts, the commenter asks
that CMS consider allowing for re-use of data already submitted to either CMS or State DOIs, and
recommends delaying the collection until July or August of 2014. CMS is appreciative of both these
recommendations.
As the commenter acknowledges, many issuers used the 2014 QHP templates to submit both facilitated
marketplace plans and non-facilitated marketplace plans to their state DOIs. In general, that process
required resubmission of the templates whenever changes were required. Thus, those issuers should
have extant sets of templates with the data subject to this request. CMS has committed to use the same
version of those templates. This will allow for upload of those same templates to HIOS for the
PlanFinder collection. The commenter requests that these templates be collected via the State DOIs.
Creating the technical possibility to do so is something CMS is already considering for future
enhancements. However, that functionality would still require the currently planned functionality being
built. CMS cannot require states to collect and submit that data under existing authority.
As regards the timing of the submission, CMS recognizes the concerns. It should be noted, however, that
a number of issuers have already entered the data into the templates being requested. Additionally, in
those States which did not require the use of these templates for non-marketplace plans, any small
group plans being offered through a facilitated marketplace were submitted via these templates. CMS
has been providing training on these templates for over a year, has materials available for training at
this time, has already provided copies of the templates, and has communicated to issuers that this was
likely to be the direction communicated through the information request. These steps should create a
degree of familiarity with the templates and some existing systemic ability to generate the appropriate
documents.
CMS will take into consideration the possible need for extending the collection windows. We believe the
recommendation for a phased approach allowing for the submission of individual and family plans prior
to small group plans is a good one, and we will adopt that recommendation. CMS has determined that
we will need the data for consumers and to allow for use of the data to support premium stabilization
efforts in the early Fall. CMS has communicated a June date for opening the submission windows, but
will work with issuers to allow for sufficient time to submit their data unimpeded by other reporting
requirements.

9. Payments/Gifts to Respondents
There are no payments/gifts to respondents.

10. Confidentiality
To the extent provided by law, we will maintain respondent privacy with respect to the information
being collected. HealthCare.gov collects issuer opinions regarding confidentiality of any new data
elements for review by the Freedom of Information Act (FOIA) office at CMS. Certain fields have
been determined as confidential on the basis of this review and are redacted from public files.

11. Sensitive Questions
There are no sensitive questions included in this collection effort.

12. Burden Estimates (Hours & Wages)
The estimated hour burden on issuers for the PlanFinder data collection in the first year is
estimated as 29,733 total burden hours, or 119 hours per organization. This estimate is based on an
assumed average of 450 individual plan issuers and 700 small group plan issuers (750 total, as some
issuers offer both individual and small group plans) per each of the four quarterly collections. It
includes 30 hours per organization for training and communication. Additionally, for each of the
issuers it includes 11 hours of preparation time, one hour of login and upload time, two hours of
troubleshooting and data review, and one half hour for attestation per organization per quarterly
refresh.

Insurance Issuers:
Issuers

Submissions

750

Hours Total

Xs Annual
Hours

Per
Total Cost
Hour

Explanation

Training and
Communication
Submission
PreparationIndividual

30

22,500 1x 22,500

$100 $2,250,000

450

11

4950

4

19800

$65

$1,287,000

700

11

7700

4

30800

$65

$2,002,000

450

1

450

4

1800

$65

$117,000

700

1

700

4

2800

$65

$182,000

450

2

900

4

3600

$65

$234,000

Submission
PreparationSmall Group
Data EntryIndividual
Data Entry- Small
Group
TroubleshootIndividual

700

2

1400

4

5600

$65

$364,000

450
700

0.5
0.5

225
350

4
4

900
1400

$100 $90,000
$100 $140,000
Total $6,666,000

TroubleshootSmall Group
Attest- Individual
Attest-Small Grp.

State Burden
The estimated hour burden on the States for the PlanFinder data is informed by the fact that they
have already submitted the data once and only need to update their submissions. The overall hours
estimate is 575, or 10.5 per Department of Insurance. This is premised on 2 hours of training and
communication, 8 hours for data collection, and one half hour for submission.

States Submissions Hours Total

Xs

50

1
1
1

2
8
0.5

50
50

100
400
25

Annual
Hours
100
400
25
525

Per
Hour
$100
$65
$65
$100

Total
Cost
$10,000
$26,000
$1,625
$37,625

Explanation
Training
Data Collection
Submission

13. Capital Costs
There is no capital costs needed for this collection effort.

14. Cost to Federal Government
The initial burden to the Federal Government for the development and implementation of the
collection of basic, pricing, and benefits information of issuers on the web portal is $15,161,494.
The calculations for CCIIO employees’ hourly salary was obtained from the OPM website:
http://www.opm.gov/oca/10tables/html/dcb_h.asp.

Software Development and Hosting
Managing and Coordinating Contracts

$15,000,000

3 GS – 13: 3 x $42.66 x 416 $53,240.00
Analysis and QA
4 GS – 13:4 x $42.66 x 416
Overhead Costs

$70,986.00

84,978.72 * 30% $37,267.80
Total Cost to Government

$15,161,494

15. Changes to Burden
The included burden estimates are premised on the opinion that costs for the current collection
materials will not change dramatically, and does not include a reduction in cost associated with
anticipated system changes taken by issuers. A one hour addition has been made to the submission
time to include the new elements associated with the SBC. A decrease in the overall burden is due
to a decrease in the number of issuers reporting from 800 to 750.

16. Publication/Tabulation Dates
The collection of detailed information from issuers to post on HealthCare.gov’s PlanFinder is
anticipated under this request for collection in June 2014.

17. Expiration Date
CCIIO has no objections to displaying the expiration date.

18. Certification Statement
There are no exceptions to the certification statement.