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. Health insurance issuers will manually
enter enrollment and payment data into a Microsoft Excel-based
spreadsheet, and submit the information to HHS. The data collection
will be used by HHS to make payments or collect charges from
issuers under the following programs: advance payments of the
premium tax credit, advanced cost-sharing reductions, and
Marketplace user fees. HHS will use the information collected to
make payments and collect charges in January 2014 and for a number
of months thereafter, as may be required based on HHS's operational
progress.
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
As detailed above, certain
burden estimates for information collection requirements associated
with the reinsurance, risk adjustment, risk corridors, premium tax
credit, cost-sharing reduction, and user fee programs would change
from what was previously estimated in the Premium Stabilization
Rule and 2014 Payment Notice due to changes in the proposed HHS
notice of benefit and payment parameters for 2015. We have also
updated burden to reflect our most current estimates of program
operations, including increasing our estimate of the number of risk
adjustment covered issuers in the individual and small group
insurance market.
$0
No
No
Yes
No
No
Uncollected
Jamaa Hill 301 492-4190
No
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:
(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;
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.
Form CMS-10515 Monthly Data Submission Accuracy Certification Form
CMS-10515_PaymentCollectionsOperationsContingencyPlanSupporting.pdf
CMS-10515_Appendix_A_comment and respose.docx
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