CMS-10433 - Supporting Statement QHP 4162015

Supporting Statement for Initial Plan Data Collection to Support QHP
Certification and other Financial Management and Exchange Operations
(OMB Control No. 0938-1187)

A. Background

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act
(P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 (P.L.
111-152) was signed into law. The two laws are collectively referred to as the Affordable Care Act.
The Affordable Care Act (ACA) establishes new competitive private health insurance markets called
Affordable Insurance Exchanges (Exchanges) which give millions of Americans and small businesses
access to affordable, quality insurance options. By providing a place for one-stop shopping,
Exchanges make purchasing health insurance easier and more transparent, and put greater control
and more choice in the hands of individuals and small businesses. Additionally, reinsurance, risk
corridors, and risk adjustment programs provide market stabilization to lower costly premiums
associated with individual and small business coverage.
As directed by the rule Establishment of Exchanges and Qualified Health Plans; Exchange Standards
for Employers (77 FR 18310) (Exchange rule), each Exchange will assume responsibilities related to
the certification and offering of Qualified Health Plans (QHPs). To offer insurance through an
Exchange, a health insurance issuer must have its health plans certified as QHPs by the Exchange. A
QHP must meet certain minimum certification standards, such as network adequacy, inclusion of
Essential Community Providers (ECPs), and non-discrimination. The Exchange is responsible for
ensuring that QHPs meet these minimum certification standards as described in the Exchange rule
under 45 CFR 155 and 156, based on the ACA, as well as other standards determined by the
Exchange.

Issuers can offer individual and small group market plans outside of the Exchanges that are not
QHPs. Such plans are referred to in this document as “non-Exchange.” The reinsurance and risk
adjustment programs outlined by the ACA, detailed in the rule Standards for Reinsurance, Risk
Corridors, and Risk Adjustment (77 FR 17220), have general information reporting requirements
that apply to QHPs offered through the Exchanges and non-Exchange plans in the outside market.
For the reinsurance program, administrative information is used to identify all entities required to
contribute to the reinsurance program by state. In addition, non-Exchange plan information such as
plan type and location is used to identify non-grandfathered individual market plans eligible by
state for reinsurance payments. For the risk adjustment program, administrative information is
used to identify all non-grandfathered small group and individual market non-Exchange plan
offerings 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.

On March 13, 2013, the Office of Management and Budget (OMB) granted approval to the data
collection Initial Plan Data Collection to Support QHP Certification and other Financial Management
and Exchange Operations (OMB Control Number 0938-1187). This certification is valid for three
years and expires on March 31, 2016. Based on changing needs of the Exchange program, revisions
to this data collection to be applicable for 2015 certification and beyond were proposed through a
Federal Register notice published on November 1, 2013 (78 FR 65656) and again on February 10,
2014 (79 FR 7674). These notices provided 60-day and 30-day public comment periods,
respectively. The Centers for Medicare & Medicaid Services (CMS) is now finalizing these templates
based on the comments received. Several of these templates will be used for 2015 QHP certification,
in conjunction with some of the templates that were previously approved under this information

collection last year. We intend to use the templates in this information collection for the 2016
certification process and believe that providing these templates now will give issuers and other
stakeholders more opportunity to familiarize themselves with the templates before the 2016
application. While we intend to use these templates in 2016, we may propose further revisions to
this data collection in the future as necessary, including for 2016, and also reserve the ability to use
the templates that were previously approved in 2013.

B. Justification

1. Circumstances Making the Collection of Information Necessary

QHP Information Collection: Certification and Standards
An Exchange certifies, recertifies and decertifies QHPs. The ACA authorizes QHP certification as
well as other operational standards for the Exchange in following sections: 1301- 1304, 1311-1312,
1321-1322, 1324, 1334, 1401-1402, 1411 and 1412. Standards for QHP issuers are codified at 45
CFR parts 155 and 156.

An Exchange needs to collect data from issuers as part of QHP certification and recertification, and
to monitor compliance with QHP certification standards on an ongoing basis. QHP issuer and plan
data also supports additional operational activities, including the calculation of each individual’s
advance payment of the premium tax credit (APTC), the display of plan information on the
Exchange website, and managing the ongoing relationships between QHP issuers and the Exchange.
Feedback about the QHP certification and recertification process is be collected from issuers in an
effort to improve the efficiency and effectiveness of data collection. Much of the information
collected for QHP certification purposes supports these operational activities on an ongoing basis.

Stand-Alone Dental Plan Information Collection
Section 1311 of the Affordable Care Act and 45 CFR 155.1065 direct each Exchange to permit
issuers to offer limited scope dental benefits as stand-alone dental plans or in conjunction with a
QHP. All reasonably applicable QHP certification requirements apply to stand-alone dental plans
offered in an Exchange, and dental issuers are required to complete the same application as all
other QHPs. However, dental issuers will only be required to complete applicable data elements
such as: Licensure and Good Standing; Network Adequacy; Essential Community Providers; and
Actuarial Value. An Exchange needs to collect data from dental issuers in order to certify and
recertify stand-alone dental plans, and to monitor ongoing compliance with applicable QHP
certification standards. This data allows the Exchange to understand the difference between an
estimated and actual rate or to calculate the portion of an individual’s premium tax credit allocated
to a stand-alone dental plan, and display plan and premium information for these plans.

Necessary Data for QHP Certification
The data collected for QHP certification, recertification, ongoing QHP oversight, financial
management, and eligibility and enrollment functions (including the Exchange website) are
reflected in the categories identified below and in the attached appendices. This data is also used to
support other Exchange business functions such as determinations of the second-lowest-cost-silver
plan, payments for cost-sharing reductions (CSRs), APTCs, and the display of information on the
Exchange website. The data collection requirements apply to stand-alone dental plans as applicable.
The Exchange is establishing a process for recertification of QHPs that, at a minimum, includes a
review of the general certification criteria as outlined in § 155.1000(c), including data collection
requirements as applicable. Feedback about the QHP certification and recertification process,
including information regarding the data collection and templates, has and will be collected from
issuers in an effort to improve the efficiency and effectiveness of the process. CMS will also collect

issuers’ logos to display on HealthCare.gov and data to support and apply state-specific laws and
requirements, such as premium payment method requirements, premium payment grace period
non-APTC requirements, dependent age limits, fraud definitions and termination data parameters,
and state provisions that allow consumers to have a “free look” at coverage documents and cancel
coverage within a specified time frame for a full refund of premium. Collecting data from issuers
also supports transparency of coverage in accordance with §156.220. CMS also collects information
from Small Business Health Options Program (SHOP) QHP issuers on whether they will allow plan
year rates to be established based on composite (or average) rates of employees and dependents at
the time of initial application. CMS collects information from SHOP QHP and dental issuers on
whether benefits are based on a plan year or calendar year. QHP issuers need to provide
information that demonstrates that they meet patient safety standards if requested by an Exchange.
CMS will collect the following data to support these functions:

Appendix A: Issuer Application Data
• Issuer Administrative Data Elements: Basic information required to identify issuers and
the Exchange markets they intend to serve, and to facilitate communications with and
payment to issuers. The data elements may include issuer contact information and banking
information.
•

•

•

•

•

State Licensure Documentation: Documentation necessary to demonstrate that an issuer
is licensed and has authority to sell all applicable products in all states in which it intends to
offer a QHP, including submission of the state certification form.

Documentation of Good Standing: Documentation necessary to demonstrate that an
issuer is in compliance with all applicable state solvency requirements and other relevant
state regulatory requirements, including submission of the state certification form.

Network Adequacy Data Elements: Documentation necessary to demonstrate compliance
with state network adequacy rules or, in the absence of such standards, documentation
necessary to demonstrate that an issuer has an adequate range of providers for the intended
service areas.

Network ID and Provider Directory URL Data Elements: Network ID numbers
identifying each provider network for purposes of plan-to-network mapping and specific
URLs associated with the provider directory for each plan.

Essential Community Provider (ECP) Data Elements: Number of participating Essential
Community Providers participating in an issuer's provider network or other documentation
necessary to demonstrate that that an issuer has an adequate range of ECPs for the intended
service areas.

• Provider File: Information detailing the QHP issuer’s provider network, including information
such as provider name, county, and type.
•

Accreditation Data Elements: If applicable, an issuer must provide certain data elements
about accreditation conducted by any recognized accrediting entity, including URAC, the
National Committee for Quality Assurance (NCQA), or the Accreditation Association for
Ambulatory Health Care (AAAHC). Issuer must also authorize the release of accreditation
survey data to an Exchange.

•

•

Supporting Documentation: Additional documentation required by the Exchange for
oversight purposes such as a compliance plan including an organization chart.
Attestations: Attestations regarding compliance with applicable regulation.

Appendix B: Benefit and Service Area Data
• Service Area: Information identifying a plan’s geographic service area.
•

•

•

•

•

Additional Supporting Documentation: Additional documentation required by the
Exchange such as discrimination/cost sharing outlier justifications.

Benefits and Associated Cost Sharing and Limits: Data necessary to describe benefits
offered by a plan including covered services, co-payments, coinsurance, tiers, intervals, and
limits.

Summary of Benefits and Coverage Data Reporting Requirements: Data elements from
the Summary of Benefits and Coverage scenarios for display on the Exchange website.

High-level Plan Data: Basic plan- level information for plans and products including
information necessary for in-network and out-of-network deductibles and maximum outof-pocket cost by benefit category.
Formulary Information including Tiers and Classes: Formulary information including
RxNorm Concept Unique Identifiers (RxCUIs), pricing tiers, co-insurance, co-payment
information, drugs included in the formulary, formulary version number, and its effective
date.

Appendix C: Rating Tables and Issuer Business Rules Data
• Premium Rating Information and Business Rules: Rating tables, factors and business
rules required to perform rate review, populate the premium calculator and perform
calculations for risk adjustment. Information will include collecting secondary eligibility
criteria, such as grandchild, adult child, disabled dependent, spouse, and life partner.
•

Partial Month Premium Calculation Rule: Rules and/or formulas to support the
calculation of partial month premiums.

The following information will be collected for QHP certification and the burden is defined, as
applicable, in Rate Increase Disclosure and Review Requirements (45 CFR Part 154),OMB Control
Number CMS – 10379.
•

•

Rate Review Data Elements: Financial information by market and product necessary for
rate review and the evaluation of CSR payments. This could include: base period claims
experience, projected period medical trend factors, and projected period administrative
factors.
Essential Health Benefits (EHB) and Additional Coverage Data including Allocation of
Premium Information: Data required to determine the allocation of premiums for EHB
and those services offered in excess of EHB.

•

•

CSR Advance Payments and Justification: Data to support the payments for CSRs. The
information will also support the variations in AV levels for CSR silver plan variations.

Actuarial Memorandum: Actuarial narrative and certification required for the review of
rates for rate review, premium allocation for APTCs, and CSR payment.

Non-Exchange Plan Information Collection: Reinsurance and Risk Adjustment
Section 1341 of the ACA 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 nongrandfathered 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 153.
Please note the below information amends this collection for year one.

Reinsurance Reporting Requirements for non-Exchange Plans
The temporary reinsurance program will reduce the uncertainty of insurance risk in the individual
market by making payments for high-cost enrollees. Health insurance issuers and self-insured
group plans are required to remit contributions on behalf of certain enrollees in certain 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 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 operating 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.

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 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.
Necessary Data for Reinsurance and Risk Adjustment Operations
Frequency of collection and types of information to be collected is determined by CMS.

Appendix D: Transitional Reinsurance and Risk Adjustment Operations Data
Data necessary for reinsurance and risk adjustment operations include:
•

•

•

•

Administrative Data Elements: Basic information required to facilitate communications
regarding reinsurance contributions and payments, risk adjustment charges and payments,
and other financial program payments. The data elements may include issuer contact
information and banking information.

EDGE Server Registration and Provisioning Data Elements: Data elements related to
EDGE Server registration activities, including applicable attestations and agreements, and
provisioning of the Amazon Web Services (AWS) EDGE Server and the Issuer On-Premise
EDGE server.

State Licensure Data Elements: Documentation necessary to demonstrate that an issuer is
licensed and has authority to sell all applicable products in all states in which they intend to
offer plan, including the state certification form.
Plan Level and Additional Coverage Data Entities: Plan information to include market
participation, plan type, and basic plan characteristics such as location.

Data for risk adjustment operations includes:
•

Premium Rating Information and Business Rules: Factors, rating areas and business
rules required to perform calculations for risk adjustment.

CMS is proposing an emergency modification to Appendix D of this data collection to include
account registration elements associated with submitting data through the Amazon Cloud EDGE
Server or the On-Premise EDGE server. As a result of contractor changes and CMS’s decision to
permit issuers to provision EDGE servers through AWS, CMS must change the data elements that
issuers will submit as part of the distributed data collection (DDC) information collection
requirements.

These modifications to Appendix D of this information collection will result in a very small additional
burden, and will permit us to link EDGE servers that have been set up with the appropriate accounts,
permitting us to make payments and enforce data collection for risk adjustment charges. Because,
pursuant to our EDGE server implementation schedule, risk adjustment covered issuers and
reinsurance eligible issuers will need to submit this information by the end of August 2014, CMS will
not have time to complete 60-day and 30-day comment periods for this proposed information
collection. This submission date is necessary to permit the risk adjustment and reinsurance
programs to meet statutory and regulatory deadlines. Therefore, HHS is requesting emergency action
for clearance by the Office of Management and Budget no later than August 29, 2014. The changes
CMS seeks to make through this request for emergency review and clearance apply only to Appendix
D, and exclude all other parts of this information collection.
People with disabilities may contact Danielle Chestang at (410) 786-7815 or
danielle.chestang@cms.hhs.gov if they require assistance in reading the appendices.

2. Purpose and Use of Information Collection

The Exchange collects plan- and issuer-level data from issuers to facilitate the certification and
recertification of QHPs, Exchange operations, other Federal operations, QHP oversight, and ongoing

market analysis. The data includes administrative data, enrollment data, financial data,, issuer
information, rate and benefit data and information, and process-related feedback data. All of this data
is leveraged across multiple business areas in the Exchange to facilitate other operational tasks such
as plan comparisons on the insurance portal and various payment activities, such as determination of
the second lowest cost silver plan, APTCs, or risk adjustment.

In addition, CMS will collect organizational and plan-level data from issuers, self-insured group
health plans and third party administrators (and administrative services only contractors). The
data will include administrative data, financial data, and rate and benefit data. This data will be
used to remit payments and to operate the premium stabilization programs.

3. Use of Improved Information Technology and Burden Reduction

CMS has and continues to engage with states, issuers, and the National Association of Insurance
Commissioners (NAIC) in the effort to develop data standards for QHP certification, reinsurance, risk
adjustment, and other plan management activities that would make reporting to the Exchanges
more streamlined for issuers across the country, and allow them to submit information in a manner
that is standardized to the greatest extent possible. We encourage states to leverage existing
infrastructure to the extent possible and CMS is aware that states are hoping to incorporate their
current data collection systems for Exchange operations including the NAIC’s System for Electronic
Rate and Form Filing (SERFF). In this spirit, CMS and the NAIC have jointly worked to enhance SERFF,
which is currently used by many state Departments of Insurance for its traditional regulatory
activities. CMS and the NAIC’s technical teams have pursued a collaborative development approach
such that the data submission interfaces are very similar, if not identical. We believe that this initiative
will ease the burden on both issuers and states.

4. Efforts to Identify Duplication and Use of Similar Information

CMS will make every effort to reduce the burden on issuers and reuse the information that is
collected under the various provisions of the ACA. As such, data obtained under other authorized
collections implementing provisions of the ACA will be utilized to meet some Exchange
requirements, for example in Rate Increase Disclosure and Review Requirements (45 CFR Part
154),OMB Control Number CMS – 10379. CMS will make every effort to avoid duplication of data
collections with these other efforts. CMS is developing an integrated modular collection instrument
and database system to support these various needs.

5. Impact on Small Businesses or Other Small Entities
Small businesses are not significantly affected by this collection.

6. Less Frequent Collection

QHPs will be certified utilizing an annual certification process. The year two and three burden
estimates include estimates for recertification, as noted below. We will continue to reassess the
certification and recertification burden and make every effort to minimize burden as much as
possible in the future.

Non-Exchange plans that are reinsurance-eligible plans, reinsurance contributing entities, or risk
adjustment covered plans must submit data for the purposes of facilitating program operations.
Issuers would be required to submit the account registration data elements in Appendix D only one
time, when they establish EDGE servers.

7. Special Circumstances

Issuers submitting in the SHOP Exchange have the option to submit formulary, rate and benefit
information more frequently; therefore, additional submissions may be necessary.

8. Comments in Response to the Federal Register/Outside Consultation

As required by the Paperwork Reduction Act of 1995 (44 U.S.C.2506 (c)(2)(A)), the Center for
Consumer Information and Insurance Oversight (CCIIO) published a 60-day notice in the Federal
Register (80 FR 7607, February 11, 2015) requesting public comment on its proposed modification of
the information collection requirements specified in the Initial Plan Data Collection to Support QHP
Certification and other Financial Management and Exchange Operations ICR (OMB Control No. 09381187). No public comments were submitted in response to the notice.

The goal of this data collection is to inform the QHP certification and recertification process, as well
as non-Exchange plan reporting requirements needed for the reinsurance and risk adjustment
programs. This information collection previously went through 60-day and 30-day public comment
processes, and was approved under OMB control number (OCN) 0938-1187. Prior to finalizing this
package, CMS received extensive feedback from key stakeholders through webinars and user groups
calls with the NAIC, and through discussions with states, issuers, and issuer associations regarding
data elements and collection. It is the goal of CMS and stakeholders to identify shared data points
and improve the validity of data. CMS will continue to work with states to minimize any required
document submission to streamline and reduce duplication.

9. Explanation of any Payment/Gift to Respondents
There are no payments or gifts to respondents.

10. Assurance of Confidentiality Provided to Respondents
Information collected for plan management, reinsurance and risk adjustment contains
proprietary information, trade secret, commercial and/or financial information. Therefore it is
privileged, private to the extent permitted by law, and protected from disclosure.

These data are protected from disclosure under Exemption 4 of the Freedom of Information Act
(FOIA). Exemption 4 is provided below and is part of the HHA FOIA implementation regulation (45
CFR 5.65) available at http://www.hhs.gov/foia/45cfr5.html#Subf.

11. Justification for Sensitive Questions

No sensitive questions are asked in this PRA package.

12. Burden Estimates (Hours and Wages)

The burden associated with this data collection can be attributed to QHP issuers, nonExchange plan issuers, larger group issuers, self-insured, third party-administrators, and
states. We developed these burden estimates based off CMS’s experience collecting similar
categories of data from issuers in the Medicare Advantage and Prescription Drug Benefit
Programs, Federal Rate Review Program, and Healthcare.gov reporting. The burden for each of
these entities was considered when developing these burden estimates. We have modified the
burden estimates that were approved in the initial package on March 13, 2013. The revised
figures reflect projections based on actual experience since receiving the initial approval. We
have included information on the original year-one estimates in footnotes.

Burden for QHP Issuers: QHP Certification 1
The burden on issuers for the QHP certification (including issuer application, rate and benefit
submission, and formulary submission) per year is estimated to be 69,825 burden hours, or 147
1

In the original package for this data collection, as approved March 13, 2013, for year one we estimated a total of
1,200 issuers and a total of 175 hours per issuer, for a total burden of $13,475 per issuer and 210,000 hours across all
issuers. This reflected a higher number of burden hours based on initial start-up hours.

hours per issuer. This estimate was based on an assumed 475 issuers each offering 15 plans as
potential QHPs. The burden estimate included data required for QHP certification, risk adjustment,
and reinsurance. We have adjusted the burden to account for feedback on the certification and
recertification process. We have further revised these estimates, in terms of the number of issuers.
We estimate 475 issuers will incur costs for QHP certification, risk adjustment, and reinsurance. We
developed this number based upon the number of applications received from issuers for the
2014 plan year in addition to the expectation that additional issuers will apply in future years.

Table 1. Burden for QHP Issuers: QHP Certification
Year

Number of Issuers Hours Per Issuer Total Hours Total Burden Cost Per
Issuer

One

475

147

69,825

$11,319

Two

475

147

69,825

$11,319

Three

475

147

69,825

$11,319

Burden for Stand-Alone Dental Issuers: QHP Certification 2
The burden on stand-alone dental issuers for the QHP certification each year is estimated to be
20,000 total burden hours, or 40 hours per issuer. It was estimated that 500 issuers offering 2
plans each will participate in an Exchange or go through the certification process to offer an
Exchange- certified SADP off the Exchange. At an hourly billing rate of $77, the total cost was
estimated to be $3,080 per issuer. The estimates also include recertification for SADP issuers.

2

In the original package for this data collection, as approved March 13, 2013, we estimated the total year-one
cost to be $462 per issuer for a total of 6 hours per issuer and estimated that 40 issuers would participate.

Table 2. Burden for Stand-Alone Dental Issuers: QHP Certification
Year

Number of Issuers Hours Per Issuer Total Hours Total Burden Cost Per
Issuer

One

500

40

20,000

$3,080

Two

500

40

20,000

$3,080

Three

500

40

20,000

$3,080

Burden for Non-QHP Issuers and QHP Issuers (for plans outside the Exchange) Offering
Plans in the Individual and Small Group Market: Reinsurance and Risk Adjustment3
All issuers in the individual and small group market are required to submit reference data, to
include but not be limited to administrative information about the issuer and its non-QHP
offerings, AV levels for those plans, which will be used for the reinsurance and risk adjustment
programs. It is estimated there are 2,400 issuers in the individual and small group market. The
total estimated burden of submission for these issuers is 7,200 hours or 3 hours per issuer at a
cost of approximately $250 per issuer per year.

We estimate that submitting additional data elements related to the Amazon Cloud EDGE Server or
On-premise EDGE server option will result in a small additional burden for risk adjustment
covered and reinsurance eligible issuers. We estimate that each issuer will spend an additional 15
minutes (at an hourly wage rate of $77 for a senior manager) to submit this additional data.
Therefore, we estimate an aggregate incremental burden of approximately 600 hours and $46,200
for all 2,400 issuers as a result of this requirement.

Table 3. Burden for Non-QHP Issuers and QHP Issuers Offering Plans in the
Individual and Small Group Market: Reinsurance and Risk Adjustment

3

Year

Number of
Issuers

Hours Per Issuer

Total Hours

Total Burden Cost Per
Issuer

One

2,400

3.25

7,800

$250

Two

2,400

3

7,200

$231

Three

2,400

3

7,200

$231

In the original package for this data collection, as approved March 13, 2013, we estimated the total year-one cost
to be $1001 per issuer for a total of 13 hours per issuer, which included startup hours.

Burden for Large Group Issuers, and Self- Insured Group Plans and Third-Party
Administrators: Reinsurance4
Some issuers in the large group market, self-insured group plans, and third-party administrators
on behalf of either will be required to submit administrative information for reinsurance
contributions. It is estimated that 23,800 entities are eligible reinsurance contributors. The total
estimated burden for this submission is 119,000 or 5 hours per entity, at a cost of $385 per entity.

Table 4. Burden for Large Group Issuers, and Self- Insured Group Plans and Third-Party
Administrators: Reinsurance
Year

Number of Entities Hours Per Entity Total Hours Total Burden Cost Per
Entity

One

23,800

5

119,000

$385

Two

23,800

5

119,000

$385

Three

23,800

5

119,000

$385

Burden for States: State-based Exchanges and Partnership States5
CMS projects that all states that have received any type of Exchange grant funding (Planning,
Innovator, Level 1, or Level 2 Establishment) from CMS will pursue a State Partnership or a
State- based Exchange. Those states who are engaged with CMS as a State Partner will have an
identical Plan Management burden as those operating a State-based Exchange since they will be
performing all of the Plan Management activities, including QHP certification. It is assumed that
the majority of states in State-based Exchanges and Partnerships will continue to leverage their
existing systems that are used by the state departments of insurance. The state will have a
burden of 3 hours to submit data to the Federal government for a total burden of $157 per state
per year.

4

In the original package for this data collection, as approved March 13, 2013, we estimated the total year-one cost
to be $1,155, because we estimated a total of 15 hours per entity, which included startup hours.

Table 5. Burden for States: State-based Exchanges and Partnership States 5
Year

Number of States Hours Per State

Total Hours

Total Burden Cost Per
State

One

50

3

150

$157

Two

50

3

150

$157

Three

50

3

150

$157

13. Capital Costs

There is no capital cost associated with this collection effort.

14. Cost to Federal Government 6

We estimate that the operations and maintenance costs for the data collection tool will be
$204,880.00 on an annual basis and an additional 485 burden hours for data collection support
for a cost of $22,580.90, for a total cost of $227,460.90 per year.

15. Changes to the Burden

HHS proposed an emergency modification of this data collection for the DDC information
collection in Appendix D. This information collection was also published in the Federal
Register for public comment on July 30, 2014. We estimate that this modification would
result in an additional burden of approximately 600 hours and $46,200 for all 2,400 risk
adjustment covered and reinsurance eligible issuers.

16. Publication/Tabulation Dates

The information collection from issuers is anticipated under this request to occur in the
first quarter of 2013.

17. Expiration Date

CMS has no objections to displaying the expiration date.

5

In the original package for this data collection, as approved March 13, 2013, we estimated the total year-one cost
to be $20,157 per year, because we estimated a one-time $20,000 expense for system upgrades.
6
In the original package for this data collection, as approved March 13, 2013, we estimated an initial, one-time
cost to the Federal government of $2,433,860.90 to develop and implement the data collection tool. We do not reestimate this one-time cost in this package.