Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
279277	Third Party Survey Vendors	New
279136	Stand-Alone Dental Issuers for NA Template and ECP Data Collection	New
266278	QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection	Modified
251109	Essential Community Provider and Network Adequacy Data Requirements Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1415	ICR Reference No: 202602-0938-012
Status: Received in OIRA	Previous ICR Reference No: 202408-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification (CMS-10803)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/03/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2027
Responses	631	536
Time Burden (Hours)	226,178	249,410
Cost Burden (Dollars)	142,245	316,583

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Abstract: In accordance with section 1311(c)(1)(C) of the Affordable Care Act (ACA), Qualified Health Plan (QHP) issuers, including Stand-alone Dental Plan (SADP) issuers, are required to ensure access to a sufficient number and geographic distribution of essential community providers (ECPs), where available, that serve predominantly low-income, medically-underserved individuals. Under 45 Code of Federal Regulations (CFR) 156.235, the Secretary of HHS has established criteria for inclusion of a sufficient number and geographic distribution of ECPs, where available, in an issuer’s network to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in their service areas. To satisfy this ECP requirement, medical QHP and SADP issuers must submit an Essential Community Provider/Network Adequacy (ECP/NA) template as part of their QHP application, in which they must list the ECPs with whom they have contracted. In the Issuer Module, issuers will also have to attest to meeting each element of the ECP standard. In accordance with section 1311(c)(1)(B) of the ACA, QHP issuers, including SADP issuers, are required to ensure a sufficient choice of providers (in a manner consistent with the applicable provisions under section 2702(c) of the Public Health Service Act). Under CFR 156.230, QHPs that use a provider network must ensure that the network is sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to assure that all services will be accessible without unreasonable delay. This information collection request (ICR) serves as a formal request for a new clearance associated with the Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2023 Proposed Rule (2023 Payment Notice). This ICR details the burden associated with collecting and reviewing essential community provider and network adequacy data.

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Authorizing Statute(s): US Code: 45 USC 156 Name of Law: Health Insurance Issuer Standards Under The Affordable Care Act, Including Standards Related To Exch
   PL: Pub.L. 111 - 156 1311 Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: US Code: 45 USC 156.230 Name of Law: Network adequacy standards
US Code: 45 USC 156.235 Name of Law: Essential community providers

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV62	Proposed rulemaking	91 FR 6292	02/11/2026

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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
Essential Community Provider and Network Adequacy Data Requirements	CMS-10803, CMS-10803	Appendix A ,   Non-Network Plan Attestation - Questions
QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection
Stand-Alone Dental Issuers for NA Template and ECP Data Collection
Third Party Survey Vendors

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ICR Summary of Burden

	Total Request	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	631	536	0	0	95	0
Annual Time Burden (Hours)	226,178	249,410	0	0	-23,232	0
Annual Cost Burden (Dollars)	142,245	316,583	0	0	-174,338	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: There is an overall decrease in the financial burden from the 2024 PRA package. There is a decrease in QHP issuers for the NA Template and ECP data collection from 171 to 164 issuers, a decrease in stand-alone dental issuers for the NA Template and ECP data collection from 194 to 157 issuers, and a decrease in QHP Issuers for the appointment wait time secret shopper data collection from 171 to 155 issuers. The reductions in the number of issuers was based on PY2026 data. Additionally, since non-network plans would be required to meet the same general certification criteria and follow similar data collection and submission requirements as current network plans, we do not anticipate increases in financial burden. The total annual burden hours decreased from 249,410 to 226,178, which is a decrease of 23,232 hours. The estimated annual costs decreased from $18,482,456.84 to $17,332,987.94, which is a decrease of $1,149,468.90.

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Annual Cost to Federal Government: $1,672,524

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 03/03/2026

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