[Federal Register Volume 78, Number 19 (Tuesday, January 29, 2013)]
[Notices]
[Pages 6109-6111]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-01770]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10438, CMS-10439 and CMS-10440]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS), Department of Health and Human Services, is publishing 
the following summary of proposed collections for public comment. 
Interested persons are invited to send comments regarding this burden 
estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the Agency's function; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    1. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Data 
Collection to Support Eligibility Determinations and Enrollment for 
Employees in the Small Business Health Options Program; Use: Section 
1311(b)(1)(B) of the Affordable Care Act requires that the Small 
Business health Option Program (SHOP) assist qualified small employers 
in facilitating the enrollment of their employees in qualified health 
programs (QHPs) offered in the small group market. Section 
1311(c)(1)(F) of the Affordable Care Act requires HHS to establish 
criteria for certification of health plans as QHPs and that these 
criteria must require plans to utilize a uniform enrollment form that 
qualified employers may use. Further, section 1311(c)(5)(B) requires 
HHS to develop a model application and Web site that assists employers 
in determining if they are eligible to participate in SHOP. Consistent 
with these authorities, HHS has developed a single, streamlined form 
that employees will use apply to the SHOP. Section 155.730 of the 
Exchanges Final Rule (77 FR 18310) provides more detail about this 
``single employee application,'' which will be used to determine 
eligibility.
    The information will be required of each employee upon initial 
application with subsequent information collections for the purposes of 
confirming accuracy of previous submissions or updating information 
from previous submissions. Information collection will begin during 
initial open enrollment in October 2013, per Sec.  155.410 of the 
Exchanges Final Rule. Applications for the SHOP will be collected year 
round, per the rolling enrollment requirements of Sec.  155.725 of the 
Exchanges Final Rule.
    Employees will be able to submit an application for the SHOP 
online, using a paper application, over the phone through a call center 
operated by an Exchange, or in person through an agent, broker, or 
Navigator, per Sec.  155.730(f) of the Exchanges Final Rule. If an 
employee does not enroll in coverage through the SHOP, the information 
will be erased after a specified period of time. If an employee enrolls 
in coverage through the SHOP, the information will be retained to 
document the enrollment, to allow reconciliation with issuer records, 
and to provide information for future coverage renewals or changes in 
coverage.
    Every qualified employee of an employer participating in the SHOP 
who wishes to apply for coverage through the SHOP will need to complete 
an application to determine his or her eligibility. The applicant will 
also be asked to verify his or her understanding of the application and 
sign attestations regarding information in the application. The 
completed application will be submitted to the SHOP in the employer's 
state.
    Applicants who choose to complete the electronic application will 
need to create an online account at the beginning of the application 
process.
    We estimate that it will take approximately 0.159 hours (9.53 
minutes) per applicant to submit a completed paper application. The 
Congressional Budget Office (CBO) estimates approximately 3 million 
people will enroll in health insurance through a SHOP in 2014. Assuming 
family size of approximately 3 per employee, we expect approximately 1 
million employees to complete an application in 2014 for a total of 
approximately 93,300 burden hours.
    CBO estimates approximately 2 million people will enroll in health 
insurance through a SHOP in 2015 and 3 million in 2016. Consequently, 
we estimate that approximately 666,666 employees will apply to a SHOP 
in 2015

[[Page 6110]]

and approximately 1 million will apply in 2016.
    The 60-day Federal Register notice published on July 6, 2012 (77 FR 
40061). We received public comments from over 20 entities addressing 
topics such as the purpose and use of the information collection and 
burden estimates. Some of the commenters were concerned with duplicate 
or overly burdensome data collection as related to the employee 
application. CMS is working with states to minimize any required 
document submission to streamline and reduce duplication, especially in 
future years. We have taken into consideration all of the proposed 
suggestions and have made changes to this collection of information, 
such as adding a privacy statement, information on the availability of 
other coverage, pre-population of certain applicant information, and 
whether the employee is waiving SHOP coverage.
    Form Number: CMS-10438 (OCN: 0938-NEW); Frequency: Once; Affected 
Public: Individuals or Households; Number of Respondents: 1,000,000; 
Total Annual Responses: 1,000,000; Total Annual Hours: 93,300 hours. 
(For policy questions regarding this collection contact Leigha Basini 
at 301-492-4307. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: Data 
Collection to Support Eligibility Determinations and Enrollment for 
Small Businesses in the Small Business Health Options Program; Use: 
Section 1311(b)(1)(B) of the Affordable Care Act requires that the SHOP 
assist qualified small employers in facilitating the enrollment of 
their employees in QHPs offered in the small group market. Section 
1311(c)(1)(F) of the Affordable Care Act requires HHS to establish 
criteria for certification of health plans as QHPs and that these 
criteria must require plans to utilize a uniform enrollment form that 
qualified employers may use. Further, section 1311(c)(5)(B) requires 
HHS to develop a model application and web site that assists employers 
in determining if they are eligible to participate in SHOP. Consistent 
with these authorities, HHS has developed a single, streamlined form 
that employers will use apply to the SHOP. Section 155.730 of the 
Exchanges Final Rule provides more detail about this ``single employer 
application,'' which will be used to determine employer eligibility.
    The information will be required of each employer upon initial 
application with subsequent information collections for the purposes of 
confirming accuracy of previous submissions or updating information 
from previous submissions. Information collection will begin during 
initial open enrollment in October 2013, per Sec.  155.410 of the 
Exchanges Final Rule. Applications for the SHOP will be collected year 
round, per the rolling enrollment requirements of Sec.  155.725 of the 
Exchanges Final Rule
    Employers will be able to submit an application for the SHOP 
online, using a paper application, over the phone through a call center 
operated by an Exchange, or in person through an agent, broker, or 
Navigator, per Sec.  155.730(f) of the Exchanges Final Rule. If an 
employer does not complete the application, the information will be 
erased after a specified period of time. If an employer completes the 
application and offers coverage to qualified employees through the 
SHOP, the information will be retained to document the offer of 
coverage, to allow reconciliation with issuer records, and to provide 
information for future coverage renewals or changes in coverage.
    Every employer wishing to apply for coverage through the SHOP will 
need to complete an application to determine its eligibility to 
participate in the SHOP. The applicant will also be asked to verify his 
or her understanding of the application and sign attestations regarding 
information in the application. The completed application will be 
submitted to the SHOP in the employer's state. Applicants who choose to 
complete the electronic application will need to create an online 
account at the beginning of the application process.
    We estimate that it will take approximately 0.209 hours (12.57 
minutes) per applicant to submit a completed paper application. We had 
several individuals fill out the paper application, averaged their 
times to complete the application, and factored in additional time due 
to potential variation in applicants' health literacy rate. The 
Congressional Budget Office (CBO) estimates approximately 3 million 
people will enroll in health insurance through a SHOP in 2014. Assuming 
a small business size of approximately 5 employees and a family size of 
approximately 3 per employee \1\, we estimate that approximately 
200,000 employers will apply to a SHOP in 2014. Consequently, we expect 
approximately 200,000 employers to complete an application in 2014 for 
a total of approximately 24,520 burden hours.
---------------------------------------------------------------------------

    \1\ Based on US Census data of business size in 2008, the vast 
majority of employer firms (restricted to employer firms with 1-99 
employees) have 1-4 employees. Based on ASPE analysis of 2011 
Current Population Survey data, the average family size (restricted 
to individuals under the age of 65) with income above 400% Federal 
Poverty Level is 3.16
---------------------------------------------------------------------------

    CBO estimates approximately 2 million people will enroll in health 
insurance through a SHOP in 2015 and 3 million in 2016. Consequently, 
we estimate that approximately 133,333 employers will apply to a SHOP 
in 2015 and approximately 200,000 will apply in 2016.
    The 60-day Federal Register notice published on July 6, 2012 (77 FR 
40061). We received public comments from over 20 entities addressing 
topics such as the purpose and use of the information collection and 
burden estimates. Some of the commenters were concerned with duplicate 
or overly burdensome data collection as related to the employer 
application. CMS is working with States to minimize any required 
document submission to streamline and reduce duplication, especially in 
future years. We have taken into consideration all of the proposed 
suggestions and have made changes to this collection of information, 
such as adding a privacy statement, ``doing business as'' information, 
employer type, and making electronic notices the default option. Some 
information related to the employer choice of plan offerings and 
contribution is removed because it is not necessary for an eligibility 
determination. Form Number: CMS-10439 (OCN: 0938-NEW); Frequency: 
Annually; Affected Public: Private Sector: Business or Other For-
Profit, Non-For-Profit Institutions, or Farms; Number of Respondents: 
200,000; Total Annual Responses: 200,000; Total Annual Hours: 24,520 
hours. (For policy questions regarding this collection contact Leigha 
Basini at 301-492-4307. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of information collection: Data 
Collection to Support Eligibility Determinations for Insurance 
Affordability Programs and Enrollment through Affordable Insurance 
Exchanges, Medicaid and Children's Health Insurance Program Agencies; 
Use: Section 1413 of the Affordable Care Act directs the Secretary of 
Health and Human Services to develop and provide to each State a 
single, streamlined form that may be used to apply for coverage through 
the Exchange and Insurance Affordability Programs, including Medicaid, 
the Children's Health Insurance Program (CHIP), and the Basic Health 
Program, as applicable. The application must be

[[Page 6111]]

structured to maximize an applicant's ability to complete the form 
satisfactorily, taking into account the characteristics of individuals 
who qualify for the programs. A State may develop and use its own 
single streamlined application if approved by the Secretary in 
accordance with section 1413 and if it meets the standards established 
by the Secretary.
    Section 155.405(a) of the Exchange Final Rule (77 FR 18310) 
provides more detail about the application that must be used by the 
Exchange to determine eligibility and to collect information necessary 
for enrollment. The regulations in Sec.  435.907 and Sec.  457.330 
establish the requirements for State Medicaid and CHIP agencies related 
to the use of the single streamlined application. CMS is designing the 
single streamlined application to be a dynamic online application that 
will tailor the amount of data required from an applicant based on the 
applicant's circumstances and responses to particular questions. The 
paper version of the application will not be able to be tailored in the 
same way but is being designed to collect only the data required to 
determine eligibility. Individuals will be able to submit an 
application online, through the mail, over the phone through a call 
center, or in person, per Sec.  155.405(c)(2) of the Exchange Final 
Rule, as well as through other commonly available electronic means as 
noted in Sec.  435.907(a) and Sec.  457.330 of the Medicaid Final Rule. 
The application may be submitted to an Exchange, Medicaid or CHIP 
agency.
    The online application process will vary depending on each 
applicant's circumstances, their experience with health insurance 
applications and online capabilities. The goal is to solicit sufficient 
information so that in most cases no further inquiry will be needed. We 
estimate that on average it will take approximately .50 hours (30 
minutes) to complete for people applying for Insurance Affordability 
Programs. It will take an estimated .25 hours (15 minutes) to complete 
without consideration for Insurance Affordability Programs. We expect 
approximately 7,840,477 applications to be submitted for Insurance 
Affordability Programs between 2014 and 2016. The total burden is 
estimated to be 5,548,859 cumulative burden hours. We estimate 
1,265,823 applications to be submitted online without consideration for 
Insurance Affordability Programs between 2014 and 2016, resulting in 
284,281 cumulative burden hours. The paper application process will 
take approximately .75 hours (45 minutes) to complete for those 
applying for Insurance Affordability Programs and .33 hours (20 
minutes) for those applying without consideration for Insurance 
Affordability Programs. We expect approximately 784,048 applications to 
be submitted for Insurance Affordability Programs on paper in 2014 
through 2016 for a cumulative total of 588,035 burden hours. We 
estimate 126,583 applications will be submitted without consideration 
for Insurance Affordability Programs from 2014 through 2016. Total 
burden hours are expected to be 41,772 burden between 2014 and 2016.
    CMS received approximately 65 public comments in response to the 60 
day notice. These comments addressed a range of topics, including the 
application process, paper and/or online accessibility, processes for 
verifying information, privacy and security of information, and the 
types of questions or data elements that should be included. CMS made 
significant changes to the application materials, namely moving from 
categories of data elements to completed draft applications. Because of 
the significant changes throughout, it is not feasible to list each 
individual change.
    CMS also adjusted the burden estimates due to changes in coverage 
estimates due to Congressional Budget Office revisions from July 2012. 
The expected number of applications between 2014-216 has increased to 
7,840,477 from 7,700,260; the estimated burden hours have increased 
from 5,548,859 to 1,812,230. Form Number: CMS-10440 (OCN: 0938-NEW); 
Frequency: Once per year; Affected Public: Individuals and Households; 
Number of Respondents: 3,035,434; Total Annual Responses: 3,035,434; 
Total Annual Hours: 1,085,944 hours. (For policy questions regarding 
this collection contact Hannah Moore at 301-492-4232. For all other 
issues call 410-786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS Web 
Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995, or 
Email your request, including your address, phone number, OMB number, 
and CMS document identifier, to Paperwork@cms.hhs.gov, or call the 
Reports Clearance Office on (410) 786-1326.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on February 28, 
2013.
    OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer, Fax Number: (202) 395-6974, Email: OIRA_submission@omb.eop.gov.

    Dated: January 22, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-01770 Filed 1-25-13; 11:15 am]
BILLING CODE 4120-01-P