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OMB Control No: 0938-1218	ICR Reference No: 202309-0938-009
Status: Historical Inactive	Previous ICR Reference No: 202212-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Basic Health Program Report for Health Insurance Exchange Premium (CMS-10510)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Preapproved	Conclusion Date: 11/21/2023
	Date Received in OIRA: 10/20/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2026	36 Months From Approved	01/31/2026
Responses	47	0	27
Time Burden (Hours)	3,172	0	2,568
Cost Burden (Dollars)	0	0	0

Abstract: CMS is requesting that an information collection request to support the development of federal payment rates for the Basic Health Program (BHP) be processed under the emergency clearance process associated with Paperwork Reduction Act of 1995 (PRA), specifically 5 CFR 1320.13(a)(2)(i). In accordance with Section 1331 of ACA, the BHP is federally funded by determining the amount of payments that the federal government would have made through premium tax credits (PTCs) and cost sharing reductions (CSRs) for people enrolled in BHP had they instead been enrolled in an Exchange. In order to calculate these amounts for each state, CMS needs the reference premiums for the second lowest cost silver plans (SLCSPs) in each geographic area in a state, as SLCSPs are a basic unit in the calculation of PTCs and CSRs under the Exchanges. Relatedly, the reference premiums for these SLCSPs are critical components in the BHP payment methodology in order to estimate what PTCs and CSRs would have been paid. Similarly, CMS also needs to collect reference premiums for the lowest cost bronze plans to appropriately account for CSR calculations for American Indians and Alaskan Natives. CMS recently determined that it does not have sufficient data from State Based Exchanges (SBEs) to determine the reference premiums for their SLCSPs and lowest cost bronze plans. Reference premiums are foundational inputs into the BHP payment methodology.

Authorizing Statute(s): PL: Pub.L. 111 - 148 1331 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1331 Name of Law: Health Care and Education Reconciliation Act of 2010

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1331 Name of Law: Patient Protection and Affordable Care Act
PL: Pub.L. 111 - 152 1331 Name of Law: Health Care and Education Reconciliation Act of 2010

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV07	Proposed rulemaking	88 FR 52262	08/07/2023

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 5262	08/07/2023
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Basic Health Program Supporting Regulations	CMS-10510, CMS-10510, CMS-10510, CMS-10510	, , ,

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	47	27	20
Annual Time Burden (Hours)	3,172	2,568	604
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: In this 2023 iteration, we propose changes that relate to updates to BHP proposed in CMS-1784-P and includes a revision of prior State burden estimates related to the State’s Blueprint submission at § 600.125. Additionally, this request revises the operation of a BHP. We propose at §600.145(a), a State must implement its BHP in accordance with (1) the approved and full certified State BHP Blueprint; or (2) the approved suspension application. We propose at § 600.145(f)(2) the State operating a BHP must perform eligibility and health services appeals as specified in § 600.335. We propose at § 600.330(f), BHP eligibility notices must be written in plain language. Finally, this creates a new information collection request for suspension of a BHP. We propose at §600.140(b) if a State decides to suspend its BHP or requests a suspension extension, a State must submit to the Secretary a suspension application or suspension extension application. The State must submit the annual report required by §600.170(a)(2) and annually remit to HHS any interest that has accrued on the balance of the BHP trust fund during the suspension period. We propose that the State must submit a transition plan to HHS that describes how the State will reinstate its BHP or terminate the program. Overall, the rule would add 604 hours.

Annual Cost to Federal Government: $93,869

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

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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