View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-1429	ICR Reference No: 202410-0938-006
Status: Active	Previous ICR Reference No: 202110-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Transparency in Pricing Information (CMS-10715)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/03/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	08/31/2025
Responses	74,462	0	74,462
Time Burden (Hours)	28,618,546	0	28,618,546
Cost Burden (Dollars)	0	0	0

Abstract: The information collection requirements contained in the proposed rule titled “Transparency in Coverage,” published November 27, 2019 (84 FR 65464), would require group health plans and health insurance issuers offering coverage in the individual and group markets to disclose to a participant, beneficiary, or enrollee (or an authorized representative on behalf of such individual), the estimated cost-sharing liability for covered items or services from a particular provider or providers, thereby allowing a participant, beneficiary, or enrollee to obtain an accurate estimate and understanding of their potential out-of-pocket expenses and to effectively shop for covered items and services. Group health plans and health insurance issuers would be required to make such information available through a self-service tool on an internet website. The self-service tool must provide the information through real-time responses and allow users to search for cost-sharing information for covered items and services. The self-service tool must also allow users to input information necessary to learn the out-of-network allowed amount for a covered item or service and have the capability to refine and reorder results. Group health plans and health insurance issuers would also be required to make this information available as a disclosure in written form. Both the self-service tool and the paper disclosure would be required to include several disclaimer statements relevant to information provided through the disclosure and could be provided by using a model notice developed by the Departments. Additionally, group health plans and health insurance issuers would be subject requirements to disclose in-network provider negotiated rates and historical payment data for allowed amounts for covered items and services furnished by out-of-network providers through two digital files in a machine-readable format to be specified by the Departments. The Negotiated Rate file and the Allowed Amount file must be posted publicly on an internet website.

Annual Cost to Federal Government: $0

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: Jamaa Hill 301 492-4190

Common Form ICR: Yes
Description/Changes for Common Form Usage: The purpose of this submission is to establish the information collection request currently approved under 0938-1429 as a Sponsoring Common Form. During the associated rulemaking (85 FR 72158) as well as in the subsequent submission to OMB, the ICR explicitly stated that it would be using the Request for Common Form (RCF) process. Once approved, the Departments would submit RCFs for their respective Departments. Due to an administrative oversight, CMS did not submit 0938-1429 as an ICR sponsoring a common form. With this submission we are correcting the oversight. We note that no changes have been made to the ICR, that is, no new requirements, no removed requirements, no additions or deletions to the respondent populations and no changes to time or cost burden. Two formatting changes were made to the supporting statement document. The supporting statement has been retitled to contain the correct OMB control number and the file was converted from a PDF file to a Word file.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
TREAS/IRS	202410-1545-001CF	Transparency in Coverage	Active	Allowed Amount File, Customer Service Representatives Training, In-Network Rate File, Internet-based Self-Service Tool, Prescription Drug File, Requests for Mailed Disclosures
DOL/EBSA	202410-1210-001CF	Transparency in Pricing Information	Active	Allowed Amount File, Customer Service Representatives Training, In-Network Rate File, Internet-based Self-Service Tool, Prescription Drug File, Requests for Mailed Disclosures