View Information Collection Request (ICR) Package

OMB Control No: 0938-1429	ICR Reference No: 202410-0938-023
Status: Historical Inactive	Previous ICR Reference No: 202410-0938-006
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OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/07/2025
	Date Received in OIRA: 10/30/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2027	36 Months From Approved	10/31/2027
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.

Authorizing Statute(s): US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in Coverage
   US Code: 45 USC 156.220 Name of Law: Transparency in Coverage
   PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act

Citations for New Statutory Requirements: US Code: 45 USC 155.1040(a)-(c) Name of Law: Transparency in Coverage
US Code: 45 USC 156.220 Name of Law: Transparency in Coverage

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV57	Proposed rulemaking	89 FR 85750	10/28/2024

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Allowed Amount File	CMS-10715, CMS-10715	,
Contraceptive Disclosure	CMS-10715
Customer Service Representatives Training	CMS-10715
In-Network Rate File	CMS-10715, CMS-10715	,
Internet-based Self-Service Tool	CMS-10715, CMS-10715	,
Prescription Drug File
Requests for Mailed Disclosures

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: The overall burden has decreased from 28,618,546 to 7,591,925 hours, resulting in a total burden reduction of 21,026,621 hours. Consequently, the associated cost has decreased from $1,036,852,972 to $28,618,546, resulting in a reduction of $1,008,234,426. Although the introduction of the proposed rule to incorporate the contraceptive disclosure into the existing internet-based self-service tool led to a slight increase in burden, the significant reduction in the overall burden is primarily due to removal of first- and second-year one-time burden for issuers and TPAs to develop and implement their internet-based self-service tool, which were incurred in 2022 and 2023. Additionally, the overall reduction in burden is partially due to the updated count of issuers and TPAs, resulting in a decreased total number of these entities. In addition to these changes in burden, CMS has updated the CFR citations in this Transparency in Coverage Supporting Statement’s ICR section headings to correct errors in the prior version of the Transparency in Coverage Supporting Statement. The citation in the section heading for the ICRs Regarding Requirements for Disclosures to Participants, Beneficiaries, or Enrollees was updated from 45 CFR 147.210(b) to 45 CFR 147.211(b). The citation in the section heading for ICRs Regarding Requirements for Public Disclosure of In-network Rates, Historical Allowed Amount Data for Covered Items and Services from Out-of-Network Providers and Prescription Drug Pricing Information was updated from 45 CFR 147.21 to 45 CFR 147.212.

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 revise the information collection request currently approved under 0938-1429 as a Sponsoring Common Form.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

View ICR - OIRA Conclusion