The Centers for Medicare and Medicaid Services (CMS), part of the Department of Health and Human Services, published a notice in the Federal Register on March 26, 2026, announcing a 30-day public comment period for revisions to an existing information collection. This collection, titled 'Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations,' supports the certification of Qualified Health Plans (QHPs) under the Affordable Care Act (ACA). It also aids in risk adjustment and other operational aspects of health insurance Exchanges. The notice, required under the Paperwork Reduction Act of 1995 (PRA), invites feedback on the burden, utility, and clarity of the data collection, with comments due by April 27, 2026, to the Office of Management and Budget (OMB). This development underscores ongoing efforts to refine administrative processes in the health insurance marketplace, potentially affecting over 1,000 issuers and ensuring that plans meet essential standards like network adequacy and non-discrimination. By providing this opportunity for input, CMS aims to balance regulatory needs with efficiency, highlighting the procedural safeguards built into federal information gathering.
Background on the Paperwork Reduction Act and CMS's Role
The PRA, enacted in 1995 and codified at 44 U.S.C. 3501-3520, mandates that federal agencies seek OMB approval for any collection of information from the public to prevent unnecessary burdens. This includes requirements for agencies to publish notices in the Federal Register, allowing public comment on aspects such as the necessity of the data, accuracy of burden estimates, and ways to improve collection methods. In this case, CMS is complying with section 3506(c)(2)(A) of the PRA by issuing a 30-day notice for the revision of an existing collection, previously approved under OMB control number 0938-1187.
CMS oversees the certification of QHPs as outlined in the ACA, specifically through regulations like the Exchange rule (77 FR 18310), which establishes standards for Exchanges and employers. QHPs are health insurance plans certified to be offered on Exchanges, ensuring they meet criteria including essential health benefits, cost-sharing limits, and inclusion of essential community providers. The data collection in question gathers information from issuers to verify compliance with these standards under 45 CFR parts 155 and 156. Beyond certification, the data supports the risk adjustment program, which redistributes funds among plans to mitigate adverse selection by compensating for higher-risk enrollees. This program applies to non-grandfathered individual and small group market plans, both on and off Exchanges.
Key players include CMS as the administering agency, OMB as the approver, and affected parties such as private sector issuers (businesses or for-profits) and state, local, or tribal governments operating Exchanges. The notice estimates 1,073 respondents, each submitting annually, resulting in 61,154 total annual hours of burden. This revision builds on prior approvals, with CMS intending to use the updated instruments starting in 2025 for QHP certification cycles.
Key Components of the Information Collection
The collection focuses on data essential for QHP certification and Exchange operations. Issuers must provide details on network adequacy, which ensures enrollees have reasonable access to providers, and inclusion of essential community providers, such as those serving low-income or medically underserved populations. Other elements include non-discrimination provisions to prevent bias based on health status or other factors.
For the risk adjustment program, the collection requires administrative data like rating areas, rating factors, and actuarial value levels. These inputs are critical for calculating payments and charges, as they help determine how funds are transferred between plans with lower-risk and higher-risk enrollees. The notice clarifies that while QHPs are offered through Exchanges, issuers can also provide non-QHP plans in individual and small group markets outside Exchanges, and the data helps identify eligible plans for risk adjustment.
CMS emphasizes that this is a revision of a currently approved collection, with form number CMS-10433. The agency notes that the instruments will be used for the 2025 certification process and beyond, allowing stakeholders time to review them. However, future revisions may be proposed, subject to full 60-day and 30-day comment periods. Supporting statements and forms are available on the CMS PRA website, and comments can address automated collection techniques to reduce burden.
Implications and Perspectives
This notice has short-term implications for issuers preparing for the 2025 QHP certification, as they may need to adapt to revised data requirements. By soliciting public input, CMS could refine the process to enhance data quality and clarity, potentially reducing the estimated 61,154 annual hours of burden. Long-term, these revisions support the stability of ACA Exchanges by ensuring robust certification and risk adjustment, which have been key to marketplace functionality since the ACA's implementation in 2010.
Relevant legal precedents include court challenges to ACA provisions, such as King v. Burwell (2015), which upheld subsidies on federal Exchanges, reinforcing the framework for QHP certification. Political forces include ongoing debates over ACA reforms, with some stakeholders advocating for reduced regulatory burdens to encourage more issuer participation, while others emphasize strong oversight to protect consumers.
Perspectives vary: Issuers may view the collection as necessary but burdensome, seeking ways to minimize reporting through technology. Consumer advocates might support it for ensuring plan quality, while policymakers could see it as a tool for Exchange efficiency. State-operated Exchanges, numbering 18 as of recent counts, might provide input on how data collection aligns with local needs. No perspective is universally endorsed, but the PRA process ensures diverse views are considered.
In summary, this Federal Register notice represents a procedural step in maintaining the integrity of health insurance markets under the ACA. Potential next steps include OMB review of comments and possible approval of the revised collection. Future challenges may involve adapting to technological advancements in data submission or addressing any evolving ACA regulations. Ongoing debates could center on balancing administrative efficiency with consumer protections, influencing how Exchanges evolve in coming years.
