SUPPLEMENTARY INFORMATION:

Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires federal agencies to publish a 30-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice that summarizes the following proposed collection(s) of information for public comment.

Information Collection

1. Type of Information Collection Request: New collection (Request for a new OMB control number); Title of Information Collection: State Exchange Improper Payment Measurement (SEIPM); Use: The Payment Integrity Information Act of 2019 (PIIA) requires Federal agencies to annually identify, review, measure, and report on the programs they administer that have been determined to be susceptible to significant improper payments. In 2016, HHS determined that payments of APTC are susceptible to significant improper payments and, as a result, are subject to the requirements of PIIA. In accordance with 45 CFR part 155, FFEs, SBE-FPs, and state Exchanges that operate their own eligibility and enrollment systems, determine the amount of APTC to be paid to qualified applicants. Starting in the FY22 Agency Financial Report (AFR), HHS began annually reporting improper payments of APTC administered through FFEs and SBE-FPs as part of the Exchange Improper Payment Measurement (EIPM) program. In 2024, HHS required State Exchanges to participate in the Improper Payment Pre-Testing and Assessment (IPPTA) to prepare State Exchanges for the future implementation of the SEIPM program.

HHS proposes to require state Exchanges to submit to HHS, a sample of tax household information from Qualified Health Plans (QHPs) that have associated APTC payments, for the purpose of being reviewed for improper payments. HHS proposes that the sample size would be of a sufficient quantity to produce a statistically valid estimate of improper payments and in accordance with requirements established by the Office of Management and Budget (OMB). HHS proposes that the measurement of all state Exchanges would occur on an annual basis unless otherwise determined by HHS. The calculated estimate of improper payments would be reported annually in the HHS Agency Financial Report (AFR) as an aggregate rate across all state Exchanges. At HHS' discretion, contractors would be used to support these activities. The burden associated with completion and return of the proposed required information will be the time it will take each state Exchange to meet with HHS to review the information. We estimate that the burden associated with this data collection and transfer will be no more than 8 hours for each sample collected. Form Number: CMS-10942 (OMB control number: 0938-NEW); Frequency: Annually; Affected Public: State, Local, or Tribal Governments; Number of Respondents: 20; Total Annual Responses: 20; Total Annual Hours: 800. (For policy questions regarding this collection contact Halina DeSantis at halina.desantis@cms.hhs.gov.)

2. Type of Information Collection Request: Revision of currently approved collection; Title of Information Collection: Consumer Experience Survey Data Collection; Use: Section 1311(c)(4) of the Affordable Care Act requires the Department of Health and Human Services (HHS) to develop an enrollee satisfaction survey system that assesses consumer experience with qualified health plans (QHPs) offered through an Exchange. It also requires public display of enrollee satisfaction information by the Exchange to allow individuals to easily compare enrollee satisfaction levels between comparable plans. HHS established the QHP Enrollee Experience Survey (QHP Enrollee Survey) to assess consumer experience with the QHPs offered through the Marketplaces. The survey includes topics to assess consumer experience with the health care system such as communication with providers and ease of access to health care services.

CMS developed the survey using the Consumer Assessment of Health Providers and Systems (CAHPS®) principles ( https://www.ahrq.gov/​cahps/​about-cahps/​principles/​index.html) and established an application and approval process for survey vendors who want to participate in collecting QHP enrollee experience data. The QHP Enrollee Survey, which is based on the CAHPS® Health Plan Survey, will be used to (1) help consumers choose among competing health plans, (2) provide actionable information that the QHPs can use to improve performance, (3) provide information that regulatory and accreditation organizations can use to regulate and accredit plans, and (4) provide a longitudinal database for consumer research. To develop the QHP Enrollee Survey, CMS completed developmental testing, including psychometric testing and beta testing. Additional changes made the survey since its development have been informed by focus groups with consumers and QHP issuers, cognitive testing with consumers, and input CMS received from interested parties. CMS previously obtained clearance for the 2016-2026 administrations of the QHP Enrollee Survey. At this time, CMS is requesting to renew approval for the information collection related to the QHP Enrollee Experience Survey in 2027-2029. These activities are necessary to ensure that CMS fulfills legislative mandates established by section 1311(c)(4) of the Affordable Care Act to develop an “enrollee satisfaction survey system” and provide such information on Marketplace websites. CMS is also seeking approval to revise the QHP Enrollee Survey beginning with 2027 to improve response rates, reduce burden on QHP enrollees and improve overall instrument alignment with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) 5.1 Survey. To accomplish this, CMS is proposing to remove four questions related to tobacco-usage that are used to calculate the Medical Assistance with Smoking and Tobacco Use Cessation measure. CMS is also proposing to replace the two demographic questions related to race and ethnicity with one question aligned with the Office of Management and Budget (OMB) Revisions to OMB's Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. CMS is further proposing to refine the survey instrument to align questions related to telehealth with the CAHPS 5.1 Survey. CMS is also proposing to add 5 gate questions to allow participants to screen out of detailed follow-up questions that do not apply to them (see the Crosswalk of Changes to the QHP Enrollee Survey). CMS proposes allowing the customization of the mail and internet survey instruments to replace ( printed page 43095) “Qualified Health Plan (QHP)” with the QHP issuer's name on the cover page. CMS is also proposing to update the QHP Enrollee Survey sampling protocol to allow oversampling at any level. CMS is also seeking to add a third email reminder on Day 40 of the fielding timeline and to extend the telephone dialing period by one week to begin on Day 48 of the fielding timeline. Finally, CMS is proposing revisions to the survey instrument, prenotification letter, reminder letter, survey cover letter, and notification/reminder emails for plain language to reduce repetition and improve readability. Form Number: CMS-10488 (OMB control number: 0938-1221); Frequency: Annually; Affected Public Sector: (Individuals and Households), Private sector (Business or other for-profits and Not-for-profit institutions); Number of Respondents: 72,008 respondents; Total Annual Responses: 72,008; Total Annual Hours: 12,013. (For policy questions regarding this collection contact Preeti Hans 301-492-5114).