52994 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 

Pesticide chemical CAS Reg. No. Uses 

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Sulfuric acid .......................... 7664–93–9 ......................... Food-contact surfaces in public eating places, dairy-processing equipment, and 

food-processing equipment and utensils in antimicrobial formulations. Not to exceed 600 ppm. 

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[FR Doc. 2014–21109 Filed 9–4–14; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Parts 146, 147, 148, 155, and 

156 

[CMS–9941–F] 

RIN 0938–AS32 

Patient Protection and Affordable Care 

Act; Annual Eligibility 

Redeterminations for Exchange 

Participation and Insurance 

Affordability Programs; Health 

Insurance Issuer Standards Under the 

Affordable Care Act, Including 

Standards Related to Exchanges 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule. 

SUMMARY: This final rule specifies 

additional options for annual eligibility 

redeterminations and renewal and reenrollment notice requirements for 

qualified health plans offered through 

the Exchange, beginning with annual 

redeterminations for coverage for benefit 

year 2015. This final rule provides 

additional flexibility for Exchanges, 

including the ability to propose unique 

approaches that meet the specific needs 

of their state, while streamlining the 

consumer experience. 

DATES: These regulations are effective 

on October 6, 2014. 

FOR FURTHER INFORMATION CONTACT: 

Jacob Ackerman, (301) 492–4179, for 

questions regarding parts 146 through 

148. Christine Hammer, (301) 492–4431, 

for questions regarding part 155. 

Spencer Manasse, (301) 492–5141, for 

questions regarding part 156. 

SUPPLEMENTARY INFORMATION: This 

Federal Register document is also 

available from the Federal Register 

online database through Federal Digital 

System (FDsys), a service of the U.S. 

Government Printing Office. This 

database can be accessed via the 

internet at http://www.gpo.gov/fdsys. 

Table of Contents 

I. Background 

A. Legislative Overview 

B. Stakeholder Consultation and Input 

C. Structure of the Final Rule 

II. Provisions of the Proposed Regulations 

and Analysis and Responses to Public 

Comments 

A. Part 146—Requirements for the Group 

Health Insurance Market; Subpart E— 

Provisions Applicable to Only Health 

Insurance Issuers 

B. Part 147—Health Insurance Reform 

Requirements for the Group and 

Individual Health Insurance Markets 

C. Part 148—Requirements for the 

Individual Health Insurance Market; 

Subpart B—Requirements Relating to 

Access and Renewability of Coverage 

D. Part 155—Exchange Establishment 

Standards and Other Related Standards 

Under the Affordable Care Act; Subpart 

D—Exchange Functions in the 

Individual Market: Eligibility 

Determinations for Exchange 

Participation and Insurance Affordability 

Programs 

E. Part 156—Health Insurance Issuer 

Standards Under the Affordable Care 

Act, Including Standards Related to 

Exchanges; Subpart M—Qualified Health 

Plan Issuer Responsibilities 

III. Collection of Information Requirements 

IV. Regulatory Impact Statement 

I. Background 

A. Legislative Overview 

The Patient Protection and Affordable 

Care Act (Pub. L. 111–148) was enacted 

on March 23, 2010. The Health Care and 

Education Reconciliation Act of 2010 

(Pub. L. 111–152), which amended and 

revised several provisions of the Patient 

Protection and Affordable Care Act, was 

enacted on March 30, 2010. In this final 

rule, we refer to the two statutes 

collectively as the ‘‘Affordable Care 

Act.’’ Subtitles A and C of Title I of the 

Affordable Care Act reorganized, 

amended, and added to the provisions 

of part A of Title XXVII of the Public 

Health Service Act (PHS Act) relating to 

group health plans and health insurance 

issuers in the group and individual 

markets. 

Starting on October 1, 2013 for 

coverage starting as soon as January 1, 

2014, qualified individuals and 

qualified employers have been able to 

purchase qualified health plans 

(QHPs)—private health insurance that 

has been certified as meeting certain 

standards—through competitive 

marketplaces called Exchanges or 

Health Insurance Marketplaces. The 

word ‘‘Exchanges’’ refers to both State 

Exchanges, also called State-based 

Exchanges, and Federally-facilitated 

Exchanges (FFEs). In this final rule, we 

use the terms ‘‘State Exchange’’ or 

‘‘FFE’’ when we are referring to a 

particular type of Exchange. When we 

refer to ‘‘FFEs,’’ we are also referring to 

State Partnership Exchanges, which are 

a form of FFE. 

Section 1411(f)(1)(B) of the Affordable 

Care Act directs the Secretary of Health 

and Human Services (the Secretary) to 

establish procedures to redetermine the 

eligibility of individuals on a periodic 

basis in appropriate circumstances. 

Section 1321(a) of the Affordable Care 

Act provides authority for the Secretary 

to establish standards and regulations to 

implement the statutory requirements 

related to Exchanges, QHPs and other 

components of Title I of the Affordable 

Care Act. Section 2703 of the PHS Act, 

as added by the Affordable Care Act, 

and sections 2712 and 2741 of the PHS 

Act, as added by the Health Insurance 

Portability and Accountability Act of 

1996, require health insurance issuers in 

the group and individual markets to 

guarantee the renewability of coverage 

unless an exception applies. 

B. Stakeholder Consultation and Input 

The Department of Health and Human 

Services (HHS) has consulted with 

stakeholders on a number of policies 

related to the operation of Exchanges, 

including eligibility redetermination. 

HHS has held a number of listening 

sessions with consumers, providers, 

employers, health plans, and State 

representatives to gather public input. 

HHS consulted with stakeholders 

through regular meetings with the 

National Association of Insurance 

Commissioners (NAIC), regular contact 

with states through the Exchange grant 

process, meetings with the CMS Tribal 

Technical Advisory Group and an All 

Tribes Call on July 21, 2014 with tribal 

leaders and representatives, health 

insurance issuers, trade groups, 

consumer advocates, employers, and 


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Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 52995 

other interested parties. We considered 

all of the public input as we developed 

the policies in this final rule. 

C. Structure of the Final Rule 

The regulations in this final rule will 

be codified in 45 CFR parts 146, 147, 

148, 155, and 156. Part 146 specifies 

standards related to the group health 

insurance market, including guaranteed 

renewability of coverage for employers 

in the group market. Part 147 specifies 

standards related to health insurance 

reforms for the group and individual 

health insurance markets, including 

guaranteed renewability of coverage. 

Part 148 specifies standards for the 

individual health insurance market, 

including guaranteed renewability of 

individual health insurance coverage. 

Part 155 specifies standards related to 

the establishment, operation, and 

minimum functionality of Exchanges, 

including annual eligibility 

redeterminations. Part 156 specifies 

standards for health insurance issuers 

with respect to participation in an 

Exchange. 

II. Provisions of the Proposed 

Regulations and Analysis and 

Responses to Comments 

On July 1, 2014, we published a 

proposed rule in the Federal Register 

(79 FR 37262) entitled, Patient 

Protection and Affordable Care Act; 

Annual Eligibility Redeterminations for 

Exchange Participation and Insurance 

Affordability Programs; Health 

Insurance Issuer Standards Under the 

Affordable Care Act, Including 

Standards Related to Exchanges. The 

July 1, 2014 proposed rule (hereinafter 

referred to as the July 1, 2014 Annual 

Eligibility Redeterminations proposed 

rule) proposed additional options for 

annual eligibility redeterminations and 

renewal and re-enrollment notice 

requirements for QHPs offered through 

the Exchange, beginning with annual 

redeterminations for the 2015 benefit 

year. In total, we received 36 comments 

on the July 1, 2014 Annual Eligibility 

Redeterminations proposed rule. 

Comments represented a wide variety of 

stakeholders, including but not limited 

to states, tribal organizations, health 

plans, healthcare providers, consumer 

groups, and industry experts. We note 

that we received some public comments 

that were outside the scope of the 

proposed rule and are not addressed in 

this final rule. We have not provided 

explicit responses to such comments. 

In this final rule, we provide a 

summary of each proposed provision, a 

summary of and responses to public 

comments received, and the provisions 

we are finalizing. 

A. Part 146—Requirements for the 

Group Health Insurance Market; 

Subpart E—Provisions Applicable to 

Only Health Insurance Issuers 

For a discussion of the provisions of 

this final rule related to Part 146, see 

section II.B of this preamble. 

B. Part 147—Health Insurance Reform 

Requirements for the Group and 

Individual Health Insurance Markets 

In the preamble to the July 1, 2014 

Annual Eligibility Redeterminations 

proposed rule, we proposed establishing 

a notice requirement that would apply 

to all issuers subject to the guaranteed 

renewability requirements that 

nonrenew coverage based on continued 

coverage not being available in the 

enrollee’s service area as a result of 

changes that do not result in product 

discontinuances. This proposal was 

intended to ensure that enrollees receive 

notice when the product (as defined in 

45 CFR 144.103) that they purchased no 

longer covers their location in its service 

area and their coverage will be 

nonrenewed consistent with the 

guaranteed renewability provisions. We 

sought comment on this proposal, 

including the appropriate timeframe for 

providing the notice. We received no 

comments on this proposal. 

In this final rule, we amend the 

guaranteed renewability regulations at 

§ 146.152(b)(5), § 147.106(b)(5), and 

§ 148.122(c)(4) to direct an issuer that 

nonrenews coverage based on enrollees’ 

movement outside the service area to 

provide notice in writing to each plan 

sponsor or individual, as applicable, 

(and to all participants and beneficiaries 

covered under the coverage) affected by 

such nonrenewal. This notice must be 

provided in the form and manner 

specified by the Secretary for notices of 

product discontinuances. This 

requirement applies to grandfathered 

and non-grandfathered coverage in the 

individual, small group, and large group 

markets offered through or outside an 

Exchange. 

Final Rule Action: We are amending 

the guaranteed renewability regulations 

at § 146.152, § 147.106, and § 148.122 to 

establish a notice requirement for 

issuers that nonrenew coverage based 

on an enrollee no longer being located 

within the product’s service area. 

C. Part 148—Requirements for the 

Individual Health Insurance Market; 

Subpart B—Requirements Relating to 

Access and Renewability of Coverage 

For a discussion of the provisions of 

this final rule related to Part 148, see 

section II.B of this preamble. 

D. Part 155—Exchange Establishment 

Standards and Other Related Standards 

Under the Affordable Care Act; Subpart 

D—Exchange Functions in the 

Individual Market: Eligibility 

Determinations for Exchange 

Participation and Insurance 

Affordability Programs 

In § 155.330, we proposed to amend 

paragraph (b)(4), which addresses 

reporting changes in the context of 

eligibility redeterminations during a 

benefit year. Our proposal provided that 

the Exchange must allow an enrollee, or 

an application filer on behalf of the 

enrollee, to report changes via the 

channels available for the submission of 

an application; however, we proposed 

that the Exchange be permitted, but not 

required, to allow an enrollee, or an 

application filer, on behalf of the 

enrollee, to report changes via mail. We 

noted that experience has shown that 

eligibility changes reported by mail are 

often difficult to process because they 

frequently trigger telephone contact to 

gather additional information needed to 

process the change. We noted that, if 

finalized, we anticipate that the FFE 

would not accept changes reported via 

mail for the foreseeable future. 

Comment: We received several 

comments on the proposed changes to 

§ 155.330(b)(4). Some comments 

requested that HHS retain the 

requirement that Exchanges allow 

enrollees to use mail to report changes 

during the benefit year. These 

commenters expressed concern that 

finalizing the provision as proposed 

would place an undue burden on 

vulnerable populations who may not 

have ready access to phones, the 

Internet, or transportation to in-person 

assisters. A few commenters 

recommended creating a paper change 

report form to elicit the correct 

information to process changes reported 

by mail. In contrast, a few commenters 

supported the flexibility the proposed 

provision provided to Exchanges and 

viewed the proposal as administratively 

efficient. 

Response: We are finalizing the 

provision as proposed, permitting 

Exchanges flexibility to determine 

whether to provide a process to report 

changes via mail and note that the FFE 

will be using this flexibility to not 

provide such a process via mail. We 

agree that vulnerable populations must 

have ready access to the Exchange to 

report changes. However, as noted in 

the preamble to the proposed rule, 

experience has shown that changes 

reported via mail often require 

significant follow-up and can result in 

delays in processing pertinent eligibility 


tkelley on DSK3SPTVN1PROD with RULES
52996 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 

1 Guidance on Annual Redeterminations for 

Coverage for 2015, available at http://

www.coms.gov/cciio/resources/Regulations-andGuidance/index.html. 

information, often to the detriment of 

the consumer. Accordingly, while 

Exchanges may allow for the reporting 

of changes by mail, they are not 

required to do so. The FFE will elect not 

to allow changes by mail for the 

foreseeable future. 

Comment: One commenter asked 

whether the call center would be able to 

inform the individual the result of 

reporting a change. Another commenter 

questioned whether the Exchange 

would provide written confirmation, 

including an explanation of any action 

taken, to the enrollee who submits a 

change. 

Response: In the FFE, we anticipate 

that the majority of enrollees will know 

the outcome of the changes reported 

through the call center during their call. 

As with all actions that result in a new 

eligibility determination, the enrollees 

will receive an eligibility determination 

notice (in the format—hard copy or 

electronic—that they have chosen). 

Final Rule Action: We are finalizing 

the provision as proposed in 

§ 155.330(b)(4). 

In § 155.335(a), we proposed 

amendments to the general requirement 

for annual eligibility redetermination. 

Specifically, we proposed in paragraph 

(a)(1) that, except as specified in 

paragraphs (l) and (m) of this section, 

the Exchange must redetermine the 

eligibility of a qualified individual on 

an annual basis. In paragraph (a)(2), we 

proposed the Exchange must conduct 

annual redeterminations using one of 

three options: (1) The procedures 

described in § 155.335(b) through (m); 

(2) alternative procedures specified by 

the Secretary for the applicable plan 

year; or (3) alternative procedures 

approved by the Secretary based on a 

showing by the Exchange that the 

alternative procedures would facilitate 

continued enrollment in coverage for 

which the enrollee remains eligible, 

provide clear information about the 

process to the qualified individual or 

enrollee (including regarding any action 

by the qualified individual or enrollee 

necessary to obtain the most accurate 

redetermination of eligibility), and 

provide adequate program integrity 

protections. 

Comment: We received many 

comments supporting the flexibility 

provided by the three options for 

Exchanges to implement annual 

redetermination procedures. These 

commenters believed that the proposal 

would promote uninterrupted coverage 

for enrollees, as well as enhance and 

streamline the redetermination process. 

Response: We appreciate the support 

for the three options we proposed for 

Exchanges to conduct annual eligibility 

redeterminations. 

Comment: A few commenters 

supported moving Exchanges toward a 

single standard for annual eligibility 

redeterminations, primarily in 

accordance with § 155.335(b) through 

(m). 

Response: We anticipate that the 

flexibility offered to Exchanges to select 

procedures for conducting annual 

redeterminations will encourage 

innovation and best practices that will 

benefit both Exchanges and stakeholders 

over time. We caution that no matter 

which option an Exchange implements 

for annual redeterminations, the 

Exchange will be held to applicable 

program integrity and oversight 

standards to ensure an effective process. 

Comment: Several commenters asked 

that a fully-automated redetermination 

process be implemented. Specifically, 

these commenters recommended that 

enrollees not be required to reapply at 

their Exchange in order to maintain 

accurate subsidies and program 

eligibility by the 2016 benefit year. In 

contrast, one commenter requested that 

auto-redeterminations not be 

implemented until 2016. 

Response: We recognize the 

importance of a simple consumer 

experience during the eligibility 

redetermination and re-enrollment 

process as well as the potential benefits 

consumers may receive by regularly 

updating their application information, 

or simply confirming its accuracy. 

Comment: We received a few 

comments from the issuer community 

citing concern that the guidance 

released alongside the proposed rule, 

specifying the alternative procedures 

that the FFE would use under proposed 

§ 155.225(a)(2)(ii) (the Guidance on 

Annual Redeterminations for 2015 1), is 

limited to the 2015 benefit year 

Response: We indicated in the July 1, 

2014 Annual Eligibility 

Redeterminations proposed rule that 

these are the procedures the FFE would 

use for the 2015 benefit year, if the 

proposed option to select these 

alternative procedures were finalized. 

The flexibility provided for the 

Secretary to update the alternative 

procedures under § 155.335(a)(2)(ii) is 

intended to ensure that HHS can learn 

from the Exchanges’ experience and 

improve the alternative procedures over 

time. Although HHS may issue revised 

alternative procedures annually, we 

intend to work with stakeholders to 

ensure there is sufficient lead time in 

the event changes are made. 

Comment: Commenters, particularly 

State-based Exchanges, were supportive 

of the option proposed in 

§ 155.335(a)(2)(iii) allowing Exchanges 

to propose alternative procedures, 

subject to approval by the Secretary, for 

conducting annual redeterminations. In 

contrast, one commenter encouraged 

HHS to standardize redetermination 

procedures across all Exchanges to 

reduce administrative burden on the 

issuer community. 

Response: Although we understand 

the desire to create uniform processes 

across Exchanges by permitting this 

flexibility, Exchanges will be able to 

benefit from the experiences of one 

another and be able to apply lessonslearned to improve their consumers’ 

redetermination experience. 

Comment: We received a few 

comments regarding how HHS should 

conduct reviews of alternative 

procedures proposed by Exchanges. One 

commenter requested that reviews of 

alternative procedures be conducted on 

an individualized basis, considering 

state-specific factors, including 

operational structure, 2014 experience, 

and information technology capabilities. 

Similarly, several commenters 

recommended specifying additional 

standards that Exchanges’ alternative 

procedures must meet as part of the 

review process. Other commenters 

recommended that alternative 

procedures must meet minimum federal 

standards, not be burdensome for 

consumers, and be clear improvements 

from the process implemented by the 

FFE. Finally, a commenter requested 

that alternative procedures for 

redeterminations be publicly available. 

Response: We appreciate the many 

suggestions for standards for alternative 

redetermination procedures under 

§ 155.335(a)(2)(iii), as well as 

recommendations for the approval 

process for those procedures. We note 

that the alternative procedures we are 

finalizing under § 155.335(a)(2)(iii) must 

provide consumer and program integrity 

protections to ensure a consistent, 

effective process that safeguards public 

funds. We will work with Exchanges to 

develop and provide guidance about the 

process for submitting alternative 

procedures for approval under 

§ 155.335(a)(2)(iii). 

Comment: Several commenters 

submitted comments regarding the 

substance of the Guidance on Annual 

Redeterminations for 2015 released 

contemporaneously with the July 1, 

2014 Annual Eligibility 

Redeterminations proposed rule. 


tkelley on DSK3SPTVN1PROD with RULES
Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 52997 

Response: The substance of the 

Guidance on Annual Redeterminations 

for 2015 is beyond the scope of the 

proposed rule and these comments are 

not addressed in this final rule. 

Final Rule Action: We are finalizing 

§ 155.335(a) with a minor modification 

changing ‘‘plan year’’ to ‘‘benefit year’’ 

in § 155.335(a)(2)(ii). 

In § 155.335(e), we proposed to revise 

the language regarding change reporting 

to generally align with the standards in 

§ 155.330(b), so that § 155.335(e) would 

specify that, except as specified in 

proposed paragraph (e)(1), the Exchange 

must require a qualified individual to 

report any change with respect to the 

eligibility standards specified in 

§ 155.305 within 30 days of any such 

change. In paragraph (e)(1), we 

proposed that the Exchange must not 

require a qualified individual who did 

not request an eligibility determination 

for insurance affordability programs to 

report changes that affect eligibility for 

insurance affordability programs. 

Finally, in paragraph (e)(2), we 

proposed to amend the existing 

provision requiring that the Exchange 

must allow a qualified individual, or an 

application filer, on behalf of the 

qualified individual, to report changes 

via the channels available for 

submission of an application, as 

described in § 155.405(c)(2). We 

proposed that this requirement would 

continue to apply, except that the 

Exchange would be permitted but not 

required to allow a qualified individual, 

or an application filer, on behalf of the 

qualified individual, to report changes 

via mail. 

Comment: We received some 

comments regarding the proposed 

provisions in paragraph (e). A few 

commenters recommended not revising 

the provisions in paragraph (e) at all. 

Other commenters sought clarification 

as to whether the changes reported at 

annual redetermination should be based 

on current circumstances or could be 

based on expected changes in the 

coming benefit year. Another 

commenter supported the proposed 

provision in paragraph (e)(1), which 

would not permit Exchanges to require 

a qualified individual who did not 

request an eligibility determination for 

insurance affordability programs to 

report changes that affect eligibility for 

insurance affordability programs. One 

commenter recommended that 

Exchanges be required to inform people 

about the availability of financial 

assistance through the Exchange even if 

they are not currently receiving it. 

Finally, one commenter requested that 

Exchanges be required to include a 

summary of the individual’s application 

on file in the annual redetermination 

notice and to ensure that this 

information is in plain language so it is 

easily accessible for all consumers. 

Response: We believe the 

amendments made to this paragraph are 

necessary to generally align with the 

standards in § 155.330, including 

proposed § 155.330(b)(4), which governs 

the corresponding requirements for 

eligibility redeterminations during the 

benefit year. We note that non-income 

related eligibility criteria, such as 

residency changes must be reported 

within 30 days following the change in 

accordance with § 155.330(b)(1). 

However, we further clarify, in response 

to comment, that eligibility for advance 

payments of the premium tax credit and 

cost-sharing reductions is based on 

projected annual household income and 

consumers may update that information 

at any time throughout the year. We also 

note that Exchanges may, but are not 

required, to remind consumers who do 

not currently receive advance payments 

of the premium tax credit or costsharing reductions through the 

Exchange that they may be eligible for 

this financial assistance. Consistent 

with all applicable requirements, 

Exchanges can provide additional 

information at their discretion. 

Comment: Several commenters 

requested that paragraph (e) provide a 

minimum threshold below which 

income changes would not be required 

to be reported for annual 

redetermination. We also received a 

comment asking that Exchanges use 

consistent messaging about reporting 

changes in income to reduce consumer 

confusion. 

Response: We note that the provision 

for reporting changes during the benefit 

year at § 155.330 does permit Exchanges 

to establish a reasonable threshold for 

reporting changes in income. However, 

we have declined to establish a 

threshold in this instance, in order to 

promote the greatest possible accuracy 

of annual eligibility redeterminations. 

Because all consumers will be subject to 

annual redeterminations, we consider 

the accuracy of annual redeterminations 

to be a priority and a significant way in 

which Exchanges can help reduce the 

risk that consumers may have to pay 

back any amount of their advance 

payments of the premium tax credit at 

tax filing time if, through the 

reconciliation process, the IRS 

determines the advance payment of the 

premium tax credit to be in excess of the 

premium tax credit for which the 

consumer was actually eligible. We note 

that consumers who do not have steady 

or predictable income have the same 

change reporting options as all other 

consumers and are able to project 

income-related changes for the year as 

part of their annual eligibility 

redetermination, reducing the frequency 

with which they must report an incomerelated change. Finally, Exchanges must 

adhere to the standards in § 155.330(b) 

requiring consumers to report changes 

during the benefit year; however, 

Exchanges have flexibility to establish 

reasonable thresholds below which 

changes in income do not have to be 

reported for purposes of a mid-year 

redetermination. Given this flexibility, 

we do not believe it is necessary to 

impose specific requirements regarding 

change reporting messages across 

Exchanges. 

Comment: We received several 

comments about the requirement in 

proposed § 155.335(e) that qualified 

individuals report any change with 

respect to eligibility standards within 30 

days of such a change. One commenter 

questioned what the consequences were 

if an individual fails to report a change 

within 30 days or reports the change 

more than 30 days after the change. 

Another commenter suggested clarifying 

that individuals who report changes 

more than 30 days after they occur can 

still receive an updated eligibility 

determination. 

Response: The requirement to report 

changes within 30 days is intended to 

ensure that eligibility determinations 

remain accurate in view of qualified 

individuals’ most current eligibility 

information, and reduce the risk that 

consumers may have to repay advance 

payments of the premium tax credit in 

excess of what they are eligible for, 

through the reconciliation process. 

Individuals who report changes more 

than 30 days after the change will still 

receive an updated eligibility 

determination. 

Comment: We received comments 

both supporting and opposing the 

proposed change in paragraph (e)(2) to 

eliminate the requirement for Exchanges 

to accept changes reported by mail, with 

many commenters focusing on the 

potential lack of access vulnerable 

populations may have to the methods 

Exchanges are required to provide for 

reporting changes. We also received a 

few general recommendations related to 

this provision. For example, one 

commenter recommended Exchanges 

establish tiered support through the call 

center. Another comment emphasized 

the need for a streamlined process for 

consumers to update their income and 

eligibility information without having to 

go through the entire application 

process. 

Response: As noted in responses to 

the comments regarding the proposed 


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52998 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 

changes to § 155.330(b)(4), we agree that 

vulnerable populations must have 

access to the Exchange to report 

changes. However, changes reported by 

mail often require significant follow-up 

in order to obtain enough information to 

process the change, which creates a 

burden on both the Exchange and the 

consumer to complete the change 

reporting process. The required methods 

for accepting reported changes should 

only require a one-time interaction with 

the Exchange and we do not believe 

they inappropriately limit the ability of 

consumers to efficiently report changes. 

Therefore, we are finalizing the 

provision as proposed, permitting 

Exchanges flexibility to determine 

whether to accept reports of changes via 

mail. 

Final Rule Action: We are finalizing 

§ 155.335(e) as proposed. 

In § 155.335(j), we proposed to modify 

the standards for re-enrollment in 

coverage. First, in paragraph (j)(1), we 

proposed that if an enrollee remains 

eligible for enrollment in a QHP through 

the Exchange upon annual 

redetermination, and the product under 

which the QHP in which he or she was 

enrolled remains available for renewal, 

consistent with 45 CFR 147.106, such 

enrollee will have his or her enrollment 

in a QHP under the product renewed 

unless he or she terminates coverage, 

including termination of coverage in 

connection with voluntarily selecting a 

different QHP, in accordance with 

§ 155.430. In this situation, we proposed 

that the QHP in which the enrollee will 

be renewed will be selected according to 

the following order of priority: (1) In the 

same plan as the enrollee’s current QHP; 

(2) if the enrollee’s current QHP is not 

available, the enrollee’s coverage will be 

renewed in a plan at the same metal 

level as the enrollee’s current QHP; (3) 

if the enrollee’s current QHP is not 

available and the enrollee’s product no 

longer includes a plan at the same metal 

level as the enrollee’s current QHP, the 

enrollee’s coverage will be renewed in 

a plan that is one metal level higher or 

lower than the enrollee’s current QHP; 

and (4) if the enrollee’s current QHP is 

not available and the enrollee’s product 

no longer includes a plan that is at the 

same metal level as, or one metal level 

higher or lower than the enrollee’s 

current QHP, the enrollee’s coverage 

will be renewed in any other plan 

offered under the product in which the 

enrollee’s current QHP is offered in 

which the enrollee is eligible to enroll. 

Second, in paragraph (j)(2), we 

proposed standards to address reenrollment in situations in which the 

product under which an enrollee’s QHP 

is offered is not available through the 

Exchange for renewal, consistent with 

§ 147.106. In this situation, we proposed 

the issuer may still re-enroll the enrollee 

in a different product offered by the 

same issuer, to the extent permitted by 

applicable state law, unless the enrollee 

terminates coverage. To the extent that 

an issuer is re-enrolling such an 

enrollee, we proposed that the plan in 

which the enrollee will be renewed will 

be selected according to the following 

order of priority: (1) In a plan through 

the Exchange at the same metal level as 

the enrollee’s current QHP in the 

product offered by the issuer that is the 

most similar to the enrollee’s current 

product; (2) if the issuer does not offer 

another plan through the Exchange at 

the same metal level as the enrollee’s 

current QHP, the enrollee will be reenrolled in a plan through the Exchange 

that is one metal level higher or lower 

than the enrollee’s current QHP in the 

product offered by the issuer through 

the Exchange that is the most similar to 

the enrollee’s current product; (3) if the 

issuer does not offer another plan 

through the Exchange at the same metal 

level as, or one metal level higher or 

lower than the enrollee’s current QHP, 

the enrollee will be re-enrolled in any 

other plan offered through the Exchange 

by the QHP issuer in which the enrollee 

is eligible to enroll; and (4) if the issuer 

does not offer any plan through the 

Exchange in which the enrollee is 

eligible to enroll, the enrollee may be reenrolled in a plan offered outside the 

Exchange by the QHP issuer under the 

product that is the most similar to the 

enrollee’s current product, in which the 

enrollee is eligible to enroll. We also 

solicited comment regarding whether 

paragraphs (j)(1)(iii) and (j)(2)(ii) should 

only prioritize a plan with a lower metal 

level, and whether in general, priority 

should be placed on plans that have a 

premium that is closest to the plan in 

which an enrollee is currently enrolled. 

Comment: One commenter noted the 

importance of continuity of coverage 

without gaps and suggested that 

consumers have full transparency into 

the process and be informed why they 

are being enrolled in a product and 

notified that some issuers who did not 

participate in the Exchange in the 2014 

benefit year may be offering plans in the 

2015 benefit year that consumers may 

want to consider. Similarly, a 

commenter did not support the reenrollment provisions, believing they 

would steer members away from the 

shopping experience and discourage 

incumbent issuers from creating new 

and innovative products. A few 

commenters noted their general support 

for the provisions in paragraph (j) and 

noted that they would cause the least 

amount of disruption to the enrollee. 

Response: We believe that the rule, as 

finalized, best furthers the goal of 

creating continuity of coverage for 

consumers at annual redetermination 

and enrollment. We agree that 

consumers should understand why they 

are being enrolled into a new plan, if 

applicable, and be reminded that, in all 

cases, after being redetermined to be 

eligible for coverage through the 

Exchange, they can return to the 

Exchange to shop for another plan, if 

they wish. 

Comment: Some commenters 

suggested delaying the implementation 

of the proposed auto-enrollment policy 

until the 2016 benefit year due to 

concerns about operational readiness. A 

commenter asked that, if HHS did 

proceed with 2015 implementation, the 

enrollment policy be permitted only at 

the end of open enrollment after all 

enrollee outreach has been conducted. 

Response: We understand that QHP 

issuers, Exchanges, consumers, and 

other stakeholders are concerned that 

they have time to prepare for the 

redetermination and enrollment period 

for benefit year 2015 coverage. We agree 

that encouraging aggressive outreach 

and enrollee engagement are important. 

However, it is important for 

stakeholders to have sufficient guidance 

to conduct redetermination and reenrollment in accordance with federal 

standards during the entire open 

enrollment period for the 2015 benefit 

year. Postponing the implementation of 

enrollment procedures until the end of 

the open enrollment period could result 

in some consumers experiencing gaps in 

coverage. We believe that the Exchange 

should complete the redetermination 

and re-enrollment process early enough 

so that consumers have coverage (and 

financial assistance, if applicable) 

effective January 1, 2015. 

Comment: A few commenters 

provided general comments on and 

alternatives to the proposed hierarchies 

in paragraphs (j)(1) and (2). For 

instance, one commenter disagreed with 

the use of the hierarchy because of the 

substantial differences in plans that a 

consumer may be renewed or reenrolled into at different metal levels 

and in different product lines. Another 

commenter thought enrolling a 

consumer in a product or plan other 

than the consumer’s identical QHP 

would cause confusion and interrupt 

established provider-patient care, and 

inflate premiums. Similarly, a few 

commenters requested flexibility in 

applying the hierarchy in cases where 

its application could harm consumers or 

where the enrollee is in a unique 


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situation. For example, if the enrollee 

lives outside of the plan’s service area, 

is enrolled in a catastrophic plan, or has 

aged off a parent’s policy, the consumer 

may not have eligibility to re-enroll in 

the same plan. 

Response: We understand the 

complexities that may result when 

consumers are placed in a different plan 

or product as the result of renewal or reenrollment. However, we note that 

placement into another plan or product 

is not intended to be the usual result of 

the open enrollment period. The 

hierarchy proposed in § 155.335(j)(1) 

and (2) is only intended for use when 

a consumer’s plan is no longer available 

or the product is discontinued, which 

we do not expect to be the typical 

scenario. The hierarchy then provides a 

structured process for renewal and reenrollment which are intended to limit 

the differences between the consumer’s 

current plan and new plan. We are 

finalizing the renewal and re-enrollment 

provisions with the hierarchical 

structure to guide the renewal and reenrollment process while protecting the 

interests of the enrollee. Finally, we 

note that we are reviewing the unique 

situations noted by commenters and 

intend to issue guidance as to how to 

handle re-enrollment in these situations 

in the future. 

Comment: We received several 

comments regarding the issuer’s role in 

the re-enrollment process, particularly 

around the determination of when a 

product is ‘‘most similar’’ to an 

enrollee’s current product, as stated in 

§ 155.335(j)(2)(i), (ii), and (iv). For 

example, a few commenters suggested 

that the Exchange, not the QHP issuer, 

should determine comparability of 

plans to ensure that these 

determinations are objective and in a 

consumer’s best interest. Commenters 

requested that HHS define the criteria 

used in determining plan comparability 

and to define how a product will be 

determined ‘‘similar.’’ Finally, one 

commenter indicated support for 

allowing the issuer to determine which 

product is most similar 

Response: QHP issuers are in a unique 

position to understand both the 

characteristics of enrollees’ current 

products and the issuers’ other product 

offerings. As part of the QHP 

certification process QHP issuers in the 

FFE will submit crosswalks, mapping 

similar plans and products. Mapping 

enrollees in a given product to a similar 

product is a common industry practice. 

As noted earlier, a key priority during 

the open enrollment period is to ensure 

that current enrollees have continuity of 

coverage and do not experience a gap in 

that coverage or their financial 

assistance. QHP issuers, coordinating 

with Exchanges to implement the reenrollment and renewals, can 

streamline the re-enrollment and 

renewal process because they can easily 

determine whether a product will be 

available and, if not, what product, in 

accordance with the hierarchy 

established in this rule, would cause the 

least amount of disruption to the 

enrollee for re-enrollment. 

Finally, we note that a product (as 

defined in § 144.103) means a unique 

set of health insurance coverage benefits 

that an issuer offers using a particular 

product network type (for example, 

HMO, PPO, POS, EPO, or indemnity) 

within a service area. Accordingly, 

when mapping individuals to a new 

product, we expect that QHP issuers 

will select a product that most closely 

resembles the benefits, network type, 

and service area of the enrollee’s current 

product. Nonetheless, we are not 

establishing a ‘‘most similar’’ standard 

in this final rule. States, Exchanges, and 

QHP issuers may use a reasonable, good 

faith interpretation to determine what 

constitutes the most similar product for 

this purpose. Finally, we note that Statebased Exchanges that opt to implement 

an alternative approach to annual 

redeterminations, in accordance with 

§ 155.335(a)(2)(ii) or (iii), may also 

choose to establish a standard in this 

regard for renewal or re-enrollment. 

Comment: A few commenters 

representing the issuer community 

submitted questions regarding the link 

between stand-alone dental plans and 

the renewal of medical coverage. For 

example, a commenter questioned 

whether there is an impact on 

enrollment in a stand-alone dental plan 

if an individual re-enrolls into a 

different medical plan. We received one 

suggestion that re-enrollment for standalone dental plans should emphasize 

maintaining the same plan type, such as 

high or low coverage, and design, such 

as family or child-only coverage. 

Response: As excepted benefits, 

dental plans are not subject to the 

guaranteed renewability standards in 

§ 147.106 and, therefore, the hierarchies 

in § 155.335(j) do not need to apply to 

them in the same way. 

Nonetheless, to minimize disruptions 

in coverage for enrollees, in the FFE, reenrollment for stand-alone dental plan 

(SADP) enrollees will follow the 

hierarchy in § 155.335(j) if the enrollee 

does not make any new SADP 

selections. We also note that SADPs are 

identified as either high or low plans, 

rather than using metal levels like 

medical plans. Therefore, the 

application of the hierarchy in the FFE 

for renewal or re-enrollment will 

account for this difference. For example, 

where a medical plan renewal will 

require, in accordance with 

§ 155.335(j)(1)(ii), renewal in a plan at 

the same metal level as the enrollee’s 

current QHP for medical coverage, 

application of this standard to SADP 

will result in renewal in a plan at the 

same plan level, either high or low, as 

the enrollee’s current SADP QHP. 

Similarly, where the hierarchy states at 

§ 155.335(j)(1)(iii) that if a plan at the 

same metal level as the enrollee’s 

current plan is no longer available 

within the enrollee’s current product, 

the enrollee will be renewed in a plan 

that is one metal level higher or lower 

than the enrollee’s current QHP, in the 

SADP context, the FFE will renew or reenroll the enrollee into the plan within 

the product that is offered at the 

permissible level other than the one of 

the enrollee’s current SAPD (e.g., if the 

enrollee is currently in a high SAPD, he 

or she will be renewed into the low 

SADP). 

We clarify that if an enrollee visits the 

FFE during the 2015 open enrollment 

period to change his or her QHP 

enrollment, he or she will need to reselect his or her SADP at the same time, 

because the FFE requires that QHPs and 

SADPs be selected at the same time. If 

an enrollee doesn’t return to the FFE to 

affirmatively select plans by December 

15, 2014, the FFE will process the 

renewal or re-enrollment plan indicated 

by SADP and QHP issuers on the 2015 

Plan ID Crosswalk Template in 

accordance with the hierarchies set 

forth in this rule. We note that changes 

in medical QHP coverage during Open 

Enrollment are independent of changes 

to SADP, and vice versa. 

Comment: A few commenters 

requested that HHS clarify the meaning 

of ‘‘a plan at the same metal level’’ 

proposed at paragraph (j)(1)(ii). One 

commenter suggested that this meant a 

plan with the same QHP issuer. 

Response: We clarify that the 

hierarchy in § 155.335(j)(1) and (2) only 

refer to plans and products offered by 

the enrollee’s current issuer. The 

hierarchy does not permit autoenrollment into a product offered by a 

different issuer; however, the enrollee 

always has the option to shop for 

coverage with another issuer during the 

open enrollment period. We have added 

the word ‘‘same’’ before the word 

‘‘issuer’’ in § 155.335(j)(2)(i), (ii), and 

(iii) to help clarify the intent. We also 

note one technical addition to 

§ 155.335(j)(2)(ii) where we have added 

the word ‘‘or’’ at the end of the 

paragraph. 

Comment: We received a few 

comments regarding the proposed 


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requirement to re-enroll an enrollee in 

a plan that is one metal level higher or 

lower than the enrollee’s current QHP at 

§ 155.335(j)(1)(iii) and (j)(2)(ii). For 

example, one commenter noted that the 

proposed rule did not specify whether 

the consumer or the QHP issuer decides 

whether to enroll into a higher or lower 

plan if the QHP issuer no longer offers 

the same level plan, and recommended 

that the Exchange, not the QHP issuer, 

make the enrollment decision. Another 

commenter recommended that QHP 

issuers must clearly inform the 

consumer what metal level the new plan 

will be and whether it is a higher or 

lower metal level than the consumer’s 

existing plan. 

A few commenters also addressed the 

request for comment regarding whether 

the hierarchy should only prioritize a 

plan with a lower metal level, or 

whether, in general, priority should be 

placed on plans that have a premium 

that is closest to the premium of the 

plan in which an enrollee is currently 

enrolled. 

Response: We note that there was no 

consensus in favor of one approach over 

the other. As noted before, these 

provisions are not expected to be used 

frequently and are positioned in the 

hierarchy to promote less-disruptive reenrollment scenarios first. These 

provisions are being finalized without 

substantive changes. 

We also clarify, in response to the 

comments, that these provisions impose 

requirements on the Exchange because, 

although the QHP issuers will facilitate 

the enrollment by submitting plan 

crosswalks, the Exchange is ultimately 

responsible for ensuring that enrollment 

is effectuated according to the 

hierarchy. To reflect this, we are not 

finalizing proposed § 155.335(j)(2)(iv), 

because this provision addresses 

enrollment outside the Exchange. In 

cases where an enrollee cannot be reenrolled in a plan within the Exchange 

in accordance with § 155.335(j)(2)(i)– 

(iii), the issuer will follow applicable 

guaranteed renewability requirements 

and applicable state law to complete reenrollment outside the Exchange. 

Comment: We also received 

comments from tribes regarding the 

effects of proposed renewal and reenrollment regulations on American 

Indians and Alaska Natives (AI/ANs), 

noting that the zero and limited costsharing plan variations available to AI/ 

ANs cross the four metal levels. The 

commenters recommended that the 

regulations be revised to give QHP 

issuers the flexibility to keep AI/ANs in 

their current plan or another bronze 

level plan. Finally, the commenters 

highlighted the importance of 

addressing this special circumstance for 

AI/ANs because they should always 

have an alternate zero or limited costsharing plan at any level available to 

them and should never be moved to a 

higher level plan if their zero or limited 

cost-sharing plan variation is 

eliminated. 

Response: All QHPs must offer zero 

and limited cost-sharing plan variations 

at every metal level and, thus, if a 

particular QHP is no longer offered, the 

AI/AN should be able to enroll in 

another zero or limited cost-sharing 

plan variation at the same metal level, 

if a QHP is offered at that metal level. 

However, if a QHP is not available at a 

specific metal level, such as the bronze 

metal level, then no plan variations will 

be available at that level. If a qualified 

individual who is an Indian, as defined 

by section 4 of the Indian Health Care 

Improvement Act is auto-enrolled in a 

higher level metal plan than desired, 

pursuant to § 155.420(d)(8), he or she 

can change his or her enrollment once 

per month, mitigating any undesired 

outcome of automatic enrollment. 

Comment: One commenter urged HHS 

to adopt a mechanism to accommodate 

auto-enrollment within an insurance 

holding company system. 

Response: We disagree that a QHP 

issuer should be permitted to autoenroll individuals into a product of 

another licensed issuer. Section 2703(c) 

of the Public Health Service (PHS) Act 

and § 147.106(c) provide that, in any 

case in which a QHP issuer decides to 

discontinue offering a particular 

product offered in the individual 

market, that product may be 

discontinued by the issuer in 

accordance with applicable state law in 

the applicable market only if certain 

requirements are met. Among the 

requirements for product 

discontinuation is that the issuer must 

offer to each individual provided that 

particular product the option to 

purchase, on a guaranteed availability 

basis, any other health insurance 

coverage offered by the issuer in that 

market. An issuer does not satisfy the 

requirement to offer other health 

insurance coverage currently being 

offered ‘‘by the issuer’’ if it auto-enrolls 

qualified individuals into a product of 

another issuer that is separately licensed 

to engage in the business of insurance 

in a State. Nothing in the PHS Act or the 

regulations under the PHS Act prevents 

an issuer that elects to discontinue 

offering all health insurance coverage in 

a market (market withdrawal under 

§ 147.106(d)) from auto-enrolling 

affected individuals into a product of 

another licensed issuer, to the extent 

permitted by applicable state law. 

Comment: We received many 

comments concerning the possibility for 

enrollees to be re-enrolled in a plan that 

prevents them from continuing to 

receive financial assistance through the 

Exchange. Two specific scenarios 

created concern for commenters. First, 

commenters were concerned that 

enrollees might lose access to costsharing reductions if they are reenrolled into a non-silver level plan. 

Second, commenters noted that 

enrollees who are re-enrolled into a 

product outside the Exchange would 

lose eligibility for both advance 

payments of the premium tax credit and 

cost-sharing reductions. We received 

many recommendations regarding how 

to address these two scenarios. Several 

commenters urged HHS to simply 

prevent issuers from auto-enrolling 

qualified individuals into plans outside 

the Exchange if the qualified individual 

is eligible for advance payments of the 

premium tax credit, or into a non-silver 

level plan if the qualified individual is 

eligible for cost-sharing reductions. 

Similarly, a few commenters suggested 

that we add consideration of a plan’s 

cost-sharing structure as a factor in any 

auto-enrollment schema. Another 

commenter suggested that if an 

individual is re-enrolled in a plan that 

results in a negative impact on his or 

her financial assistance that the 

Exchange should permit the individual 

to change plans during open enrollment 

and for a 90-day period following open 

enrollment. 

Response: We agree with commenters 

that losing access to advance payments 

of the premium tax credit and/or costsharing reductions in order to maintain 

coverage under a product that is no 

longer available through an Exchange is 

not the preferable outcome for renewal 

and re-enrollment. The hierarchy of 

renewal and re-enrollment options set 

out in § 155.335(j) was created in order 

to minimize such disruptions. We 

contend that instances where an 

enrollee will be re-enrolled into 

coverage that prevents the enrollee from 

taking advantage of advance payments 

of the premium tax credit and/or costsharing reductions will be rare. We note 

that § 156.200(c)(1) requires all issuers 

offering a QHP through the Exchange to 

offer at least one plan at the silver level. 

Issuers generally have found that plans 

offered at this level are their most 

popular plans, and they understand the 

role of advance payments of the 

premium tax credit and/or cost-sharing 

reductions in making coverage 

affordable to their enrollees. We also 

note that the hierarchy is designed to 

prioritize options that generally do not 


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eliminate eligibility for advance 

payments of the premium tax credit (or 

the premium tax credit) and/or costsharing reductions. 

Section 155.335(j)(2) of this final rule 

specifically addresses re-enrollment in 

Exchange coverage when an enrollee’s 

current product is not available for 

renewal ‘‘through the Exchange.’’ 

Nonetheless, the product may continue 

to be available for renewal outside the 

Exchange. We interpret the guaranteed 

renewability provisions of § 147.106 to 

mean that, if the product remains 

available for renewal, including outside 

the Exchange, the issuer must renew the 

coverage within the product in which 

the enrollee is currently enrolled at the 

option of the enrollee, unless an 

exception to the guaranteed 

renewability requirements applies. 

However, for the reasons stated above, 

to the extent that the issuer is subject to 

45 CFR 155.335(j) with regard to an 

enrollee’s coverage through the 

Exchange, the issuer must, subject to 

applicable state law regarding automatic 

enrollments, automatically enroll the 

enrollee in accordance with the reenrollment hierarchy, even where that 

results in re-enrollment in a plan under 

a different product offered by the same 

QHP issuer through the Exchange. 

Enrollments completed pursuant to 

§ 155.335(j) will be considered to be a 

renewal of the enrollee’s coverage, 

provided the enrollee also is given the 

option to renew coverage within his or 

her current product outside the 

Exchange. We intend to evaluate this 

policy and may provide future guidance 

on how an issuer continuing to offer an 

enrollee’s product outside the Exchange 

can comply with the guaranteed 

renewability provisions. We reiterate 

that enrollees have the opportunity to 

shop for a new plan during the open 

enrollment period regardless of whether 

they are automatically re-enrolled into 

plan that does not meet their needs. We 

encourage Exchanges and QHP issuers 

to remind enrollees of that option. 

Final Rule Action: We are finalizing 

§ 155.335(j) with a few modifications. 

First, we have added the word ‘‘same’’ 

before the word ‘‘issuer’’ in 

§ 155.335(j)(2)(i), (ii), and (iii). Second, 

we have added the word ‘‘or’’ at the end 

of § 155.335(j)(2)(ii). We are not 

finalizing § 155.335(j)(2)(iv). 

B. Part 156—Health Insurance Issuer 

Standards Under the Affordable Care 

Act, Including Standards Related to 

Exchanges; Subpart M—Qualified 

Health Plan Issuer Responsibilities 

In 45 CFR 147.106(f)(1) of the final 

rule entitled, ‘‘Patient Protection and 

Affordable Care Act; Exchange and 

Insurance Market Standards for 2015 

and Beyond,’’ published on May 27, 

2014 (79 FR 30240) (Market Standards 

Rule), we specified that health 

insurance issuers of non-grandfathered 

plans in the individual market will 

provide written notice of renewals 

before the first day of the next annual 

open enrollment period in a form and 

manner specified by the Secretary. 

Under § 147.106(c)(1), health insurance 

issuers of non-grandfathered plans in 

the individual market also will provide 

written notices of product 

discontinuances. 

We proposed adding a new 

§ 156.1255, which would require a 

health insurance issuer in the 

individual market that is renewing an 

enrollment group’s coverage in a QHP 

offered through the Exchange (including 

a renewal with modifications), or that is 

discontinuing a product that includes 

plans offered through the Exchange and 

automatically enrolling an enrollee in a 

QHP under a different product offered 

by the same QHP issuer through the 

Exchange, to include certain 

information in the renewal or 

discontinuation notices, as applicable. 

We proposed that the additional 

information include premium and 

advance payment of premium tax credit 

information, an explanation of the 

requirement to report changes to the 

Exchange, a description of the 

reconciliation process for advance 

payments of the premium tax credit, 

and an explanation that if the 

enrollment group’s coverage is being 

renewed in a QHP at a different (nonsilver) metal level, cost-sharing 

reductions will not be provided for the 

upcoming year unless the enrollment 

group changes its enrollment to select a 

new silver-level plan. 

Finally, we proposed establishing a 

notice requirement that would apply to 

all plans subject to the guaranteed 

renewability requirements that 

nonrenew coverage based on continued 

coverage not being available in the 

enrollee’s service area as a result of 

changes that do not result in product 

discontinuances. We sought comment 

on this proposal, including the 

appropriate timeframe for providing the 

notice. 

Comment: Commenters were 

generally supportive of the additional 

required content proposed for the 

renewal and re-enrollment notices. For 

example, commenters approved of the 

inclusion of information about changes 

to the advance payment of the premium 

tax credit and the reminders of the 

requirement to report changes, the 

reconciliation process, and the 

availability of cost-sharing reductions. 

Two commenters were concerned that 

the issuer notice content would not 

encourage enrollees to take any action. 

A few commenters urged issuers to 

ensure notices are provided in plain 

language and include appropriate 

accessibility features. Finally, one 

commenter recommended including 

language reminding enrollees to 

consider how changes in their 

enrollment might affect their access to 

financial assistance for health coverage 

and that they have the option to shop 

for other coverage. 

Response: We appreciate the support 

received for the proposed additional 

required content for the renewal and reenrollment notices. We note that, 

pursuant to § 156.250, issuer notices 

must comply with the standards for 

notices found at § 155.230(b) (which 

also cross-references § 155.205(c)), 

which includes accessibility and 

readability requirements. 

We also note that issuers are required 

to provide enrollees a Summary of 

Benefits and Coverage (SBC), a 

document that summarizes benefits and 

cost-sharing under a plan. Issuers must 

provide the SBC at various specific 

points in time, including annually upon 

renewal. At renewal, the SBC must 

reflect any modified policy or plan 

terms that will be effective on the first 

day of the new policy or benefit year. If 

a written application is required for 

renewal or reissuance, the SBC must be 

provided no later than the date written 

application materials are distributed. If 

renewal or reissuance is automatic, the 

SBC generally must be provided no later 

than 30 days prior to the first day of the 

new policy or benefit year. 45 CFR 

147.200(a)(1)(ii)(E)(2) and 

(a)(1)(iv)(C)(2). This requirement also 

applies in the situation in which an 

issuer nonrenews or discontinues 

coverage under an existing health 

insurance product and, consistent with 

applicable Federal and State law, 

automatically enrolls an individual or 

plan sponsor (and participants and 

beneficiaries covered under such 

coverage) in a plan under a different 

product offered by such issuer in which 

the individuals are eligible to enroll. As 

such, the requirements to provide an 

SBC in connection with an automatic 

renewal or reissuance of coverage apply 

and the SBC generally is required to be 

provided no later than 30 days prior to 

the first day of the new policy or benefit 

year. An issuer is not prohibited from 

providing the SBC earlier than 30 days 

prior to the new policy or benefit year, 

and when possible issuers are 

encouraged to provide SBCs by the first 

day of the open enrollment period to 

allow individuals enough time to 


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consider their coverage options 

available with respect to the upcoming 

policy or benefit year. If an issuer does 

provide the SBC earlier than 30 days 

prior to the new plan or policy year, and 

there are no changes to the information 

reflected in the SBC prior to the first day 

of the new plan or policy year, the 

issuer will have satisfied the 

requirement to provide the renewal 

SBC. 

Comment: Some commenters were 

concerned that the implementation of 

§ 156.1255(a), which requires the 

inclusion of premium and advance 

payments of the premium tax credit 

information, would not provide useful 

information to the enrollee. Specifically, 

commenters noted that the advance 

payments of the premium tax credit 

information could reflect the enrollee’s 

2014 advance payment of the premium 

tax credit while the premium 

information could reflect 2015 benefit 

year costs. The commenters also 

suggested that if updated information 

regarding the household size and 

income was not available, the Exchange 

should either perform outreach 

encouraging the enrollee to obtain an 

updated eligibility determination or the 

Exchange should provide advance 

payment of the premium tax credit 

information reflecting the second 

lowest-cost silver plan for that Exchange 

and enrollee-type. 

Response: We agree that it is 

important to provide enrollees with 

information that will help them make 

informed decisions about their coverage 

for the upcoming benefit year. As part 

of that process, and as discussed in the 

guidance issued alongside the July 1, 

2014 Annual Eligibility 

Redeterminations proposed rule, the 

FFE will encourage enrollees to return 

to the Exchange to update their 

application information and obtain an 

eligibility determination that will 

account for updated FPL thresholds, 

household size, and income, as all 

Exchanges must require enrollees to 

report changes with respect to eligibility 

standards. 

In the proposed rule, § 156.1255(a) 

would have required QHP issuers to 

provide the premium and premium tax 

credit information for the enrollee’s 

2015 plan. In the final rule, we retain 

this requirement but clarify that issuers 

must provide advance payment of the 

premium tax credit information by 

adding the phrase ‘‘advance payment of 

the’’ before ‘‘premium tax credit 

information[.]’’ 

Comment: We received comments 

regarding providing specific notice 

messages for re-enrollment options for 

American Indians and Alaskan Natives 

(AI/ANs). For example, cost-sharing 

reductions for these enrollees is 

implemented differently from how it is 

implemented for other enrollees, and 

the information described in 

§ 156.1255(d) may not be applicable for 

these enrollees, who may need a more 

targeted explanation. 

Response: We understand the concern 

that AI/ANs receive the appropriate 

messaging regarding requirements 

specific to their coverage. We have 

revised § 156.1255(d) by adding a 

clarification that in accordance with 

§ 155.305(g)(1)(ii), cost-sharing 

reductions are only available to an 

individual who is not an Indian if he or 

she is enrolled in a silver-level QHP. 

This reflects that AI/ANs can continue 

to enroll or renew in a zero or limited 

cost-sharing plan at any metal level and 

still qualify for cost-sharing reductions. 

The FFE will continue to provide 

education and outreach to AI/ANs 

regarding the cost-sharing reductions 

that may be available to them at any 

metal level. We also are making a 

technical edit to remove the word 

‘‘with’’ from § 156.1255(d) and replace it 

with ‘‘being provided[.]’’ 

Final Rule Action: We are finalizing 

the provisions proposed in § 156.1255 

with minor modifications. We are 

replacing the phrase ‘‘discontinuing a 

product’’ with ‘‘nonrenewing coverage’’ 

to clarify that the additional notice 

content required by § 156.1255 will be 

included in notices required to be 

provided not only when issuers 

discontinue a product, but also when 

issuers nonrenew coverage based on 

enrollees’ movement outside the service 

area, as set forth in § 147.106(b)(5) of 

this final rule and discussed in more 

detail in section II.B of this preamble. 

We are also adding a cross-reference to 

§ 147.106(b)(5), accordingly. We are 

adding the phrase ‘‘advance payment of 

the’’ before ‘‘premium tax credit 

information’’ in § 156.1255(a). We 

clarified the reference to 

§ 155.305(g)(1)(ii) by adding ‘‘of this 

subchapter’’ after the citation. Finally, 

we are removing the word ‘‘with’’ from 

§ 156.1255(d) and replacing it with 

‘‘being provided[.]’’ 

III. Collection of Information 

Requirements 

Emergency Clearance: Public 

Information Collection Requirements 

Submitted to the Office of Management 

and Budget (OMB) 

In compliance with section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995 (PRA), we have 

also submitted to the Office of 

Management and Budget (OMB) the 

final information collection request for 

emergency approval review for a 180- 

day period. While the collection is 

necessary to ensure compliance with an 

initiative of the Administration, we are 

requesting emergency review under 5 

CFR 1320.13(a)(2)(i) because public 

harm is reasonably likely to result if the 

regular clearance procedures are 

followed. 

In the July 1, 2014 Annual Eligibility 

Redeterminations proposed rule (79 FR 

37262), we solicited public comments 

on each of the sections identified as 

containing information collection 

requirements (ICRs), as required by 

section 3506(c)(2)(A) of the PRA. We 

received several comments on the notice 

requirements, which have been 

addressed earlier in the preamble. We 

generally used data from the Bureau of 

Labor Statistics to derive average labor 

costs (including fringe benefits) for 

estimating the burden associated with 

the ICRs. 

The approval of this data collection 

process is essential to ensuring that 

renewal and discontinuance notices 

associated with the 2015 benefit year are 

provided to consumers in a timely 

manner prior to the open enrollment 

period for the 2015 benefit year. 

Consumers will need the information in 

these notices in order to make decisions 

regarding their coverage for the 2015 

benefit year. 

ICRs Regarding Renewal and Reenrollment Notice Requirements 

(§ 156.1255) 

As specified in § 156.1255, a health 

insurance issuer that is renewing an 

enrollment group’s coverage in the 

individual market in a QHP offered 

through the Exchange (including a 

renewal with modifications), in 

accordance with § 147.106, or that is 

discontinuing a product and 

automatically enrolling an enrollee in a 

QHP under a different product offered 

by the same QHP issuer through the 

Exchange, in accordance with § 155.335, 

must include certain information in the 

written notice required by 

§ 147.106(b)(5), (c)(1), or (f)(1), as 

applicable. Contemporaneously with the 

issuance of this final rule, we are 

issuing a bulletin specifying the form 

and manner of the notices by providing 

standard notices that issuers generally 

will use when discontinuing or 

renewing coverage in the individual 

market. 

Since there are existing requirements 

for issuers to send renewal and 

discontinuance notices, we only 

estimate the burden for QHP issuers to 

revise current notices to comply with 

the provisions of this final rule. We 


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estimate that there are 575 QHP issuers 

and assume that they would all revise 

their existing notices to comply with the 

requirements in this final rule. 

For renewal notices, we estimate that, 

for each issuer, it will require three 

hours of clerical labor (at a cost of 

$33.67 per hour) to prepare the notice 

and one hour for a senior manager (at 

a cost of $75.34 per hour) to review it. 

We also estimate that it will take a 

computer programmer 20 hours (at a 

cost of $52.53 per hour) to write and test 

a program to automate the notices. The 

total burden for each issuer to prepare 

the notice will be 24 hours with an 

equivalent cost of approximately $1,277. 

For all 575 QHP issuers, the total 

burden will be 13,800 hours with an 

equivalent cost of approximately 

$705,479. 

For re-enrollment (or nonrenewal) 

notices, we estimate that, for each 

issuer, it will require two hours of 

clerical labor (at a cost of $33.67 per 

hour) to prepare the notice and one hour 

for a senior manager (at a cost of $75.34 

per hour) to review the notice. We also 

estimate that it will take a computer 

programmer six hours (at a cost of 

$52.53 per hour) to write and test a 

program to automate the notices. The 

total annual burden for each issuer to 

prepare the notice will be nine hours 

with an equivalent cost of 

approximately $492. For all 575 QHP 

issuers, the total annual burden will be 

5,175 hours with an equivalent cost of 

approximately $263,265. These burden 

estimates are lower than those in the 

proposed rule, because we assume that 

simplifications made to the form of the 

nonrenewal notices to reduce variable 

text will reduce clerical and computer 

programming hours by approximately 

one third. 

The accompanying bulletin ‘‘Form 

and Manner of Notices When 

Discontinuing or Renewing a Product in 

the Group or Individual Market’’ 

provides that states that are enforcing 

the Affordable Care Act may develop 

their own standard notices, provided 

the State-developed notices are at least 

as protective as the Federal standard 

notices. However, we anticipate that 

fewer than 10 states would opt for this 

alternative. Under 5 CFR 1320.3(c)(4), 

this requirement is not subject to the 

PRA as it would affect fewer than 10 

entities in a 12-month period. 

We have submitted an information 

collection request to OMB for review 

and approval of the ICRs contained in 

this final rule. The requirements are not 

effective until approved by OMB and 

assigned a valid OMB control number. 

IV. Regulatory Impact Statement 

A. Summary 

We are publishing this final rule to 

implement the protections intended by 

the Congress in the most economically 

efficient manner possible. We have 

examined the effects of this rule as 

required by Executive Order 13563 (76 

FR 3821, January 21, 2011), Executive 

Order 12866 (58 FR 51735, September 

1993, Regulatory Planning and Review), 

the Regulatory Flexibility Act (RFA) 

(September 19, 1980, Pub. L. 96–354), 

the Unfunded Mandates Reform Act of 

1995 (Pub. L. 104–4), Executive Order 

13132 on Federalism, and the 

Congressional Review Act (5 U.S.C. 

804(2)). 

B. Executive Orders 12866 and 13563 

Executive Order 12866 (58 FR 51735) 

directs agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects; distributive impacts; and 

equity). Executive Order 13563 (76 FR 

3821, January 21, 2011) is supplemental 

to and reaffirms the principles, 

structures, and definitions governing 

regulatory review as established in 

Executive Order 12866. 

Section 3(f) of Executive Order 12866 

defines a ‘‘significant regulatory action’’ 

as an action that is likely to result in a 

rule—(1) having an annual effect on the 

economy of $100 million or more in any 

one year, or adversely and materially 

affecting a sector of the economy, 

productivity, competition, jobs, the 

environment, public health or safety, or 

State, local or tribal governments or 

communities (also referred to as 

‘‘economically significant’’); (2) creating 

a serious inconsistency or otherwise 

interfering with an action taken or 

planned by another agency; (3) 

materially altering the budgetary 

impacts of entitlement grants, user fees, 

or loan programs or the rights and 

obligations of recipients thereof; or (4) 

raising novel legal or policy issues 

arising out of legal mandates, the 

President’s priorities, or the principles 

set forth in the Executive Order. 

A regulatory impact analysis (RIA) 

must be prepared for rules with 

economically significant effects (for 

example, $100 million or more in any 1 

year), and a ‘‘significant’’ regulatory 

action is subject to review by the OMB. 

We have concluded that this final rule 

is not likely to have economic impacts 

of $100 million or more in any one year, 

and therefore does not meet the 

definition of ‘‘economically significant 

rule’’ under Executive Order 12866. 

1. Need for Regulatory Action 

This final rule specifies additional 

options for annual eligibility 

redeterminations, and renewal and reenrollment notice requirements for 

QHPs in the Exchange beginning with 

annual redeterminations for coverage for 

benefit year 2015. 

2. Summary of Impacts 

We do not expect that there will be 

additional costs related to the additional 

options provided in this final rule for 

annual eligibility redeterminations, 

because we believe Exchanges will 

implement an alternative method only if 

doing so is less costly than the current 

method. 

QHP issuers will incur costs to 

prepare and send renewal notices to 

comply with the final provisions, as 

detailed in section III of this final rule. 

States that choose to develop their own 

notices will incur costs to do so. 

Providing consumers with information 

such as benefit changes and premium 

amounts will enable them to make 

decisions regarding their coverage for 

the next benefit year. 

C. Regulatory Flexibility Act 

The Regulatory Flexibility Act (RFA) 

requires agencies that issue a regulation 

to analyze options for regulatory relief 

of small businesses if a rule has a 

significant impact on a substantial 

number of small entities. The RFA 

generally defines a ‘‘small entity’’ as: (1) 

a proprietary firm meeting the size 

standards of the Small Business 

Administration (SBA); (2) a nonprofit 

organization that is not dominant in its 

field; or (3) a small government 

jurisdiction with a population of less 

than 50,000 (states and individuals are 

not included in the definition of ‘‘small 

entity’’). HHS uses as its measure of 

significant economic impact on a 

substantial number of small entities a 

change in revenues of more than 3 to 5 

percent. We do not believe that this 

threshold will be reached by the 

provisions of this final rule. 

D. Unfunded Mandates Reform Act 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 (UMRA) 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule that includes a federal mandate that 

could result in expenditure in any one 

year by State, local or tribal 

governments, in the aggregate, or by the 

private sector, of $100 million in 1995 

dollars, updated annually for inflation. 


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In 2014, that threshold level is 

approximately $141 million. 

UMRA does not address the total cost 

of a rule. Rather, it focuses on certain 

categories of cost, mainly those ‘‘Federal 

mandate’’ costs resulting from: (1) 

Imposing enforceable duties on State, 

local, or tribal governments, or on the 

private sector; or (2) increasing the 

stringency of conditions in, or 

decreasing the funding of, State, local, 

or tribal governments under entitlement 

programs. 

This final rule will allow Exchanges 

to choose one of three methods for 

conducting annual eligibility 

redeterminations. We assume that 

Exchanges will choose an alternative 

method only if it is less costly than the 

current method. It will also require QHP 

issuers to include specific information 

in renewal and nonrenewal notices sent 

to enrollees and issuers will incur costs 

to comply with this requirement. States 

that choose to develop their own notices 

will incur costs to do so. Consistent 

with policy embodied in UMRA, this 

final rule has been designed to be the 

least burdensome alternative for State, 

local and tribal governments, and the 

private sector while achieving the 

objectives of the Affordable Care Act. 

E. Federalism 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a rule 

that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

States are the primary regulators of 

health insurance coverage, and State 

laws will continue to apply to health 

insurance coverage and the business of 

insurance. However, if any State law or 

requirement prevents the application of 

a Federal standard, then that particular 

State law or requirement will be 

preempted. State requirements that are 

more stringent than the Federal 

requirements will not be preempted by 

this final rule. Accordingly, states have 

significant latitude to impose 

requirements with respect to health 

insurance coverage that are more 

restrictive than the Federal law. 

F. Congressional Review Act 

This final rule is subject to the 

Congressional Review Act provisions of 

the Small Business Regulatory 

Enforcement Fairness Act of 1996 (5 

U.S.C. 801, et seq.), which specifies that 

before a rule can take effect, the federal 

agency promulgating the rule shall 

submit to each House of the Congress 

and to the Comptroller General a report 

containing a copy of the rule along with 

other specified information. This final 

rule will be transmitted to Congress and 

the Comptroller General in accordance 

with such provisions. 

List of Subjects 

45 CFR Part 146 

Health care, Health insurance, 

Reporting and recordkeeping 

requirements. 

45 CFR Part 147 

Health care, Health insurance, 

Reporting and recordkeeping 

requirements, State regulation of health 

insurance. 

45 CFR Part 148 

Administrative practice and 

procedure, Health care, Health 

insurance, Penalties, Reporting and 

recordkeeping requirements. 

45 CFR Part 155 

Administration and calculation of 

advance payments of the premium tax 

credit, Administrative practice and 

procedure, Advance payments of 

premium tax credit, Cost-sharing 

reductions, Health care access, Health 

insurance, Reporting and recordkeeping 

requirements, State and local 

governments. 

45 CFR Part 156 

Administrative practice and 

procedure, Health care, Health 

insurance, Reporting and recordkeeping 

requirements. 

For the reasons set forth in the 

preamble, the Department of Health and 

Human Services amends 45 CFR parts 

146, 147, 148, 155, and 156 as set forth 

below: 

PART 146—REQUIREMENTS FOR THE 

GROUP HEALTH INSURANCE 

MARKET 

■ 1. The authority citation for part 146 

continues to read as follows: 

Authority: Secs. 2702 through 2705, 2711 

through 2723, 2791, and 2792 of the PHS Act 

(42 U.S.C. 300gg–1 through 300gg–5, 300gg– 

11 through 300gg–23, 300gg–91, and 300gg– 

92). 

■ 2. Section 146.152 is amended by 

revising paragraph (b)(5) to read as 

follows: 

§ 146.152 Guaranteed renewability of 

coverage for employers in the group 

market. 

* * * * * 

(b) * * * 

(5) Enrollees’ movement outside 

service area. For network plans, there is 

no longer any enrollee under the group 

health plan who lives, resides, or works 

in the service area of the issuer (or in 

the area for which the issuer is 

authorized to do business); and in the 

case of the small group market, the 

issuer applies the same criteria it would 

apply in denying enrollment in the plan 

under § 146.150(c); provided the issuer 

provides notice in accordance with the 

requirements of paragraph (c)(1) of this 

section. 

* * * * * 

PART 147—HEALTH INSURANCE 

REFORM REQUIREMENTS FOR THE 

GROUP AND INDIVIDUAL HEALTH 

INSURANCE MARKETS 

■ 3. The authority citation for part 147 

continues to read as follows: 

Authority: Secs. 2701 through 2763, 2791, 

and 2792 of the Public Health Service Act (42 

U.S.C. 300gg through 300gg–63, 300gg–91, 

and 300gg–92), as amended. 

■ 4. Section 147.106 is amended by 

revising paragraph (b)(5) to read as 

follows: 

§ 147.106 Guaranteed renewability of 

coverage. 

* * * * * 

(b) * * * 

(5) Enrollees’ movement outside 

service area. For network plans, there is 

no longer any enrollee under the plan 

who lives, resides, or works in the 

service area of the issuer (or in the area 

for which the issuer is authorized to do 

business); and in the case of the small 

group market, the issuer applies the 

same criteria it would apply in denying 

enrollment in the plan under 

§ 147.104(c)(1)(i); provided the issuer 

provides notice in accordance with the 

requirements of paragraph (c)(1) of this 

section. 

* * * * * 

PART 148—REQUIREMENTS FOR THE 

INDIVIDUAL HEALTH INSURANCE 

MARKET 

■ 5. The authority citation for part 148 

continues to reads as follows: 

Authority: Secs. 2701 through 2763, 2791, 

and 2792 of the Public Health Service Act (42 

U.S.C. 300gg through 300gg–63, 300gg–91, 

and 300gg–92), as amended. 

■ 6. Section 148.122 is amended by 

revising paragraph (c)(4) to read as 

follows: 

§ 148.122 Guaranteed renewability of 

individual health insurance coverage. 

* * * * * 

(c) * * * 

(4) Movement outside the service area. 

For network plans, the individual no 

longer resides, lives, or works in the 

service area of the issuer, or area for 

which the issuer is authorized to do 


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Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 53005 

business, but only if coverage is 

terminated uniformly without regard to 

any health status-related factor of 

covered individuals; provided the issuer 

provides notice in accordance with the 

requirements of paragraph (d)(1) of this 

section. 

* * * * * 

PART 155—EXCHANGE 

ESTABLISHMENT STANDARDS AND 

OTHER RELATED STANDARDS 

UNDER THE AFFORDABLE CARE ACT 

■ 7. The authority citation for part 155 

continues to read as follows: 

Authority: Title I of the Affordable Care 

Act, sections 1301, 1302, 1303, 1304, 1311, 

1312, 1313, 1321, 1322, 1331, 1332, 1334, 

1402, 1411, 1412, 1413, Pub. L. 111–148, 124 

Stat. 119 (42 U.S.C. 18021–18024, 18031– 

18033, 18041–18042, 18051, 18054, 18071, 

and 18081–18083). 

■ 8. Section 155.330 is amended by 

revising paragraph (b)(4) to read as 

follows: 

§ 155.330 Eligibility redetermination during 

a benefit year. 

* * * * * 

(b) * * * 

(4) The Exchange must allow an 

enrollee, or an application filer on 

behalf of the enrollee, to report changes 

via the channels available for the 

submission of an application, as 

described in § 155.405(c)(2), except that 

the Exchange is permitted but not 

required to allow an enrollee, or an 

application filer, on behalf of the 

enrollee, to report changes via mail. 

* * * * * 

■ 9. Section 155.335 is amended by 

revising paragraphs (a), (e), and (j) to 

read as follows: 

§ 155.335 Annual eligibility 

redetermination. 

(a) General requirement. (1) Except as 

specified in paragraphs (l) and (m) of 

this section, the Exchange must 

redetermine the eligibility of a qualified 

individual on an annual basis. 

(2) The Exchange must conduct 

annual redeterminations required under 

paragraph (a)(1) of this section using 

one of the following: 

(i) The procedures described in 

paragraphs (b) through (m) of this 

section; 

(ii) Alternative procedures specified 

by the Secretary for the applicable 

benefit year; or 

(iii) Alternative procedures approved 

by the Secretary based on a showing by 

the Exchange that the alternative 

procedures would facilitate continued 

enrollment in coverage for which the 

enrollee remains eligible, provide clear 

information about the process to the 

qualified individual or enrollee 

(including regarding any action by the 

qualified individual or enrollee 

necessary to obtain the most accurate 

redetermination of eligibility), and 

provide adequate program integrity 

protections. 

* * * * * 

(e) Changes reported by qualified 

individuals. Except as specified in 

paragraph (e)(1) of this section, the 

Exchange must require a qualified 

individual to report any change with 

respect to the eligibility standards 

specified in § 155.305 within 30 days of 

such change. 

(1) The Exchange must not require a 

qualified individual who did not 

request an eligibility determination for 

insurance affordability programs to 

report changes that affect eligibility for 

insurance affordability programs. 

(2) The Exchange must allow a 

qualified individual, or an application 

filer, on behalf of the qualified 

individual, to report changes via the 

channels available for the submission of 

an application, as described in 

§ 155.405(c)(2), except that the 

Exchange is permitted but not required 

to allow a qualified individual, or an 

application filer, on behalf of the 

qualified individual, to report changes 

via mail. 

* * * * * 

(j) Re-enrollment. If an enrollee 

remains eligible for enrollment in a QHP 

through the Exchange upon annual 

redetermination— 

(1) And the product under which the 

QHP in which he or she is enrolled 

remains available through the Exchange 

for renewal, consistent with § 147.106 of 

this subchapter, such enrollee will have 

his or her enrollment through the 

Exchange in a QHP under that product 

renewed, unless he or she terminates 

coverage, including termination of 

coverage in connection with voluntarily 

selecting a different QHP, in accordance 

with § 155.430. The Exchange will 

ensure that re-enrollment in coverage 

under this paragraph (j)(1) occurs under 

the same product in which the enrollee 

was enrolled, as follows: 

(i) The enrollee’s coverage will be 

renewed in the same plan as the 

enrollee’s current QHP, unless the 

current QHP is not available. 

(ii) If the enrollee’s current QHP is not 

available, the enrollee’s coverage will be 

renewed in a plan at the same metal 

level as the enrollee’s current QHP. 

(iii) If the enrollee’s current QHP is 

not available and the enrollee’s product 

no longer includes a plan at the same 

metal level as the enrollee’s current 

QHP, the enrollee’s coverage will be 

renewed in a plan that is one metal level 

higher or lower than the enrollee’s 

current QHP; or 

(iv) If the enrollee’s current QHP is 

not available and the enrollee’s product 

no longer includes a plan that is at the 

same metal level as, or one metal level 

higher or lower than the enrollee’s 

current QHP, the enrollee’s coverage 

will be renewed in any other plan 

offered under the product in which the 

enrollee’s current QHP is offered in 

which the enrollee is eligible to enroll. 

(2) And the product under which the 

QHP in which he or she is enrolled is 

not available through the Exchange for 

renewal, consistent with § 147.106 of 

this subchapter, such enrollee may be 

enrolled in a plan under a different 

product offered by the same QHP issuer, 

to the extent permitted by applicable 

State law, unless he or she terminates 

coverage, including termination of 

coverage in connection with voluntarily 

selecting a different QHP, in accordance 

with § 155.430. The Exchange will 

ensure that re-enrollment in coverage 

under this paragraph (j)(2) occurs as 

follows: 

(i) The enrollee will be re-enrolled in 

a plan through the Exchange at the same 

metal level as the enrollee’s current 

QHP in the product offered by the same 

issuer that is the most similar to the 

enrollee’s current product; 

(ii) If the issuer does not offer another 

plan through the Exchange at the same 

metal level as the enrollee’s current 

QHP, the enrollee will be re-enrolled in 

a plan through the Exchange that is one 

metal level higher or lower than the 

enrollee’s current QHP in the product 

offered by the same issuer through the 

Exchange that is the most similar to the 

enrollee’s current product; or 

(iii) If the issuer does not offer another 

plan through the Exchange at the same 

metal level as, or one metal level higher 

or lower than the enrollee’s current 

QHP, the enrollee will be re-enrolled in 

any other plan offered through the 

Exchange by the same issuer in which 

the enrollee is eligible to enroll. 

* * * * * 

PART 156—HEALTH INSURANCE 

ISSUER STANDARDS UNDER THE 

AFFORDABLE CARE ACT, INCLUDING 

STANDARDS RELATED TO 

EXCHANGES 

■ 10. The authority citation for part 156 

continues to read as follows: 

Authority: Title I of the Affordable Care 

Act, sections 1301–1304, 1311–1313, 1321– 

1322, 1324, 1334, 1342–1343, 1401–1402, 

Pub. L. 111–148, 124 Stat. 119 (42 U.S.C. 

18021–18024, 18031–18032, 18041–18042, 


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53006 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Rules and Regulations 

18044, 18054, 18061, 18063, 18071, 18082, 

26 U.S.C. 36B, and 31 U.S.C. 9701). 

■ 11. Add § 156.1255 to read as follows: 

§ 156.1255 Renewal and re-enrollment 

notices. 

A health insurance issuer that is 

renewing an enrollment group’s 

coverage in an individual market QHP 

offered through the Exchange (including 

a renewal with modifications) in 

accordance with § 147.106 of this 

subchapter, or that is nonrenewing 

coverage offered through the Exchange 

and automatically enrolling an enrollee 

in a QHP under a different product 

offered by the same QHP issuer through 

the Exchange in accordance with 

§ 155.335 of this subchapter, must 

include the following information in the 

applicable notice described in 

§ 147.106(b)(5), (c)(1), or (f)(1) of this 

subchapter: 

(a) Premium and advance payment of 

the premium tax credit information 

sufficient to notify the enrollment group 

of its expected monthly premium 

payment under the renewed coverage, 

in a form and manner specified by the 

Exchange, provided that if the Exchange 

does not provide this information to 

enrollees and does not require issuers to 

provide this information to enrollees, 

consistent with this section, such 

information must be provided in a form 

and manner specified by HHS; 

(b) An explanation of the requirement 

to report changes to the Exchange, as 

specified in § 155.335(e) of this 

subchapter, the timeframe and channels 

through which changes can be reported, 

and the implications of not reporting 

changes; 

(c) For an enrollment group that 

includes an enrollee on whose behalf 

advance payments of the premium tax 

credit are being provided, an 

explanation of the reconciliation 

process for advance payments of the 

premium tax credit established in 

accordance with 26 CFR 1.36B–4; and 

(d) For an enrollment group that 

includes an enrollee being provided 

cost-sharing reductions, but for whom 

no QHP under the product remains 

available for renewal at the silver level, 

an explanation that in accordance with 

§ 155.305(g)(1)(ii) of this subchapter, 

cost-sharing reductions are only 

available to an individual who is not an 

Indian if he or she is enrolled in a silverlevel QHP. 

Dated: August 15, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: August 27, 2014. 

Sylvia M. Burwell, 

Secretary. 

[FR Doc. 2014–21178 Filed 9–2–14; 4:15 pm] 

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Clinchco, Virginia; Coal Run, Kentucky 

AGENCY: Federal Communications 

Commission. 

ACTION: Final rule; application for 

review. 

SUMMARY: The Audio Division grants a 

settlement request filed by Dickenson 

County Broadcasting Corporation 

(‘‘Dickenson County’’), licensee of 

Station WDIC–FM, Clinchco, Virginia, 

and East Kentucky Broadcasting 

Corporation (‘‘East Kentucky’’), licensee 

of Station WPKE–FM, Coal Run, 

Kentucky. The staff dismisses 

Dickenson County’s Application for 

Review with prejudice and returns 

Stations WDIC–FM and WPKE–FM to 

the channels that they occupied before 

this proceeding commenced. See also 

Supplementary Information. 

DATES: September 5, 2014. 

FOR FURTHER INFORMATION CONTACT: 

Andrew J. Rhodes, Media Bureau, (202) 

418–2700. 

SUPPLEMENTARY INFORMATION: This is a 

synopsis of the Commission’s 

Memorandum Opinion and Order, MB 

Docket No. 04–319; DA 14–1198, 

adopted August 14, 2014, and released 

August 15, 2014. The full text of this 

Commission decision is available for 

inspection and copying during normal 

business hours in the FCC Reference 

Information Center (Room CY–A257), 

445 12th Street, SW., Washington, DC. 

The complete text of this decision may 

also be purchased from the 

Commission’s copy contractor, Best 

Copy and Printing, Inc., Portals II, 445 

12th Street, SW., Room CY–B402, 

Washington, DC 20054, telephone 1– 

800–378–3160 or www.BCPIWEB.com. 

The Reconsideration Decision in this 

proceeding reinstated and granted a 

Petition for Rule Making filed by East 

Kentucky, upgrading its Station WPKE– 

FM, Coal Run, from Channel 276A to 

Channel 221C3 at a new transmitter site. 

To accommodate the Station WPKE–FM 

upgrade, the Reconsideration Decision 

involuntarily modified the license for 

Dickenson County’s Station WDIC–FM, 

Clinchco, to specify operation on 

Channel 276A in lieu of Channel 221A. 

See 76 FR 44279, July 25, 2011. 

Dickenson had filed an Application for 

Review of the Reconsideration Decision. 

The staff finds that the settlement 

would serve the public interest because 

it would resolve a proceeding that has 

been pending for ten years. The staff 

also finds that the settlement complies 

with § 1.420(j) of the Commission’s 

rules. 

In order to implement the settlement, 

the staff modifies the Media Bureau’s 

Consolidated Data Base System to 

reflect as the reserved assignments for 

the listed stations: (1) Channel 276A in 

lieu of Channel 221C3 at Coal Run, 

Kentucky, for Station WPKE–FM, and 

(2) Channel 221A in lieu of Channel 

276A at Clinchco, Virginia, for Station 

WDIC–FM. The staff also rescinded the 

Reconsideration Decision. Finally, as 

part of this settlement, the staff 

concurrently approves the dismissal of 

Dickenson County’s Petition to Deny 

directed against the WPKE–FM license 

renewal application and East 

Kentucky’s objection to the WDIC–FM 

license renewal application. 

The Commission will not send a copy 

of the Memorandum Opinion and Order 

pursuant to the Congressional Review 

Act, see 5 U.S. C. 801(a)(1)(A), because 

the Commission is not adopting any 

rules in the proceeding. 

Federal Communications Commission. 

Peter H. Doyle, 

Chief, Audio Division, Media Bureau. 

[FR Doc. 2014–21127 Filed 9–4–14; 8:45 am] 

BILLING CODE 6712–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

[Docket No. 121004515–3608–02] 

RIN 0648–XD478 

Fisheries of the Caribbean, Gulf of 

Mexico, and South Atlantic; Closure of 

the 2014 South Atlantic Commercial 

Sector for Red Snapper 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary rule; closure. 


tkelley on DSK3SPTVN1PROD with RULES