37262 Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 

Dated: May 22, 2014. 

Ron Curry, 

Regional Administrator, EPA Region 6. 

[FR Doc. 2014–15268 Filed 6–30–14; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Parts 155 and 156 

[CMS–9941–P] 

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: Proposed rule. 

SUMMARY: This proposed rule would 

specify additional options for annual 

eligibility redeterminations and renewal 

and re-enrollment notice requirements 

for qualified health plans offered 

through the Exchange, beginning with 

annual redeterminations for coverage for 

plan year 2015. In particular, this 

proposed rule would provide additional 

flexibility for Marketplaces, including 

the ability for Marketplaces to propose 

unique approaches that meet the 

specific needs of their State, while 

streamlining the consumer experience. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on July 28, 2014. 

ADDRESSES: In commenting, please refer 

to file code CMS–9941–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the ‘‘Submit a comment’’ instructions. 

2. By regular mail. You may mail 

written comments to the following 

address ONLY: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–9941–P, P.O. Box 8010, Baltimore, 

MD 21244–8010. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments to the 

following address only: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–9941–P, Mail 

Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments only to the 

following addresses prior to the close of 

the comment period: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your comments 

to the Baltimore address, call telephone 

number (410) 786–7195 in advance to 

schedule your arrival with one of our 

staff members. 

Comments erroneously mailed to the 

addresses indicated as appropriate for 

hand or courier delivery may be delayed 

and received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Benjamin Walker, (301) 492–4430. 

SUPPLEMENTARY INFORMATION: 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http://

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

Electronic Access 

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 Proposed Rule 

II. Provisions of the Proposed Rule 

A. 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 

B. Part 156—Health Insurance Issuer 

Standards Under the Affordable Care 

Act, Including Standards Related to 

Exchanges; Subpart M—Qualified Health 

Plan Issuer Responsibilities 

III. Response to Comments 

IV. Collection of Information Requirements 

V. 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 

proposed 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 


tkelley on DSK3SPTVN1PROD with PROPOSALS
Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 37263 

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 proposed 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. Under section 2703 of the PHS 

Act, as added by the Affordable Care 

Act, health insurance issuers in the 

group and individual markets must 

guarantee the renewability of coverage 

unless an exception applies. 

B. Stakeholder Consultation and Input 

HHS has consulted with stakeholders 

on a number of polices 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, and meetings 

with tribal leaders and representatives, 

health insurance issuers, trade groups, 

consumer advocates, employers, and 

other interested parties. We considered 

all of the public input as we developed 

the policies in this proposed rule. 

C. Structure of the Proposed Rule 

The regulations outlined in this 

proposed rule would be codified in 45 

CFR parts 155 and 156. Part 155 

specifies standards relative 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 

A. 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 

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

Care Act directs 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. 

On March 27, 2012, we published a 

final rule entitled Patient Protection and 

Affordable Care Act; Establishment of 

Exchanges and Qualified Health Plans; 

Exchange Standards for Employers (77 

FR 18310). The final rule added 45 CFR 

155.335, which, together with the 

provisions in 45 CFR 155.330 on 

eligibility redeterminations during a 

benefit year, implements section 

1411(f)(1)(B) of the Affordable Care Act. 

On July 15, 2013, we amended § 155.335 

in a final rule entitled Medicaid and 

Children’s Health Insurance Programs: 

Essential Health Benefits in Alternative 

Benefit Plans, Eligibility Notices, Fair 

Hearing and Appeal Processes, and 

Premiums and Cost Sharing; Exchanges: 

Eligibility and Enrollment (78 FR 42160, 

42319). 

Under the process currently defined 

in § 155.335, the Exchange will provide 

a notice to all individuals who have 

been determined eligible for enrollment 

in a QHP through the Exchange 

(qualified individuals) in advance of the 

annual open enrollment period, 

consistent with § 155.335(c). For 2015, 

current regulations in § 155.335(d)(1) 

specify that this notice and the annual 

open enrollment period notice 

described in § 155.410(d) be provided as 

a single, coordinated notice. For an 

individual who requested an eligibility 

determination for insurance 

affordability programs and who 

authorized the Exchange to obtain the 

most recent tax return information 

available from the Secretary of the 

Treasury for the purposes of annual 

redetermination, this notice will include 

a projected eligibility determination for 

insurance affordability programs for the 

following year that is computed based 

on the updated income and family size 

information, all other eligibility 

information currently on file with the 

Exchange, and plan premiums for the 

following year. Specifically, if advance 

payments of the premium tax credit 

(APTC) are being paid on such an 

enrollee’s behalf and the tax filer 

authorized the Exchange to obtain 

updated tax data for the purposes of 

annual redetermination, the Exchange 

will recalculate advance payments of 

the premium tax credit and cost-sharing 

reductions (CSR) for the upcoming year 

in accordance with updated income and 

family size information and premium 

data for the applicable benchmark plan, 

as defined in 26 CFR 1.36B–3(f), 

calculated using premiums for the 

upcoming year. Consistent with 

§ 155.335(e), the Exchange will require 

qualified individuals to report changes. 

The process currently established in 

regulation allows an individual who is 

enrolled in a QHP through the Exchange 

and whose QHP remains available to 

renew coverage for the following year 

without reapplying or having to take 

other actions. This is a key element of 

the redetermination process, since it 

enables a streamlined renewal process 

for enrollees and also reduces 

administrative costs for States and the 

Federal government. 

Based on the authority in sections 

1411(f)(1)(B) and 1321(a) of the 

Affordable Care Act, we propose to 

modify § 155.335(a) to allow for an 

Exchange to choose one of three 

methods for conducting annual 

redeterminations. To accommodate 

proposed new paragraph (a)(2), we 

propose to renumber existing paragraph 

(a) as paragraph (a)(1). Then, in 

proposed paragraph (a)(2), we propose 

that the Exchange must conduct annual 

redeterminations using one of the sets of 

procedures described in proposed 

paragraphs (a)(2)(i), (a)(2)(ii), or 

(a)(2)(iii). First, in proposed paragraph 

(a)(2)(i), we propose that the Exchange 

may utilize the existing procedures 

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

Second, in paragraph (a)(2)(ii), we 

propose that the Exchange may utilize 

alternative procedures specified by the 

Secretary for the applicable plan year. 

We note that, contemporaneously with 

this proposed rule, the Secretary is 

providing guidance describing 

alternative procedures that would be 

available to Exchanges under paragraph 

(a)(2)(ii) for annual redeterminations for 

coverage for plan year 2015 if this 

proposal is finalized. We are providing 

this guidance at the same time as this 

proposed rule given the limited amount 

of time available for Exchanges and 

issuers to develop and test the systems 

and processes that will be needed to 


tkelley on DSK3SPTVN1PROD with PROPOSALS
37264 Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 

implement the annual redetermination 

process. If this proposal is finalized, 

Federally-facilitated Exchanges will 

adopt the alternative procedures 

specified in this guidance for plan year 

2015. Also, if this proposal is finalized, 

we expect that updated guidance under 

paragraph (a)(2)(ii) may be provided on 

an annual basis. Third, in proposed 

paragraph (a)(2)(iii), we propose that the 

Exchange may utilize 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 any action by the 

qualified individual or enrollee 

necessary to obtain the most accurate 

redetermination of eligibility), and 

provide adequate program integrity 

protections. We note that paragraph 

(a)(2)(iii) is designed to enable 

Exchanges to propose annual 

redetermination procedures that would 

deliver on the key goals of the annual 

redetermination process, including 

those specified in this paragraph. We 

solicit comment regarding standards for 

approving alternative procedures, and 

on other elements of the annual 

redetermination process, as well as how 

it affects renewal for individuals who 

are enrolled in a QHP through the 

Exchange. We also note that special 

procedures may be needed for an 

Exchange that is transitioning the 

eligibility and enrollment functions 

from Federal to State operation, or vice 

versa. We will work closely with 

affected States to facilitate these 

transitions. 

In addition to the proposal to allow 

Exchanges to choose one of three 

options for performing annual 

redeterminations, we propose to make 

three amendments to the detailed 

procedures described in § 155.335 and 

one corresponding amendment to 

§ 155.330, which governs eligibility 

redetermination during a benefit year. 

First, in § 155.335(e), we propose 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), 

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. Under proposed 

paragraph (e)(1), the Exchange would 

not be permitted 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. Unlike 

§ 155.330, we do not propose to allow 

the Exchange to establish a reasonable 

threshold for changes in income, such 

that a qualified individual who 

experiences a change in income that is 

below the threshold would not be 

required to report such change, since we 

believe that reporting of all income 

changes is important at the time of 

annual redetermination. With this 

exception, the proposed standards are 

identical to those currently established 

in 45 CFR § 155.330(b). We propose 

these changes to paragraph (e) because 

the existing text refers to reporting 

changes with respect to the information 

included in the annual redetermination 

notice, which is not required to include 

a summary of the qualified individual’s 

application information on file, 

although an Exchange may opt to 

include this information. These 

proposed changes would align reporting 

requirements with the notice and ensure 

that Exchanges require relevant changes 

to be reported in a timely manner, 

consistently throughout the year. 

Second, in proposed § 155.335(e)(2), 

we propose to amend the existing 

provision which specifies 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 propose that this 

requirement would continue to apply, 

except that the Exchange would no 

longer be required to allow a qualified 

individual, or an application filer, on 

behalf of the qualified individual, to 

report changes via mail. We also 

propose the same change to 

§ 155.330(b)(4), which addresses the 

reporting of changes in the context of 

eligibility redetermination during a 

benefit year. Accepting changes via mail 

would frequently require follow-up 

telephone contact with individuals 

attempting to report changes in order to 

obtain answers to questions that may be 

triggered by the reported changes. We 

propose this because of the dynamic 

nature of the eligibility process, under 

which, for example, the Exchange 

should only ask questions about an 

individual’s access to qualifying 

coverage in an eligible employersponsored plan for an individual who 

has a level of income for his or her 

family size that would qualify him or 

her for advance payments of the 

premium tax credit or cost-sharing 

reductions, if he or she is otherwise 

eligible. With a paper process, under 

this example, it frequently would not be 

possible to know in advance whether 

information about an individual’s access 

to qualifying coverage in an eligible 

employer-sponsored plan would need to 

be collected based on a reported change 

in income or family size. Since change 

reporting via mail would frequently 

trigger subsequent telephone contact, 

we believe it would promote 

administrative efficiency to eliminate 

the requirement to accept change 

reporting via mail while encouraging 

use of the telephone option, during 

which a call center representative can 

use the dynamic application to ask the 

qualified individual any follow-up 

questions that may arise from the 

change report. We note that our 

proposed policy would continue to 

require that an Exchange must permit 

change reporting online, via telephone, 

and in person with the assistance of 

Navigators, certified application 

counselors, and other in-person 

assistance personnel, and that an 

Exchange could choose to permit 

change reporting via mail. If this 

proposal is finalized, we anticipate that 

the Federally-facilitated Exchange 

would not accept changes reported via 

mail for the foreseeable future. We also 

note that this rule does not propose to 

modify 42 CFR 435.916(a)(3)(B) or (c), 

which specify that a Medicaid agency 

must allow an individual to respond to 

an annual redetermination or report 

changes via mail. 

Third, we propose to modify the 

standards for re-enrollment in coverage 

in paragraph (j). First, in paragraph 

(j)(1), we propose 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 propose 

that the QHP in which the enrollee will 

be renewed will be selected according to 

the following order of priority: First, in 

the same plan as the enrollee’s current 

QHP, unless the current QHP is not 

available; second, 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; third, if the 

enrollee’s current QHP is not available 

and the enrollee’s product no longer 


tkelley on DSK3SPTVN1PROD with PROPOSALS
Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 37265 

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 fourth, 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. 

In paragraph (j)(2), we propose 

standards to address re-enrollment in 

situations in which the product under 

which an enrollee’s QHP is offered is 

not available through the Exchange for 

renewal, consistent with 45 CFR 

147.106. In this situation, the QHP 

issuer may still re-enroll the enrollee in 

a different product offered by the same 

QHP 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 propose that the plan in 

which the enrollee will be renewed will 

be selected according to the following 

order of priority: First, 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; second, 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; third, 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 fourth, 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 note 

that the Exchange would not send an 

enrollment transaction for an 

enrollment outside the Exchange, and 

that premium tax credits and costsharing reductions are not available for 

enrollment that is not through the 

Exchange. 

The proposed changes to this 

provision include minor changes to 

improve clarity, amendments to reflect 

that renewal of coverage in a QHP 

through the Exchange intersects with 

§ 147.106, which provides market-wide 

standards for guaranteed renewability of 

coverage offered both through and 

outside the Exchange, and a specific 

order of priority to ensure that renewal 

of and re-enrollment in coverage in a 

plan through the Exchange occurs 

through the Exchange, and is in 

products that are as similar to the 

enrollee’s existing product as possible, 

in order to minimize disruption, enable 

consumers to continue with advance 

payments of the premium tax credit and 

cost-sharing reductions (which are only 

available for enrollment through the 

Exchange) and limit consumer 

confusion. Further, the current text of 

paragraph (j), if read separately from 

§ 147.106, could give the incorrect 

impression that a QHP enrollee would 

have his or her coverage in a QHP 

renewed even if the product under 

which the QHP was offered was no 

longer available for renewal, consistent 

with § 147.106. Accordingly, the 

proposed language is designed to clarify 

the dependency of renewal of coverage 

in a QHP through the Exchange on the 

continuing availability of the product 

under which the QHP is offered in 

accordance with market-wide standards. 

We solicit comments on these proposed 

standards and on the proposed order in 

which plans would be selected for 

renewal of and re-enrollment in 

coverage. In particular, we solicit 

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. 

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 45 CFR 147.106(c)(1), health 

insurance issuers of non-grandfathered 

plans in the individual market also will 

provide written notices of product 

discontinuances. 

We propose adding to subpart M 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 

qualified health plan 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 propose that the 

additional information include the 

following: (1) Premium and 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; (2) an explanation of 

the requirement to report changes to the 

Exchange, the timeframe and channels 

through which changes can be reported, 

and the implications of not reporting 

changes; (3) for an enrollment group 

that includes an enrollee on whose 

behalf advance payments of the 

premium tax credit are being provided, 

a description of the reconciliation 

process for advance payments of the 

premium tax credit; and (4) for an 

enrollment group that includes an 

enrollee whose coverage includes costsharing reductions, if the enrollment 

group’s coverage is being renewed in a 

QHP at a different (non-silver) metal 

level, an explanation that, unless the 

enrollment group changes its enrollment 

to select a new silver-level plan, costsharing reductions will not be provided 

for the upcoming year. In accordance 

with § 147.106(f)(1), renewal notices 

would need to be provided no later than 

the first day of the open enrollment 

period for the upcoming plan year. An 

issuer also may provide this notice 

along with the applicable summary of 

benefits and coverage notice that is 

provided at renewal in accordance with 

45 CFR 147.200. We seek comment on 

this proposal. 

Contemporaneously with the issuance 

of this proposed rule, we are specifying 

the form and manner of the notices 


tkelley on DSK3SPTVN1PROD with PROPOSALS
37266 Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 

1CMS Insurance Standards Bulletin, Draft 

Notices When Discontinuing or Renewing a Product 

in the Group or Individual Market (March 14, 2014), 

http://www.cms.gov/CCIIO/Resources/Regulationsand-Guidance/Downloads/draft-discontinuancerenewal-notices-03-14-14.pdf. 

described in 45 CFR 146.152, 147.106, 

and 148.122 by providing standard 

notices for issuers to use when 

discontinuing or renewing coverage. 

These notices take into account the 

feedback we received on the draft 

notices issued contemporaneously with 

the proposed Market Standards Rule.1

We believe that adding the information 

that would be specified pursuant to 

§ 156.1255 to the renewal notices 

required under § 147.106 would best 

assure that qualified individuals 

receive, in a single notice, the relevant 

information that they need to make 

informed decisions about whether to 

keep their current plan or examine other 

QHP options. Further, this approach 

potentially would reduce burden on 

health insurance issuers. As noted 

above, the Market Standards Rule 

requires that notices be provided in a 

form and manner specified by the 

Secretary. The guidance accompanying 

the standard notices that we are 

releasing for public comment 

contemporaneously with this proposed 

rule specifies that the form and manner 

may consist of standard notices 

developed by States that are enforcing 

the requirements of the Affordable Care 

Act, provided the State-developed 

notices are at least as protective as the 

standard Federal notices. 

We recognize that the current notice 

requirements do not cover every 

situation in which an issuer may nonrenew or discontinue coverage, 

consistent with the guaranteed 

renewability statute and regulations. For 

example, an issuer whose product no 

longer covers the service area of 

enrollees may non-renew those 

enrollees’ coverage under that product. 

But, as long as the issuer’s product 

continues to cover a majority of the 

same service area, the service area 

reduction would not trigger a product 

discontinuation and corresponding 

notice to affected enrollees under the 

current regulations. We also propose 

establishing a notice requirement that 

would apply to all plans subject to the 

guaranteed renewability requirements 

that non-renew 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. These notices would 

be provided in a form and manner 

specified by HHS. We solicit comments 

on this proposal, including the 

appropriate timeframe for providing the 

notice. 

III. Response to Comments 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

IV. 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, the Centers for 

Medicare & Medicaid Services (CMS), 

Department of Health and Human 

Services, is publishing a summary of 

this proposed information collection for 

public comment. Interested persons are 

invited to send comments regarding this 

collection’s proposed burden estimates 

or any other aspect of this collection of 

information, including any of the 

following subjects: (1) The necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions; (2) the accuracy 

of the estimated burden; (3) ways to 

enhance the quality, utility, and clarity 

of the information to be collected; and 

(4) the use of automated collection 

techniques or other forms of information 

technology to minimize the information 

collection burden. 

In compliance with section 

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

Reduction Act of 1995, we have also 

submitted to the Office of Management 

and Budget (OMB) the proposed 

information collection for their 

emergency review. While the collection 

is necessary to ensure compliance with 

an initiative of the Administration, we 

are requesting emergency review under 

5 CFR 1320(a)(2)(i) because public harm 

is reasonably likely to result if the 

regular clearance procedures are 

followed. The approval of this data 

collection process is essential to 

ensuring that renewal notices associated 

with the 2015 plan year are provided to 

consumers in a timely manner prior to 

the 2015 open enrollment period. 

Consumers will need the information in 

these notices in order to make decisions 

regarding their coverage for the 2015 

plan year. 

ICRs Regarding Renewal and ReEnrollment Notice Requirements 

(§ 156.1255) 

Proposed § 156.1255 would require 

that a health insurance issuer in the 

individual market that is renewing an 

enrollment group’s coverage in a 

qualified health plan offered through 

the Exchange (including a renewal with 

modifications), or that is discontinuing 

a product 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 include certain 

information in the written notice 

specified in § 147.106(c)(1) or (f)(1). 

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 proposed provisions of this 

proposed rule. We estimate that there 

are 575 QHP issuers and assume that 

they would all revise their existing 

notices to comply with the requirements 

in this proposed rule. 

For renewal notices, we estimate that, 

for each issuer, it would 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 would 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 would be 24 hours with an 

equivalent cost of approximately $1,277. 

For all 575 QHP issuers, the total 

burden would be 13,800 hours with an 

equivalent cost of approximately 

$705,479. 

For re-enrollment (or discontinuance) 

notices, which could also be used in 

cases of other terminations or nonrenewals, we estimate that, for each 

issuer, it would 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 the notice. We also 

estimate that it would take a computer 

programmer 9 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 would be 13 hours with an 

equivalent cost of approximately $649. 

For all 575 QHP issuers, the total annual 

burden would be 7,475 hours with an 

equivalent cost of approximately 

$373,237. 

States that are enforcing the 

Affordable Care Act may develop their 

own standard notices. However, we 


tkelley on DSK3SPTVN1PROD with PROPOSALS
Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 37267 

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 are requesting emergency OMB 

review with a 180-day approval period. 

Written comments and 

recommendations for this emergency 

request only will be considered from the 

public if received by the date and 

address noted below. 

The proposed information collection 

requirement at § 156.1255 is but one 

component of a broader information 

collection request. We are also soliciting 

comments for the aforementioned 

information collection request in a 

notice published elsewhere in this issue 

of the Federal Register. The notice 

provides the public with 30 days to 

submit comments. Copies of the 

supporting statement for this 

information collection request and any 

related forms can be found at: http://

www.cms.hhs.gov/

PaperworkReductionActof1995 or can 

be obtained by emailing your request, 

including your address, phone number, 

OMB number, and CMS document 

identifier, to: Paperwork@cms.hhs.gov, 

or by calling the Reports Clearance 

Office at: 410–786–1326. 

When commenting on this proposed 

information collection, please reference 

the CMS document identifier and the 

OMB control number. To be assured 

consideration, comments and 

recommendations must be received in 

one of the following ways by July 28, 

2014: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: 

CMS, Office of Strategic Operations and 

Regulatory Affairs, Division of 

Regulations Development, Attention: 

Document Identifier (CMS–10527), 

Room C4–26–05, 7500 Security 

Boulevard, Baltimore, Maryland 

21244–1850; 

and, 

OMB Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, New Executive Office 

Building, Room 10235, Washington, 

DC 20503, Fax Number: 202–395– 

6974. 

V. Regulatory Impact Statement 

A. Summary 

We are publishing this proposed 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 

proposed 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 proposed 

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 proposed 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 

plan year 2015. 

2. Summary of Impacts 

It is expected that Exchanges will 

adopt an alternative method for annual 

eligibility redeterminations only if the 

related costs are no more than those 

associated with the process currently 

defined in § 155.335. Therefore, we do 

not expect that there would be 

additional costs related to these 

provisions. 

QHP issuers would incur costs to 

prepare and send renewal notices to 

comply with the proposed provisions, 

as detailed in section IV. States that 

choose to develop their own renewal 

notices would 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 plan 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 proposed 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 


tkelley on DSK3SPTVN1PROD with PROPOSALS
37268 Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 

private sector, of $100 million in 1995 

dollars, updated annually for inflation. 

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 proposed rule would allow 

States to choose one of three methods 

for conducting annual redeterminations. 

We assume that States would choose an 

alternative method only if it is less 

costly than the current method. It would 

also require QHP issuers to include 

specific information in renewal and reenrollment notices sent to enrollees and 

issuers would incur costs to comply 

with this requirement. States that 

choose to develop their own notices 

would incur costs to do so. Consistent 

with policy embodied in UMRA, this 

proposed 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 would be 

preempted. State requirements that are 

more stringent than the Federal 

requirements would not be preempted 

by this proposed 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 proposed 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, and has 

been transmitted to Congress and the 

Comptroller General for review. 

List of Subjects 

45 CFR Part 155 

Administrative practice and 

procedure, Health care access, Health 

insurance, Reporting and recordkeeping 

requirements, State and local 

governments, Cost-sharing reductions, 

Advance payments of premium tax 

credit, Administration and calculation 

of advance payments of the premium 

tax credit 

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 proposes to amend 45 

CFR parts 155 and 156 as set forth 

below: 

PART 155—EXCHANGE 

ESTABLISHMENT STANDARDS AND 

OTHER RELATED STANDARDS 

UNDER THE AFFORDABLE CARE ACT 

■ 1. 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). 

■ 2. Amend § 155.330 to revise 

paragraph (b)(4) 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. 

* * * * * 

■ 3. Amend § 155.335 to revise 

paragraphs (a), (e), and (j) 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 plan 

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 


tkelley on DSK3SPTVN1PROD with PROPOSALS
Federal Register / Vol. 79, No. 126 / Tuesday, July 1, 2014 / Proposed Rules 37269 

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 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 issuer through the 

Exchange that is the most similar to the 

enrollee’s current product; 

(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 QHP issuer in which 

the enrollee is eligible to enroll. 

(iv) If the issuer does not offer any 

plan through the Exchange in which the 

enrollee is eligible to enroll, the enrollee 

will be re-enrolled 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. 

* * * * * 

PART 156—HEALTH INSURANCE 

ISSUER STANDARDS UNDER THE 

AFFORDABLE CARE ACT, INCLUDING 

STANDARDS RELATED TO 

EXCHANGES 

■ 4. 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, 

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

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

■ 5. 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 discontinuing a 

product 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(c)(1) or (f)(1) of this 

subchapter: 

(a) Premium and 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 with cost-sharing 

reductions, but for whom no QHP under 

the product remains available for 

renewal at the silver level, an 

explanation that unless the enrollment 

group selects a silver-level QHP through 

the Exchange, no cost-sharing 

reductions will be provided. 

Dated: June 19, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: June 24, 2014. 

Sylvia M. Burwell, 

Secretary. 

[FR Doc. 2014–15362 Filed 6–26–14; 4:15 pm] 

BILLING CODE 4120–28–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

RIN 0648–BD81 

Fisheries of the Caribbean, Gulf of 

Mexico and South Atlantic; 

Amendment 8 to the Fishery 

Management Plan for Coral, Coral 

Reefs, and Live/Hardbottom Habitats 

of the South Atlantic Region; 

Correction 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Notice of availability; 

correction. 

SUMMARY: NMFS published a notice of 

availability (NOA) for Amendment 8 to 

the Fishery Management Plan for Coral, 

Coral Reefs, and Live/Hardbottom 

Habitats of the South Atlantic Region 

(FMP) (Amendment 8) on May 20, 2014. 

Amendment 8, in part, would expand 

portions of the northern and western 

boundaries of the Oculina Bank habitat 

area of particular concern (HAPC) 

(Oculina Bank HAPC). The NOA stated 

‘‘Amendment 8 would increase the size 

of the Oculina Bank HAPC by 405.42 

square miles (1,050 square km), for a 

total area of 694.42 square miles 


tkelley on DSK3SPTVN1PROD with PROPOSALS