Federal Register / Vol. 78, No. 242 / Tuesday, December 17, 2013 / Rules and Regulations 76209 

Mild Moderate Severe 

Normal structural imaging .................................. Normal or abnormal structural imaging ........... Normal or abnormal structural imaging. 

LOC = 0–30 min ................................................. LOC > 30 min and < 24 hours ........................ LOC > 24 hrs.

AOC = a moment up to 24 hrs .......................... AOC > 24 hours. Severity based on other criteria. 

PTA = 0–1 day ................................................... PTA > 1 and < 7 days ..................................... PTA > 7 days. 

GCS = 13–15 ..................................................... GCS = 9–12 ..................................................... GCS = 3–8. 

Note: The factors considered are: 

Structural imaging of the brain. 

LOC—Loss of consciousness. 

AOC—Alteration of consciousness/mental 

state. 

PTA—Post-traumatic amnesia. 

GCS—Glasgow Coma Scale. (For purposes 

of injury stratification, the Glasgow Coma 

Scale is measured at or after 24 hours.) 

(ii) The determination of the severity 

level under this paragraph is based on 

the TBI symptoms at the time of injury 

or shortly thereafter, rather than the 

current level of functioning. VA will not 

require that the TBI meet all the criteria 

listed under a certain severity level in 

order to classify the TBI at that severity 

level. If a TBI meets the criteria in more 

than one category of severity, then VA 

will rank the TBI at the highest level in 

which a criterion is met, except where 

the qualifying criterion is the same at 

both levels. 

(Authority: 38 U.S.C. 501, 1110 and 1131) 

[FR Doc. 2013–29911 Filed 12–16–13; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R03–OAR–2010–0141; FRL–9904–14– 

Region–3] 

Approval and Promulgation of Air 

Quality Implementation Plans; 

Delaware; Attainment Plan for the 

Philadelphia-Wilmington, 

Pennsylvania-New Jersey-Delaware 

Nonattainment Area for the 1997 

Annual Fine Particulate Matter 

Standard 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Final rule. 

SUMMARY: EPA is approving a State 

Implementation Plan (SIP) revision 

submitted by the State of Delaware. The 

SIP revision (also referred to herein as 

‘‘the attainment plan’’) demonstrates 

Delaware’s attainment of the 1997 

annual fine particulate matter (PM2.5) 

national ambient air quality standard 

(NAAQS) (the 1997 PM2.5 NAAQS) for 

the Philadelphia-Wilmington, 

Pennsylvania-New Jersey-Delaware (PANJ-DE) nonattainment area 

(Philadelphia Area). The SIP revision 

includes Delaware’s attainment 

demonstration for the Philadelphia Area 

and motor vehicle emission budgets 

(MVEBs) used for transportation 

conformity purposes for New Castle 

County, Delaware. The attainment plan 

also includes an analysis of reasonably 

available control measures (RACM) and 

reasonably available control technology 

(RACT), a base year emissions 

inventory, and contingency measures. 

This action is being taken in accordance 

with the Clean Air Act (CAA). 

DATES: This final rule is effective on 

January 16, 2014. 

ADDRESSES: EPA has established a 

docket for this action under Docket ID 

Number EPA–R03–OAR–2010–0141. All 

documents in the docket are listed in 

the www.regulations.gov Web site. 

Although listed in the electronic docket, 

some information is not publicly 

available, i.e., confidential business 

information (CBI) or other information 

whose disclosure is restricted by statute. 

Certain other material, such as 

copyrighted material, is not placed on 

the Internet and will be publicly 

available only in hard copy form. 

Publicly available docket materials are 

available either electronically through 

www.regulations.gov or in hard copy for 

public inspection during normal 

business hours at the Air Protection 

Division, U.S. Environmental Protection 

Agency, Region III, 1650 Arch Street, 

Philadelphia, Pennsylvania 19103. 

Copies of the State submittal are 

available at the Delaware Department of 

Natural Resources and Environmental 

Control, 89 Kings Highway, P.O. Box 

1401, Dover, Delaware 19903. 

FOR FURTHER INFORMATION CONTACT: Rose 

Quinto, (215) 814–2182, or by email at 

quinto.rose@epa.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

By letter dated April 3, 2008, 

Delaware submitted the SIP revision at 

issue to EPA. By letter dated April 25, 

2012, Delaware submitted revisions to 

the portion of the SIP revision relating 

to the MVEBs. The April 25, 2012 

MVEBs revised submittal replaced the 

previously submitted 2009 MVEBs with 

a budget that is based on the Motor 

Vehicle Emissions Simulator (MOVES) 

model and included MVEBs for 2012. 

On November 19, 2012 (77 FR 69399), 

EPA published a notice of proposed 

rulemaking seeking comment on EPA’s 

proposed approval of this SIP revision, 

including the portion relating to the 

2009 and 2012 MVEBs for 

transportation conformity purposes for 

New Castle County, Delaware 

(hereinafter referred to as ‘‘the NPR’’). In 

response to the NPR, EPA received a 

single comment dated November 30, 

2012. A summary of the November 30, 

2012 comment and EPA’s response is 

provided in Section III (Summary of 

Public Comment and EPA Response) of 

this final rulemaking action. 

On March 4, 2013, EPA took final 

rulemaking action on the portion of the 

attainment plan relating to the base year 

emissions inventory. See 78 FR 10420. 

As a result of this March 2013 final 

rulemaking action, no further action 

needs to be taken on such portion of the 

April 3, 2008 SIP revision. Therefore, 

this final rulemaking action relates to 

the remaining portions of the attainment 

plan, including: (1) An attainment 

demonstration for the Delaware portion 

of the Philadelphia Area; (2) 2009 and 

2012 MVEBs used for transportation 

conformity purposes for New Castle 

County, Delaware; (3) an analysis of 

RACM and RACT; and, (4) contingency 

measures. 

On September 19, 2013 (78 FR 57473), 

EPA published a supplemental NPR that 

revised and expanded the basis for 

proposing approval of Delaware’s 

attainment plan for the 1997 annual 

PM2.5 NAAQS in light of the 

developments since EPA issued its 

initial proposal on November 19, 2012 

(hereinafter referred to as ‘‘the 

supplemental NPR’’). Principally, the 

supplemental NPR addressed the 

potential effects of a January 4, 2013 

decision of the United States Court of 

Appeals for the District of Columbia 

Circuit (D.C. Circuit Court) remanding 

to EPA two final rules implementing the 

1997 PM2.5 NAAQS. In the 

supplemental NPR, EPA also revised its 

proposed approval of Delaware’s 


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attainment plan for the 1997 PM2.5

NAAQS to clarify that EPA was not 

relying upon certain regulations which 

were part of the attainment plan, 

because such regulations were not 

necessary to demonstrate attainment of 

the 1997 PM2.5 NAAQS. As part of this 

supplemental NPR, EPA also proposed 

to approve the 2009 and 2012 MVEBs 

used for transportation conformity 

purposes for New Castle County, 

Delaware. EPA did not receive any 

comments on the September 19, 2013 

supplemental NPR. 

II. Summary of SIP Revision 

The portions of the SIP revision that 

are subject to this action demonstrate 

Delaware’s attainment of the 1997 PM2.5

NAAQS and includes: (1) Delaware’s 

attainment demonstration for the 

Delaware portion of the Philadelphia 

Area and (2) the 2009 and 2012 MVEBs 

used for transportation conformity 

purposes for New Castle County, 

Delaware. The remaining portion of the 

attainment plan also includes an 

analysis of RACM/RACT and 

contingency measures. The attainment 

plan does not include a Reasonable 

Further Progress (RFP) plan; however, 

for reasons explained in the November 

19, 2012 NPR and the supplemental 

NPR, EPA proposed to make a 

determination that an RFP plan is not 

required, because Delaware 

demonstrated that attainment with the 

1997 PM2.5 NAAQS occurred in the 

Delaware portion of the Philadelphia 

Area by the attainment date of April 

2010. The rationale for EPA’s proposed 

action is explained in the NPR and the 

supplemental NPR and will not be 

restated here. 

III. Summary of Public Comment and 

EPA Response 

Comment: The commenter endorsed 

EPA’s proposed approval and stated that 

EPA should approve Delaware’s 

attainment plan and the MVEBs 

included in the attainment plan. The 

commenter stated his belief that the 

reduction of PM2.5, sulfur dioxide (SO2) 

and nitrogen oxides (NOX) emissions in 

Delaware’s attainment plan will allow 

the Area to reach an overall particulate 

attainment level. Further, the 

commenter supported approval of the 

MVEBs because the MVEBs are 

consistent with Delaware’s plan for 

attaining the 1997 PM2.5 NAAQS. 

However, the commenter expressed 

some concerns about Delaware’s 

approach to attaining the 1997 PM2.5

NAAQS without regulating ammonia 

(NH3) and volatile organic compounds 

(VOCs). While the commenter noted 

that Delaware has achieved attainment 

of the 1997 PM2.5 NAAQS, the 

commenter also included a broad 

statement that New Castle County has 

not achieved attainment with 

unspecified ‘‘air quality standards 

prescribed by EPA’s regulations.’’ 

Response: EPA thanks the commenter 

for endorsing the approval of the 

Delaware attainment plan and the 

MVEBs included in the attainment plan 

and appreciates that the comments 

submitted also fulfilled an academic 

writing assignment. EPA agrees with the 

commenter’s conclusion that the 

attainment plan submitted by Delaware 

adequately addresses emissions of PM2.5

and the PM2.5 precursors SO2 and NOX

in order to provide for attainment of the 

1997 PM2.5 NAAQS. Moreover, EPA 

notes that the Agency has specifically 

reexamined the issue of whether the 

attainment plan addresses the correct 

PM2.5 precursors in the supplemental 

NPR. As indicated in the supplemental 

NPR, EPA has concluded that regulation 

of emissions of VOC and NH3 from 

sources in Delaware was not necessary 

in order to provide for attainment of the 

1997 PM2.5 NAAQS in the Philadelphia 

Area. 

As to the commenter’s divergent 

opinions that: (1) Delaware has achieved 

attainment with the NAAQS at issue 

and (2) New Castle County has not 

achieved attainment with some 

unspecified EPA air quality regulations, 

it is important to note that the SIP 

revision at issue pertains to the 

Delaware’s attainment plan for the 1997 

annual PM2.5 NAAQS. The record 

presented clearly supports EPA’s 

approval of this attainment plan for this 

purpose. Additionally, EPA refers the 

commenter to EPA’s May 16, 2012 

determination that the Philadelphia 

Area attained the 1997 annual PM2.5

NAAQS by the applicable date, April 5, 

2010, and EPA’s issuance of a clean data 

determination for the Philadelphia Area. 

See 77 FR 28782. The administrative 

record for today’s final rulemaking 

action, in conjunction with EPA’s May 

16, 2012 final rulemaking action, clearly 

supports the finding that Delaware has 

achieved the NAAQS at issue. Due to a 

lack of specificity on the commenter’s 

part, EPA is unable to further respond 

to the commenter’s concerns relating to 

New Castle County’s attainment with 

unspecified EPA air quality regulations. 

IV. Final Action 

As the base year emissions inventory 

portion of the SIP revision was 

previously approved through a separate 

action (see 78 FR 10420), EPA is 

approving the remaining portions of the 

SIP revision, which was submitted by 

the State of Delaware on April 3, 2008, 

and amended on April 25, 2012, and 

includes: (1) The attainment plan for the 

1997 PM2.5 NAAQS for the Delaware 

portion of the Philadelphia Area and (2) 

the 2009 and 2012 MVEBs for 

transportation conformity purposes for 

New Castle County, Delaware. The 

portions of the attainment plan which 

are subject to this final rulemaking 

action include Delaware’s attainment 

demonstration, an analysis of RACM/

RACT and contingency measures. 

Through this rulemaking action, EPA is 

making a final determination that 

Delaware’s attainment plan meets the 

applicable requirements of the CAA. For 

reasons explained in the supplemental 

NPR, EPA revised its original proposed 

approval of the attainment plan to 

propose approval of Delaware’s 1997 

PM2.5 attainment plan as meeting the 

requirements for attainment plans for 

the 1997 PM2.5 NAAQS, without 

reliance on the following measures 

identified in the attainment plan: (1) 

Regulation 1142 Section 2.0 for NOX

emissions at petroleum refineries; (2) 

certain control measures for VOC 

emissions; and, (3) the Clean Air 

Interstate Rule (CAIR). As discussed in 

the supplemental NPR, these measures 

are not necessary for the purposes of 

meeting the requirements for RACM, 

RACT, section 189(e) or the attainment 

demonstration. 

V. Statutory and Executive Order 

Reviews 

A. General Requirements 

Under the CAA, the Administrator is 

required to approve a SIP submission 

that complies with the provisions of the 

CAA and applicable Federal regulations. 

42 U.S.C. 7410(k); 40 CFR 52.02(a). 

Thus, in reviewing SIP submissions, 

EPA’s role is to approve state choices, 

provided that they meet the criteria of 

the CAA. Accordingly, this action 

merely approves state law as meeting 

Federal requirements and does not 

impose additional requirements beyond 

those imposed by state law. For that 

reason, this action: 

• Is not a ‘‘significant regulatory 

action’’ subject to review by the Office 

of Management and Budget under 

Executive Order 12866 (58 FR 51735, 

October 4, 1993); 

• does not impose an information 

collection burden under the provisions 

of the Paperwork Reduction Act (44 

U.S.C. 3501 et seq.); 

• is certified as not having a 

significant economic impact on a 

substantial number of small entities 

under the Regulatory Flexibility Act (5 

U.S.C. 601 et seq.); 


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Federal Register / Vol. 78, No. 242 / Tuesday, December 17, 2013 / Rules and Regulations 76211 

• does not contain any unfunded 

mandate or significantly or uniquely 

affect small governments, as described 

in the Unfunded Mandates Reform Act 

of 1995 (Pub. L. 104–4); 

• does not have Federalism 

implications as specified in Executive 

Order 13132 (64 FR 43255, August 10, 

1999); 

• is not an economically significant 

regulatory action based on health or 

safety risks subject to Executive Order 

13045 (62 FR 19885, April 23, 1997); 

• is not a significant regulatory action 

subject to Executive Order 13211 (66 FR 

28355, May 22, 2001); 

• is not subject to requirements of 

Section 12(d) of the National 

Technology Transfer and Advancement 

Act of 1995 (15 U.S.C. 272 note) because 

application of those requirements would 

be inconsistent with the CAA; and 

• does not provide EPA with the 

discretionary authority to address, as 

appropriate, disproportionate human 

health or environmental effects, using 

practicable and legally permissible 

methods, under Executive Order 12898 

(59 FR 7629, February 16, 1994). 

In addition, this rule does not have 

tribal implications as specified by 

Executive Order 13175 (65 FR 67249, 

November 9, 2000), because the SIP is 

not approved to apply in Indian country 

located in the state, and EPA notes that 

it will not impose substantial direct 

costs on tribal governments or preempt 

tribal law. 

B. Submission to Congress and the 

Comptroller General 

The Congressional Review Act, 5 

U.S.C. 801 et seq., as added by the Small 

Business Regulatory Enforcement 

Fairness Act of 1996, generally provides 

that before a rule may take effect, the 

agency promulgating the rule must 

submit a rule report, which includes a 

copy of the rule, to each House of the 

Congress and to the Comptroller General 

of the United States. EPA will submit a 

report containing this action and other 

required information to the U.S. Senate, 

the U.S. House of Representatives, and 

the Comptroller General of the United 

States prior to publication of the rule in 

the Federal Register. A major rule 

cannot take effect until 60 days after it 

is published in the Federal Register. 

This action is not a ‘‘major rule’’ as 

defined by 5 U.S.C. 804(2). 

C. Petitions for Judicial Review 

Under section 307(b)(1) of the CAA, 

petitions for judicial review of this 

action must be filed in the United States 

Court of Appeals for the appropriate 

circuit by February 18, 2014. Filing a 

petition for reconsideration by the 

Administrator of this final rule does not 

affect the finality of this action for the 

purposes of judicial review nor does it 

extend the time within which a petition 

for judicial review may be filed, and 

shall not postpone the effectiveness of 

such rule or action. This action 

approving Delaware’s SIP revision 

which demonstrates attainment of the 

1997 annual PM2.5 NAAQS for the 

Philadelphia Area may not be 

challenged later in proceedings to 

enforce its requirements. (See section 

307(b)(2).) 

List of Subjects in 40 CFR Part 52 

Environmental protection, Air 

pollution control, Incorporation by 

reference, Nitrogen dioxide, Particulate 

matter, Reporting and recordkeeping 

requirements, Sulfur oxides, Volatile 

organic compounds. 

Dated: November 29, 2013. 

W.C. Early, 

Acting Regional Administrator, Region III. 

40 CFR part 52 is amended as follows: 

PART 52—APPROVAL AND 

PROMULGATION OF 

IMPLEMENTATION PLANS 

■ 1. The authority citation for part 52 

continues to read as follows: 

Authority: 42 U.S.C. 7401 et seq. 

Subpart I— Delaware 

■ 2. In § 52.420, the table in paragraph 

(e) is amended by adding the entry for 

the 1997 Annual PM2.5 Attainment Plan 

for Delaware and the Motor Vehicle 

Emissions Budget for 2009 and 2012 at 

the end of the table to read as follows: 

§ 52.420 Identification of plan. 

* * * * * 

(e) * * * 

Name of non-regulatory SIP revision Applicable geographic area 

State 

submittal 

date 

EPA approval date Additional explanation 

*******

1997 Annual PM2.5 Attainment Plan 

for Delaware and the Motor Vehicle Emission Budgets for 2009 and 

2012.

Delaware—Philadelphia-Wilmington, 

Pennsylvania-New Jersey-Delaware Nonattainment Area.

4/3/08 

4/25/12 

12/17/13 [Insert page 

number where the document begins].

See § 52.427(c). 

■ 3. Section 52.427 is amended by 

adding paragraph (c) to read as follows: 

§ 52.427 Control strategy: Particulate 

matter. 

* * * * * 

(c) EPA approves the attainment plan 

for the 1997 annual fine particulate 

matter (PM2.5) national ambient air 

quality standard (NAAQS) for the 

Philadelphia-Wilmington, 

Pennsylvania-New Jersey-Delaware 

nonattainment area submitted by the 

Secretary of the Delaware Department of 

Natural Resources and Environmental 

Control on April 3, 2008, as amended on 

April 25, 2012. The attainment plan 

includes the attainment demonstration 

and motor vehicle emission budgets in 

tons per year (tpy) used for 

transportation conformity purposes for 

New Castle County, Delaware. The 

attainment plan also includes an 

analysis of reasonably available control 

measures and reasonably available 

control technology, contingency 

measures and the 2002 base year 

emissions inventory. The 2002 base year 

emissions inventory was approved in a 

separate rulemaking action on March 4, 

2013 (78 FR 10420). 


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76212 Federal Register / Vol. 78, No. 242 / Tuesday, December 17, 2013 / Rules and Regulations 

DELAWARE’S MOTOR VEHICLE EMISSION BUDGETS FOR THE 1997 ANNUAL PM2.5 NAAQS 

Type of control strategy SIP Year VOC NOX

Attainment Plan (Milestone Year) ................................................................................................ 2009 257 8,448 

Attainment Plan (Out Year) ......................................................................................................... 2012 199 6,273 

[FR Doc. 2013–29803 Filed 12–16–13; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Parts 147, 155 and 156 

[CMS–9945–IFC] 

RIN 0938–AS17 

Patient Protection and Affordable Care 

Act; Maximizing January 1, 2014 

Coverage Opportunities 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Interim final rule with comment 

period. 

SUMMARY: This interim final rule 

amends the date by which a qualified 

individual must select a qualified health 

plan (QHP) through any Exchange for an 

effective coverage date of January 1, 

2014. This rule generally allows 

consumers to select a QHP until 

December 23, 2013, which is a change 

from the previously stated regulatory 

date of December 15, 2013, but permits 

State Exchanges to select a different 

date. It also establishes a related policy 

regarding the date by which a consumer 

needs to pay any applicable initial 

premium to ensure timely effectuation 

of coverage. This rule pertains to the 

individual market and Small Business 

Health Options Program in both the 

Federally-facilitated Exchanges and 

State Exchanges. This rule does not 

change the plan selection or premium 

payment dates for coverage offered 

outside of the Exchanges. 

DATES: Effective date: These regulations 

are effective on December 15, 2013. 

Comment date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, no later than 5 p.m. on 

December 23, 2013. 

ADDRESSES: In commenting, please refer 

to file code CMS–9945–IFC. 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–9945–IFC, P.O. Box 8016, 

Baltimore, MD 21244–8016. 

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–9945–IFC, 

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: 

Devon Trolley, (301) 492–4404, for 

questions related to this rule. 

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://regulations.gov. 

Follow the search instructions on that 

Web site to view public comments. 

Comments received timely will be 

also 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. 

Table of Contents 

I. Background 

II. Provisions of the Interim Final Rule 

III. Waiver of Proposed Rulemaking and 

Waiver of Delay in Effective Date 

IV. Collection of Information Requirements 

V. Regulatory Impact Analysis 

I. Background 

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 

interim final rule, we refer to the two 

statutes collectively as the ‘‘Affordable 

Care Act.’’ 

As of October 2013, for coverage 

starting as soon as January 1, 2014, 

qualified individuals and qualified 

employers have been able to enroll in 

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 


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