Federal Register / Vol. 75, No. 71 / Wednesday, April 14, 2010 / Proposed Rules 19297 

DEPARTMENT OF ENERGY 

10 CFR Part 431 

[Docket No. EERE–2008–BT–STD–0015] 

RIN 1904–AB86 

Energy Conservation Program: Public 

Meeting and Availability of the 

Preliminary Technical Support 

Document for Walk-In Coolers and 

Walk-In Freezers; Correction and Date 

Change 

AGENCY: Office of Energy Efficiency and 

Renewable Energy, Department of 

Energy. 

ACTION: Date changes and corrections. 

SUMMARY: The U. S. Department of 

Energy (DOE) published a document in 

the Federal Register on April 5, 2010, 

concerning a public meeting and 

availability of the preliminary technical 

support document regarding energy 

conservation standards for walk-in 

coolers and walk-in freezers. This 

document corrects the docket number in 

that document and corrects the 

rulemaking e-mail address. This 

document also changes the dates of the 

public meeting, the deadline for 

requesting to speak at the public 

meeting, and the deadline for 

submitting written comments on the 

preliminary analysis. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Charles Llenza, U.S. Department of 

Energy, Building Technologies Program, 

EE–2J, 1000 Independence Avenue, 

SW., Washington, DC 20585–0121, (202) 

586–2192, Charles.Llenza@ee.doe.gov or 

Mr. Michael Kido, Esq., U.S. 

Department of Energy, Office of General 

Counsel, GC–71, 1000 Independence 

Avenue, SW., Washington, DC 20585– 

0121, (202) 586–8145, 

Michael.Kido@hq.doe.gov. 

DATES: DOE will hold a public meeting 

in Washington, DC on Wednesday, May 

19, 2010, beginning at 9 a.m. DOE must 

receive requests to speak at the meeting 

before 4 p.m., Wednesday, May 5, 2010. 

DOE must receive a signed original and 

an electronic copy of statements to be 

given at the public meeting before 4 

p.m., Wednesday, May 12, 2010. 

Written comments are welcome, 

especially following the public meeting, 

and should be submitted by Friday, May 

28, 2010. 

ADDRESSES: The public meeting will be 

held at the U.S. Department of Energy, 

Forrestal Building, Room 8E–089, 1000 

Independence Avenue, SW., 

Washington, DC 20585–0121. To attend 

the public meeting, please notify Ms. 

Brenda Edwards at (202) 586–2945. 

Please note that foreign nationals 

participating in the public meeting are 

subject to advance security screening 

procedures, requiring a 30-day advance 

notice. If you are a foreign national and 

wish to participate in the public 

meeting, please inform DOE as soon as 

possible by contacting Ms. Brenda 

Edwards at (202) 586–2945 so that the 

necessary procedures can be completed. 

Interested persons may submit 

comments, identified by docket number 

EERE–2008–BT–STD–0015, by any of 

the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov Follow the 

instructions for submitting comments. 

• E-mail: WICF–2008–STD– 

0015@ee.doe.gov; Include EERE–2008– 

BT–STD–0015 in the subject line of the 

message. 

• Postal Mail: Ms. Brenda Edwards, 

U.S. Department of Energy, Building 

Technologies Program, Mailstop EE–2J, 

Public Meeting for Walk-in Coolers and 

Walk-in Freezers, EERE–2008–BT–STD– 

0015, 1000 Independence Avenue, SW., 

Washington, DC 20585–0121. 

Telephone (202) 586–2945. Please 

submit one signed paper original. 

• Hand Delivery/Courier: Ms. Brenda 

Edwards, U.S. Department of Energy, 

Building Technologies Program, Sixth 

Floor, 950 L’Enfant Plaza, SW., 

Washington, DC 20024. Telephone (202) 

586–2945. Please submit one signed 

paper original. 

Instructions: All submissions received 

must include the agency name and 

docket number. 

Docket: For access to the docket to 

read background documents or a copy of 

the transcript of the public meeting or 

comments received, go to the U.S. 

Department of Energy, Sixth Floor, 950 

L’Enfant Plaza, SW., Washington, DC 

20024, (202) 586–2945, between 9 a.m. 

and 4 p.m., Monday through Friday, 

except Federal holidays. Please call Ms. 

Brenda Edwards at (202) 586–2945 for 

additional information regarding 

visiting the Resource Room. 

SUPPLEMENTARY INFORMATION: DOE 

published a notice in the Federal 

Register on April 5, 2010, (75 FR 17080) 

concerning a public meeting and 

availability of the preliminary technical 

support document regarding energy 

conservation standards for walk-in 

coolers and walk-in freezers. This notice 

corrects the docket number in that 

notice to EERE–2008–BT–STD–0015 

and corrects the rulemaking e-mail 

address in that notice to WICF–2008– 

STD–0015@ee.doe.gov. 

This notice also changes the date of 

the public meeting, the date of the 

deadline for requesting to speak at the 

public meeting, and the date of the 

deadline for submitting written 

comments on the preliminary analysis. 

The public meeting will now be held on 

Wednesday, May 19, 2010, beginning at 

9 a.m. The close of the comment period 

has been changed to Friday, May 28, 

2010, in order to accommodate 

comments received at the public 

meeting and comments that may be 

submitted based on issues raised at the 

public meeting. Interested parties are 

directed to submit their comments to 

the rulemaking e-mail address, WICF– 

2008–STD–0015@ee.doe.gov, with 

instructions to include docket number 

EERE–2008–BT–STD–0015. 

The purpose of the meeting is to 

discuss the preliminary analysis for 

standards for walk-in coolers and walkin freezers. The Department welcomes 

all interested parties, regardless of 

whether they participate in the public 

meeting, to submit written comments 

regarding matters addressed in the 

preliminary analysis, as well as any 

other related issues, by May 28, 2010. 

Issued in Washington, DC, on April 8, 

2010. 

Cathy Zoi, 

Assistant Secretary, Energy Efficiency and 

Renewable Energy. 

[FR Doc. 2010–8499 Filed 4–13–10; 8:45 am] 

BILLING CODE 6450–01–P 

DEPARTMENT OF THE TREASURY 

Internal Revenue Service 

26 CFR Part 54 

DEPARTMENT OF LABOR 

Employee Benefits Security 

Administration 

29 CFR Part 2590 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of the Secretary 

45 CFR Parts 146 and 148 

Medical Loss Ratios; Request for 

Comments Regarding Section 2718 of 

the Public Health Service Act 

AGENCY: Internal Revenue Service, 

Department of the Treasury; Employee 

Benefits Security Administration, 

Department of Labor; Office of the 

Secretary, Department of Health and 

Human Services. 

ACTION: Request for information. 


jlentini on DSKJ8SOYB1PROD with PROPOSALS
19298 Federal Register / Vol. 75, No. 71 / Wednesday, April 14, 2010 / Proposed Rules 

SUMMARY: This document is a request for 

comments regarding Section 2718 of the 

Public Health Service Act (PHS Act), 

which was added by Sections 1001 and 

10101 of the Patient Protection and 

Affordable Care Act (PPACA), Public 

Law 111–148, enacted on March 23, 

2010. Section 2718 of the PHS Act, 

among other provisions, requires health 

insurance issuers offering individual or 

group coverage to submit annual reports 

to the Secretary on the percentages of 

premiums that the coverage spends on 

reimbursement for clinical services and 

activities that improve health care 

quality, and to provide rebates to 

enrollees if this spending does not meet 

minimum standards for a given plan 

year. Section 1562 of PPACA also added 

section 715 of the Employee Retirement 

Income Security Act of 1974 (ERISA) 

and section 9815 of the Internal 

Revenue Code of 1986 (the Code). These 

two sections effectively incorporate by 

reference section 2718 and other 

amendments to title XXVII of the PHS 

Act. The Departments of Health and 

Human Services (HHS), Labor, and the 

Treasury (collectively, the Departments) 

invite public comments in advance of 

future rulemaking. 

DATES: Submit written or electronic 

comments by May 14, 2010. 

ADDRESSES: Written or electronic 

comments should be submitted to the 

Department of HHS as directed below. 

Any comment that is submitted to the 

Department of HHS will be shared with 

the Departments of Labor and Treasury. 

All comments will be made available 

to the public. Please do not include any 

personally identifiable information 

(such as name, address, or other contact 

information) or confidential business 

information that you do not want 

publicly disclosed. 

All comments are posted on the 

Internet exactly as received, and can be 

retrieved by most Internet search 

engines. No deletions, modifications, or 

redactions will be made to the 

comments received, as they are public 

records. Comments may be submitted 

anonymously. 

Comments, identified by DHHS– 

2010–MLR, may be submitted to the 

Department of HHS by one of the 

following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Written comments (one 

original and two copies) may be mailed 

to: Department of Health and Human 

Services, Attention: DHHS–2010–MLR, 

Hubert H. Humphrey Building, Room 

445–G, 200 Independence Avenue, SW., 

Washington, DC 20201. 

• Hand or courier delivery: Written 

comments (one original and two copies) 

may be delivered (by hand or courier) to 

Room 445–G, Department of Health and 

Human Services, Attention: DHHS– 

2010–MLR, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201. Because 

access to the interior of the HHH 

Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the DHHS–2010–MLR drop box located 

in the main lobby of the building. A 

stamp-in clock is available for persons 

wishing to retain proof of filing by 

stamping in and retaining an extra copy 

of the comments being filed. 

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 electronic 

comments received before the close of 

the comment period on the following 

public 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 be 

available for public inspection as they 

are received, generally beginning 

approximately 3 weeks after publication 

of a document, at Room 445–G, 

Department of Health and Human 

Services, Hubert H. Humphrey Building, 

200 Independence Avenue, SW., 

Washington, DC 20201, Monday 

through Friday of each week from 8:30 

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

appointment to view public comments, 

call 1–800–743–3951. 

FOR FURTHER INFORMATION CONTACT: 

Sharon Arnold, Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, at (202) 

690–5480; Amy Turner or Beth Baum, 

Employee Benefits Security 

Administration, Department of Labor, at 

(202) 693–8335; Russ Weinheimer, 

Internal Revenue Service, Department of 

the Treasury, at (202) 622–6080. 

Customer Service Information: 

Individuals interested in obtaining 

information about the Patient Protection 

and Affordable Care Act may visit the 

Department of Health and Human 

Services’ Web site (http:// 

www.healthreform.gov). In addition, 

information concerning employmentbased health coverage laws is available 

by calling the EBSA Toll-Free Hotline at 

1–866–444–EBSA (3272) or visiting the 

Department of Labor’s Web site (http:// 

www.dol.gov/ebsa). 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. General 

Section 1001 of the Patient Protection 

and Affordable Care Act (PPACA), 

Public Law 111–148, enacted on March 

23, 2010, amended the Public Health 

Service Act (PHS Act) to provide several 

individual and group market reforms. In 

1996, Congress enacted the Health 

Insurance Portability and 

Accountability Act of 1996 (HIPAA), 

which added title XXVII to the PHS Act, 

and parallel provisions to the Employee 

Retirement Income Security Act of 1974 

(ERISA), and the Internal Revenue Code 

of 1986 (the Code). The HIPAA 

amendments provided for, among other 

things, improved portability and 

continuity of coverage with respect to 

health insurance coverage in the group 

and individual insurance markets, and 

group health plan coverage provided in 

connection with employment. Title 

XXVII of the PHS Act is codified at 42 

U.S.C. 300gg, et seq. PPACA expanded 

Title XXVII of the PHS Act, 

redesignated several sections, and 

created new requirements affecting the 

individual and group markets. These 

amendments were incorporated by 

reference into ERISA and the Code by 

creating new sections 715 and 9815, 

respectively. The Secretaries of HHS, 

Labor, and the Treasury have shared 

interpretive and enforcement authority 

under Title XXVII of the PHS Act, Part 

7 of ERISA, and Chapter 100 of the 

Code. See section 104 of HIPAA and 

Memorandum of Understanding 

applicable to Title XXVII of the PHS 

Act, Part 7 of ERISA, and Chapter 100 

of the Code, published at 64 FR 70164, 

December 15, 1999. 

B. Public Reporting of the Ratio of 

Incurred Claims to Earned Premiums 

(Medical Loss Ratio) for Individual and 

Group Coverage 

PPACA sections 1001 and 10101 

added Section 2718 of the PHS Act, 

which, among other provisions, requires 

health insurance issuers offering 

individual or group coverage to submit 

annual reports to the Secretary on the 

percentages of premiums that the 

coverage spends on reimbursement for 

clinical services and activities that 

improve health care quality, and to 

provide rebates to enrollees if this 

spending does not meet minimum 

standards for a given plan year. 

Specifically, Section 2718(a) of the 

PHS Act requires health insurance 

issuers offering group or individual 


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coverage to submit a report to the 

Secretary for each plan year, concerning 

the ratio of the incurred loss (or 

incurred claims) plus the loss 

adjustment expense (or change in 

contract reserves) to earned premiums 

(also known as the medical loss ratio 

(MLR)). Section 2718(a) requires that 

each report include the percentage of 

total premium revenue—after 

accounting for collections or receipts for 

risk adjustment and risk corridors and 

payments of reinsurance—that the 

coverage spends: 

(1) On reimbursement for clinical 

services provided to enrollees; 

(2) for activities that improve health 

care quality; 

and 

(3) on all other non-claims costs, 

including an explanation of the nature 

of these costs, and excluding Federal 

and State taxes and licensing or 

regulatory fees. 

Section 2718(a) also directs the 

Secretary to make these reports 

available to the public on the Internet 

Web site of HHS. 

C. Uniform Definitions 

Section 2718(c) of the PHS Act directs 

the National Association of Insurance 

Commissioners (NAIC) to establish 

uniform definitions of the activities 

being reported to the Secretary under 

Section 2718(a), and standardized 

methodologies for calculating measures 

of these activities no later than 

December 31, 2010. Section 2718(c) 

specifies that NAIC’s responsibilities 

relating to this provision are to include 

defining which activities constitute 

activities that improve quality (under 

Section 2718(a)(2)). Section 2718(c) also 

directs that the uniform methodologies 

that NAIC develops are to be designed 

to take into account the special 

circumstances of smaller plans, different 

types of plans, and newer plans. Finally, 

Section 2718(c) specifies that the 

uniform definitions and standardized 

methodologies that NAIC develops are 

to be subject to the certification of the 

Secretary. 

D. Payment of Rebates to Enrollees if the 

Amount Spent on Clinical Services and 

Quality Improvement Does Not Meet 

Minimum Standards 

Section 2718(b)(1)(A) of the PHS Act 

provides that, beginning not later than 

January 1, 2011, health insurance 

issuers offering group or individual 

health insurance coverage must with 

respect to each plan year, provide an 

annual rebate to each enrollee under 

such coverage if the ratio of: (1) The 

amount of premium revenue the issuer 

spends on reimbursement for clinical 

services provided to enrollees and 

activities that improve health care 

quality to (2) the total amount of 

premium revenue for the plan year 

(excluding Federal and State taxes and 

licensing or regulatory fees and after 

accounting for payments or receipts for 

risk adjustment, risk corridors, and 

reinsurance under sections 1341, 1342, 

and 1343 of PPACA) is less than the 

following percentages, referred to here 

as ‘‘the applicable minimum standards’’: 

(1) 85 percent for coverage offered in 

the large group market (or a higher 

percentage that a given State may have 

determined by regulation); or 

(2) 80 percent for coverage offered in 

the small group market or in the 

individual market (or a higher 

percentage that a given State may have 

determined by regulation), except that 

the Secretary may adjust this percentage 

for a State if the Secretary determines 

that the application of the 80 percent 

minimum standard may destabilize the 

individual market in that State). 

Section 2718(b)(2) requires that in 

determining these minimum 

percentages, States shall seek to ensure 

adequate participation by health 

insurance issuers, competition in the 

State’s health insurance market, and 

value for consumers so that premiums 

are used for clinical services and quality 

improvements. 

Additionally, Section 2718(d) 

provides that the Secretary may adjust 

the rates described in Section 2718(b) if 

the Secretary determines that it is 

appropriate to do so, on account of the 

volatility of the individual market due 

to the establishment of State Exchanges. 

(In this context, the terms ‘‘State 

Exchange’’ and ‘‘Exchange’’ refer to the 

State health insurance exchanges 

established under PPACA). 

Section 2718(b)(1)(A) requires that the 

annual rebate be paid to each enrollee 

on a ‘‘pro rata basis’’. Section 

2718(b)(1)(B)(i) specifies that the total 

amount of the annual rebate required 

under this provision shall be equal to 

the product of: 

(1) The amount by which the 

applicable minimum standard exceeds 

the actual ratio of the issuer’s 

expenditures to its premium revenue as 

described above; and 

(2) The total amount of the premium 

revenue described above. 

Section 2718(b)(1)(B)(ii) requires that 

beginning on January 1, 2014, the 

determination of whether the percentage 

that the coverage spent on clinical 

services and quality improvement 

exceeds the applicable minimum 

standard (under Section 2718(b)(1)(A)) 

for the year involved shall be based on 

the average of the premiums expended 

on these costs and total premium 

revenue for each of the previous three 

years for the plan. 

E. Enforcement 

Section 2718(b)(3) of the PHS Act 

requires the Secretary to promulgate 

regulations for enforcing the provisions 

of Section 2718, and specifies that the 

Secretary may provide for appropriate 

penalties. 

F. Taxation of Certain Insurers 

Section 9016 of the PPACA amends 

Section 833 of the Code to provide that 

Section 833 does not apply to any 

organization unless the organization’s 

percentage of total premium revenue 

expended on reimbursement for clinical 

services (as reported under Section 2718 

of the Public Health Service Act) is not 

less than 85 percent. In general, Section 

833 provides a special deduction and a 

higher unearned premium reserve for 

certain Blue Cross or Blue Shield 

organizations that were in existence in 

1986 and to other organizations that 

satisfy enumerated criteria. The 

amendment to Section 833 applies to 

taxable years beginning after December 

31, 2009. 

G. Effective Dates 

Section 1004(a) of the PPACA 

provides that the provisions of Section 

2718 of the PHS Act shall become 

effective for plan years beginning on or 

after the date that is 6 months after the 

date of enactment of PPACA. (The date 

of enactment of PPACA is March 23, 

2010). 

II. Solicitation of Comments 

The Departments are inviting public 

comment to aid in the development of 

regulations regarding Section 2718 of 

the PHS Act. The Departments are 

interested in comments from all 

interested parties and are especially 

interested in the perspectives of health 

insurance issuers and States. To assist 

interested parties in responding, this 

request for comments describes specific 

areas in which the Departments are 

particularly interested. 

This request for comments identifies 

a wide range of issues that are of interest 

to the Departments. Commenters should 

use the questions below to assist in 

providing the Departments with useful 

information relating to the development 

of regulations regarding Section 2718 of 

the PHS Act. However, it is not 

necessary for commenters to address 

every question below and commenters 

may also address additional issues 

under Section 2718. Individuals, 

groups, and organizations interested in 

providing comments may do so at their 


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discretion by following the above 

mentioned instructions. 

Specific Areas in Which the 

Departments Are Particularly Interested 

Include the Following: 

A. Actual MLR Experience and 

Minimum MLR Standards 

The PPACA sets an 85 percent 

minimum standard for the percentage of 

premiums that coverage in the large 

group market spends on reimbursement 

for clinical services and activities that 

improve quality, and an 80 percent 

minimum standard for the small group 

and individual markets—allowing for 

higher State-level standards where 

appropriate (if they are specified in 

regulations). The PPACA allows the 

Secretary to adjust this percentage for 

the individual market in a given State: 

(1) If the Secretary determines that 

application of the 80 percent standard 

may destabilize the individual market in 

that State, and/or (2) on account of the 

volatility of the individual market due 

to the establishment of State Exchanges. 

1. How Do Health Insurance Issuers’ 

Current Medical Loss Ratios for the 

Individual, Small Group, and Large 

Group Markets Compare to the 

Minimum Standards Required in 

PPACA? 

a. What factors contribute to annual 

fluctuations in issuers’ medical loss 

ratios? 

b. To what extent do States have 

different minimum MLR requirements 

based on plan size, plan type, number 

of years of operation, or other factors? 

2. What Criteria Do States and Other 

Entities Consider When Determining if 

a Given Minimum MLR Standard 

Would Potentially Destabilize the 

Individual Market? What Other Criteria 

Could Be Considered? 

B. Uniform Definitions and Calculation 

Methodologies 

The statute requires health insurance 

issuers offering group or individual 

health insurance coverage to annually 

submit to the Secretary a report 

concerning the ratio of the incurred loss 

(or incurred claims) plus the loss 

adjustment expense (or change in 

contract reserves) to earned premiums— 

including the percentage of premiums 

spent on reimbursement for clinical 

services provided to enrollees, activities 

that improve health care quality, and on 

all other non-claims costs. PPACA also 

directs NAIC to develop uniform 

definitions and methodologies for 

calculating these statistics (subject to 

certification by the Secretary). 

1. What Definitions and Methodologies 

Do States and Other Entities Currently 

Require When Calculating MLR-Related 

Statistics? 

a. What assumptions and 

methodologies do issuers use when 

calculating MLR-related statistics? What 

are some of the major differences that 

exist, as well as pros and cons of these 

various methods? 

b. What kinds of assumptions and 

methodologies do issuers currently use 

for allocating administrative overhead 

by product, geographic area, etc.? What 

are the pros and cons of these various 

methods? 

c. What kinds of assumptions and 

methodologies do issuers currently use 

when calculating the loss adjustment 

expense (or change in contract 

reserves)? What are the pros and cons of 

these various methods? 

d. To what extent do States and other 

entities receive detailed information 

about the distribution of non-claims 

costs by function (for example, claims 

processing and marketing)? To what 

extent do they set standards as to which 

administrative overhead costs may be 

allocated to processing claims, or 

providing health improvements? 

e. What kinds of criteria do States and 

other entities use in determining if a 

given company has credible experience 

for purposes of calculating MLR-related 

statistics? 

f. What kinds of special 

considerations, definitions, and 

methodologies do States and other 

entities currently use relating to 

calculating MLR-related statistics for 

newer plans, smaller plans, different 

types of plans or coverage? 

2. What Are the Similarities and 

Differences Between the Requirements 

in Section 2718 Compared to Current 

Practices in States? 

a. What MLR-related data elements 

that are required by PPACA do issuers 

currently capture in their financial 

accounting systems, and how are they 

defined? What elements are likely to 

require systems changes in order to be 

captured? 

b. What MLR-related data elements 

that are required by PPACA do States or 

other entities currently require issuers 

to submit, and how are they defined? 

What elements are not currently 

submitted? 

3. What Definitions Currently Exist for 

Identifying and Defining Activities That 

Improve Health Care Quality? 

a. What criteria do States and other 

entities currently use in identifying 

activities that improve health care 

quality? 

b. What, if any, lists of activities that 

improve health care quality currently 

exist? What are the pros and cons 

associated with including various kinds 

of activities on these lists (for example 

disease management and case 

management)? 

c. To what extent do current 

calculations of medical loss ratios 

include the amount spent on improving 

health care quality? Is there any data 

available relating to how much this 

amount is? 

4. What Other Terms or Provisions 

Require Additional Clarification To 

Facilitate Implementation and 

Compliance? What Specific 

Clarifications Would Be Helpful? 

C. Level of Aggregation 

Depending on the context, insurancerelated data may be aggregated at the 

policy form level, by plan type, by line 

of business, by company, by State. 

1. What Are the Pros and Cons 

Associated With Using Various Possible 

Level(s) of Aggregation for Different 

Contexts Relating to Implementation of 

the Provisions in Section 2718 (That Is, 

Submitting Medical Loss Ratio-Related 

Statistics to the Secretary, Publicly 

Reporting This Information, 

Determining if Rebates Are Owed, and 

Paying Out Rebates)? 

2. What Are the Pros and Cons 

Associated With Using Various Possible 

Geographic Level(s) of Aggregation (e.g., 

State-Level, National, etc.) for Medical 

Loss Ratio-Related Statistics in These 

Same Contexts (i.e., Submitting Medical 

Loss Ratio-Related Statistics to the 

Secretary, Publicly Reporting This 

Information, Determining if Rebates Are 

Owed, and Paying Out Rebates)? 

D. Data Submission and Public 

Reporting 

PPACA requires health insurance 

issuers offering group or individual 

health insurance coverage to annually 

submit data to the Secretary relating to 

several medical loss ratio-related 

statistics (including the percentage of 

premiums spent on reimbursement for 

clinical services provided to enrollees, 

activities that improve health care 

quality, and on all other non-claims 

costs) for posting on the Department’s 

Internet Web site. 

1. To what extent do States or other 

entities currently require annual 

submission of actual medical loss ratiorelated statistics for the individual, 

small group, and large group markets? 

How do these current requirements 

compare with the requirements in 

PPACA? 


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1For example: Current policyholders, current 

policyholders who were enrolled in the coverage 

during the applicable time period, or all 

policyholders who were enrolled in the coverage 

during the applicable time period (regardless of 

whether they are still active policyholders). 

2. How soon after the end of the plan 

year do States and other entities 

typically require issuers to submit the 

required MLR-related statistics? What 

are the pros and cons associated with 

various timeframes? 

3. What kinds of supporting 

documentation are necessary for 

interpreting these kinds of statistics? 

What data elements and format are 

typically used for submitting this 

information? 

4. What methods do issuers use for 

purposes of submitting medical loss 

ratio-related data to these entities (for 

example, electronic filing and paper 

filing)? 

5. To what extent is MLR-related 

information submitted to States or other 

entities currently made available to the 

public, and how is it made available (for 

example, level of aggregation, and 

mechanism for public reporting)? What 

are the pros and cons associated with 

these various methods? 

6. Are there any industry standards or 

best practices relating to submission, 

interpretation, and communication of 

MLR-related statistics? 

7. What, if any, special considerations 

are needed for non-calendar year plans? 

E. Rebates 

PPACA requires health insurance 

issuers whose coverage does not meet 

the applicable minimum standard for a 

given plan year to provide rebates to 

enrollees on a pro rata or proportional 

basis. The rebate is to be calculated 

based on the product of: (1) The amount 

by which the applicable minimum 

standard exceeds the percentage that the 

coverage spent on clinical services and 

quality improvement for a given plan 

year; and (2) the total amount of 

premium revenue for that plan year 

(excluding Federal and State taxes and 

licensing or regulatory fees and after 

accounting for payments or receipts for 

risk adjustment, risk corridors, and 

reinsurance under sections 1341, 1342, 

and 1343 of PPACA). 

1. To what extent do States and other 

entities currently require MLR-related 

rebates for the individual, small group, 

large group, and/or other insurance 

markets, and how are these rebates 

calculated and distributed? 

2. How soon after the end of the plan 

year do States and other entities 

currently require issuers to determine if 

rebates are owed? 

3. What are the pros and cons of 

various timeframes and methodologies 

for calculating rebates? 

4. How do States and other entities 

currently determine which enrollees 

should receive medical loss ratio-related 

rebates? 1 What are the pros and cons 

associated with these approaches? 

5. What method(s) do States and other 

entities currently require issuers to use 

when notifying enrollees if rebates are 

owed, and paying the rebates? What are 

the pros and cons associated with these 

approaches? 

6. Are there any important technical 

issues that may affect the processes for 

determining if rebates are owed, and 

calculating the amount of rebates to be 

paid to each enrollee? 

F. Federal Income Tax 

Under Section 9016 of the PPACA, 

the amendment to Section 833 of the 

Code applies to taxable years beginning 

after December 31, 2009. Under Section 

2718(c) of the PHS Act, the NAIC is 

directed to establish uniform definitions 

for purposes of the reporting required 

under Section 2718(a) not later than 

December 31, 2010. 

What guidance, if any, is needed for 

purposes of applying Section 833 of the 

Code for the first taxable year beginning 

after December 31, 2009? 

G. Enforcement 

PPACA requires the Secretary to 

publish regulations for enforcing the 

provisions of this section, and specifies 

that the Secretary may provide for 

appropriate penalties. 

1. What methods do States and other 

entities currently use in enforcing 

medical loss ratio-related requirements 

for the individual, small group, large 

group, and other insurance markets (for 

example, oversight and audit 

requirements)? What other methods 

could be used? 

2. What, if any, penalties do these 

entities currently apply relating to 

noncompliance with medical loss ratiorelated requirements? What, if any, 

related appeals processes are currently 

available to issuers? 

H. Comments Regarding Economic 

Analysis, Paperwork Reduction Act, and 

Regulatory Flexibility Act 

Executive Order 12866 requires an 

assessment of the anticipated costs and 

benefits of a significant rulemaking 

action and the alternatives considered, 

using the guidance provided by the 

Office of Management and Budget. 

These costs and benefits are not limited 

to the Federal government, but pertain 

to the affected public as a whole. Under 

Executive Order 12866, a determination 

must be made whether implementation 

of Section 2718 of the PHS Act will be 

economically significant. A rule that has 

an annual effect on the economy of $100 

million or more is considered 

economically significant. 

In addition, the Regulatory Flexibility 

Act may require the preparation of an 

analysis of the economic impact on 

small entities of proposed rules and 

regulatory alternatives. An analysis 

under the Regulatory Flexibility Act 

must generally include, among other 

things, an estimate of the number of 

small entities subject to the regulations 

(for this purpose, plans, employers, and 

issuers and, in some contexts small 

governmental entities), the expense of 

the reporting, recordkeeping, and other 

compliance requirements (including the 

expense of using professional expertise), 

and a description of any significant 

regulatory alternatives considered that 

would accomplish the stated objectives 

of the statute and minimize the impact 

on small entities. 

The Paperwork Reduction Act 

requires an estimate of how many 

‘‘respondents’’ will be required to 

comply with any ‘‘collection of 

information’’ requirements contained in 

regulations and how much time and 

cost will be incurred as a result. A 

collection of information includes 

recordkeeping, reporting to 

governmental agencies, and third-party 

disclosures. 

Furthermore, Section 202 of the 

Unfunded Mandates Reform Act of 1995 

(UMRA) requires that agencies assess 

anticipated costs and benefits and take 

certain other actions before issuing a 

final rule that includes any Federal 

mandate that may result in expenditure 

in any one year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $135 million. 

The Departments are requesting 

comments that may contribute to the 

analyses that will be performed under 

these requirements, both generally and 

with respect to the following specific 

areas: 

1. What Policies, Procedures, or 

Practices of Group Health Plans, Health 

Insurance Issuers, and States May Be 

Impacted by Section 2718 of the PHS 

Act? 

a. What direct or indirect costs and 

benefits would result? 

b. Which stakeholders will be 

impacted by such benefits and costs? 

c. Are these impacts likely to vary by 

insurance market, plan type, or 

geographic area? 


jlentini on DSKJ8SOYB1PROD with PROPOSALS
19302 Federal Register / Vol. 75, No. 71 / Wednesday, April 14, 2010 / Proposed Rules 

2. Are There Unique Costs and Benefits 

for Small Entities Subject to Section 

2718 of the PHS Act? 

a. What special consideration, if any, 

is needed for these health insurance 

issuers or plans? 

b. What costs and benefits have 

issuers experienced in implementing 

requirements relating to minimum 

medical loss ratio standards, reporting 

and rebates under State insurance laws 

or otherwise? 

3. Are There Additional Paperwork 

Burdens Related to Section 2718 of the 

PHS Act, and, if so, What Estimated 

Hours and Costs Are Associated With 

Those Additional Burdens? 

Signed at Washington, DC this 6th day of 

April, 2010. 

Clarissa C. Potter, 

Deputy Chief Counsel, (Technical), Internal 

Revenue Service, U.S. Department of the 

Treasury. 

Signed at Washington, DC this 7th day of 

April, 2010. 

Michael F. Mundaca, 

Assistant Secretary, (Tax Policy), U.S. 

Department of the Treasury. 

Signed at Washington, DC this 7th day of 

April, 2010. 

Phyllis C. Borzi, 

Assistant Secretary, Employee Benefits 

Security Administration, U.S. Department of 

Labor. 

Signed at Washington, DC this 8th day of 

April, 2010. 

Donald B. Moulds, 

Acting Assistant Secretary for Planning and 

Evaluation, Office of the Secretary, 

Department of Health and Human Services. 

[FR Doc. 2010–8599 Filed 4–12–10; 10:15 am] 

BILLING CODE 4150–03–P 

DEPARTMENT OF DEFENSE 

Department of the Army 

32 CFR Part 655 

RIN 0702–AA58 

[Docket No. USA–2008–0001] 

Radiation Sources on Army Land 

AGENCY: Department of the Army, DoD. 

ACTION: Proposed rule; request for 

comments. 

SUMMARY: The Department of the Army 

proposes to revise its regulations 

concerning radiation sources on Army 

land. The Army requires Non-Army 

agencies (including their civilian 

contractors) to obtain an Army 

Radiation Permit (ARP) from the 

garrison commander to use, store or 

possess ionizing radiation sources on an 

Army Installation. For the purpose of 

this proposed rule, ‘‘ionizing radiation 

source’’ means any source that, if held 

or owned by an Army organization, 

would require a specific Nuclear 

Regulatory Commission (NRC) license 

or Army Radiation Authorization 

(ARA). The purpose of the ARP is to 

protect the public, civilian employees 

and military personnel on an 

installation from potential exposure to 

radioactive sources. The U.S. Army 

Safety Office which is the proponent for 

the Army Radiation Safety Program is 

revising the regulation to reflect the 

Nuclear Regulatory Commission 

changes to licensing of NaturallyOccurring and Accelerator-Produced 

Radioactive Material (NARM). Executive 

Order 12866 Regulatory Planning and 

Review and Executive Order 13422 

Further Amendment to Executive Order 

12866 on Regulatory Planning and 

Review were followed to rewrite this 

rule. 

DATES: Consideration will be given to all 

comments received by June 14, 2010. 

ADDRESSES: You may submit comments, 

identified by 32 CFR Part 655, Docket 

No. USA–2008–0001 and/or RIN 0702– 

AA58, by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Federal Docket Management 

System Office, 1160 Defense Pentagon, 

Washington, DC 20301–1160. 

Instructions: All submissions received 

must include the agency name and 

docket number or Regulatory 

Information Number (RIN) for this 

Federal Register document. The general 

policy for comments and other 

submissions from members of the public 

is to make these submissions available 

for public viewing on the Internet at 

http://www.regulations.gov as they are 

received without change, including any 

personal identifiers or contact 

information. 

FOR FURTHER INFORMATION CONTACT: Tim 

Mikulski, (703) 601–2408. 

SUPPLEMENTARY INFORMATION: 

A. Background 

On October 1, 2007, the Nuclear 

Regulatory Commission (NRC) issued a 

final rule which establishes 

requirements for the expanded 

definition of byproduct material. 72 FR 

55864 (Oct. 1, 2007). The final 

regulation became effective on 

November 30, 2007. The NRC revised 

the definition of byproduct material in 

10 CFR Parts 20, 30, 50, 72, 150, 170, 

and 171 to be consistent with section 

651(e) of the Energy Policy Act of 2005. 

The same revision to the definition of 

byproduct material was made in a 

separate rulemaking for 10 CFR Part 110 

(April 20, 2006; 71 FR 20336). The 

Department of the Army is revising 32 

CFR Part 655 to reflect the changes of 

the expanded definition of byproduct 

material that include NaturallyOccurring and Accelerator-Produced 

Radioactive Material (NARM). 

Specifically, the current 32 CFR 655.10 

paragraphs (a)(2), (3) and (4) have been 

removed, as the sources described in 

these sections will now be covered 

under 32 CFR 655.10(a)(1), which 

incorporates the expanded NRC 

definition of byproduct material (see, 

e.g., 10 CFR 20.1003). 

Additional changes in the rule 

include: 

—Clarification that the use, storage, or 

possession of ionizing radiation sources 

must be in connection with an activity 

of the Department of Defense or in 

connection with a service to be 

performed on the installation for the 

benefit of the Department of Defense, in 

accordance with 10 U.S.C. 2692(b)(1). 

—The use of ionizing radiation to 

differentiate between ionizing and 

nonionizing radioactive sources. 

Nonionizing radiation sources include 

lasers and radio frequency sources that 

are not covered by an ARP. 

—The addition of an exemption of (1) 

non-Army entities using Army owned/ 

licensed radioactive materials and (2) 

other Military Departments needing an 

ARP to bring radioactive sources on 

Army lands. The Radiation Safety 

Officer (RSO) must be notified prior to 

ionizing radiation sources being brought 

onto the installation. 

—Clarification on when to file a NRC 

Form 241. 

—The time the ARP is valid has been 

extended from three months to twelve 

months to reduce the need for 

reapplication. 

—Consideration of host nation 

regulations was included for Outside 

the Continental United States 

(OCONUS) military installations. 

—The land will be restored to the 

condition it was in prior to the effective 

date of the ARP. 

B. Regulatory Flexibility Act 

The Department has certified that the 

rule will not have a significant 

economic impact on a substantial 

number of small entities because the 

rule imposes no additional costs. 

However, since this is a proposed rule, 

the Department of the Army seeks 

comments from small entities that may 

be impacted by this proposed rule 

change. 


jlentini on DSKJ8SOYB1PROD with PROPOSALS