24470 Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 

of the decision. The Secretary sends a 

written decision to the sponsor or the 

applicable Secretary’s designee upon 

request. 

Subpart G—Disclosure of Data 

Inaccuracies 

§ 149.600 Sponsor’s duty to report data 

inaccuracies. 

A sponsor is required to disclose any 

data inaccuracies upon which a 

reimbursement determination is made, 

including inaccurate claims data and 

negotiated price concessions, in a 

manner and at a time specified by the 

Secretary in guidance. 

§ 149.610 Secretary’s authority to reopen 

and revise a reimbursement determination. 

(a) The Secretary may reopen and 

revise a reimbursement determination 

upon the Secretary’s own motion or 

upon the request of a sponsor: 

(1) Within 1 year of the 

reimbursement determination for any 

reason. 

(2) Within 4 years of a reimbursement 

determination for good cause. 

(3) At any time, in instances of fraud 

or similar fault. 

(b) For purposes of this section, the 

Secretary does not find good cause if the 

only reason for the revision is a change 

of legal interpretation or administrative 

ruling upon which the determination to 

reimburse was made. 

(c) A decision by the Secretary not to 

revise a reimbursement determination is 

final and binding (unless fraud or 

similar fault is found) and cannot be 

appealed. 

Subpart H—Change of Ownership 

Requirements 

§ 149.700 Change of ownership 

requirements. 

(a) Change of ownership consists of: 

(1) Partnership. The removal, addition, 

or substitution of a partner, unless the 

partners expressly agree otherwise as 

permitted by applicable state law. 

(2) Asset sale. Transfer of all or 

substantially all of the assets of the 

sponsor to another party. 

(3) Corporation. The merger of the 

sponsor’s corporation into another 

corporation or the consolidation of the 

sponsor’s organization with one or more 

other corporations, resulting in a new 

corporate body. 

(b) Change of ownership; exception. 

Transfer of corporate stock or the merger 

of another corporation into the 

sponsor’s corporation, with the sponsor 

surviving, does not ordinarily constitute 

change of ownership. 

(c) Advance notice requirement. A 

sponsor that has a sponsor agreement in 

effect under this part and is considering 

or negotiating a change in ownership 

must notify the Secretary at least 60 

days before the anticipated effective 

date of the change. 

(d) Assignment of agreement. When 

there is a change of ownership as 

specified in paragraph (a) of this 

section, and this results in a transfer of 

the liability for health benefits, the 

existing sponsor agreement is 

automatically assigned to the new 

owner. 

(e) Conditions that apply to assigned 

agreements. The new owner to whom a 

sponsor agreement is assigned is subject 

to all applicable statutes and regulations 

and to the terms and conditions of the 

sponsor agreement. 

(f) Failure to notify the Secretary at 

least 60 days before the anticipated 

effective date of the change may result 

in the Secretary recovering funds paid 

under this program. 

Dated: April 29, 2010. 

Jay Angoff, 

Director, Office of Consumer Information and 

Insurance Oversight. 

Dated: April 29, 2010 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–10658 Filed 5–4–10; 8:45 am] 

BILLING CODE 4150–03–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of the Secretary 

45 CFR Part 159 

RIN 0991–AB63 

Health Care Reform Insurance Web 

Portal Requirements 

AGENCY: Office of the Secretary, HHS. 

ACTION: Interim final rule with comment 

period. 

SUMMARY: The Patient Protection and 

Affordable Care Act (the Affordable Care 

Act) was enacted on March 23, 2010. It 

requires the establishment of an internet 

Web site (hereinafter referred to as a 

Web portal) through which individuals 

and small businesses can obtain 

information about the insurance 

coverage options that may be available 

to them in their State. The Department 

of Health and Human Services (HHS) is 

issuing this interim final rule in order 

to implement this mandate. This interim 

final rule adopts the categories of 

information that will be collected and 

displayed as Web portal content, and 

the data we will require from issuers 

and request from States, associations, 

and high risk pools in order to create 

this content. 

DATES: Effective Date: These regulations 

are effective on May 10, 2010. 

Comment Date: To be assured 

consideration, comments must be 

received at the address provided below, 

no later than 5 p.m. on June 4, 2010. 

ADDRESSES: In commenting, please refer 

to file code DHHS–9997–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): 

• Electronically. You may submit 

electronic comments on this regulation 

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

the instructions on the home page. 

• 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: 

DHHS–9997–IFC, P.O. Box 8014, 

Baltimore, MD 21244–8014. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

• 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: DHHS–9997–IFC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

• By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments before the close 

of the comment period to either of the 

following addresses: 

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, 


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Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 24471 

please call telephone number (410) 786– 

9994 in advance to schedule your 

arrival with one of our staff members. 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by following 

the instructions at the end of the 

‘‘Collection of Information 

Requirements’’ section in this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Danielle Harris, (410) 786–1819. 

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. 

I. Background 

The Patient Protection and Affordable 

Care Act (Pub. L. 111–148), hereinafter 

referred to as the Affordable Care Act, 

was enacted on March 23, 2010. Section 

1103(a), as amended by section 10102(b) 

of the same act, directs the Secretary to 

immediately establish a mechanism, 

including an internet Web site, through 

which a resident of, or small business 

in, any State may identify affordable 

health insurance coverage options in 

that State. 

In implementing these requirements, 

we seek to develop a Web site 

(hereinafter called the Web portal) that 

would empower consumers by 

increasing informed choice and 

promoting market competition. To 

achieve these ends, we intend to 

provide a Web portal that provides 

information to consumers in a clear, 

salient, and easily navigated manner. 

We plan to minimize the use of 

technical language, jargon, or excessive 

complexity in order to promote the 

ability of consumers to understand the 

information and act in accordance with 

what they have learned. We will engage 

in careful consumer testing to identify 

the best methods to achieve these goals. 

In obtaining information to populate 

the Web portal, we will be seeking all 

the statutorily required information 

from issuers, and we anticipate adopting 

electronic submission capabilities. As 

we develop the Web portal, and engage 

with consumers, this information will 

be used to create an effective consumerfriendly presentation of affordable 

health coverage option plans. In 

addition, we plan to provide 

information, consistent with applicable 

laws, in a format that is accessible for 

use by members of the public, allowing 

them to download and repackage the 

information, promoting innovation and 

the goal of consumer choice. 

As we develop the Web portal, we are 

also seeking to balance the need to 

obtain information that will promote 

informed choice with the principles of 

the Paperwork Reduction Act and 

Executive Order 12866, which call for 

minimizing burdens and maximizing 

net benefits. To that end, we are seeking 

comments on how best to achieve that 

balance, and in particular how to reduce 

unnecessary burdens on the private 

sector. 

This is an interim final rule that 

becomes effective May 10, 2010. We 

invite public comments on all relevant 

issues to make improvements. 

A. Statutory Basis 

As discussed above, Section 1103(a)of 

the Affordable Care Act, as amended by 

section 10102(b) of the same act, directs 

the Secretary to immediately establish a 

mechanism, including an internet Web 

site, through which a resident of, or 

small business in, any State may 

identify affordable health insurance 

coverage options in that State. To the 

extent practicable, the Web site 

(hereinafter called the Web portal) is to 

provide, at minimum, information on 

the following coverage options: 

1. Health insurance coverage offered 

by health insurance issuers, 

2. Medicaid coverage, 

3. Children’s Health Insurance 

Program (CHIP) coverage, 

4. State health benefits high risk pool 

coverage, 

5. Coverage under the high risk pool 

created by section 1101 of the 

Affordable Care Act, and 

6. Coverage within the small group 

market for small businesses and their 

employees. 

In order to provide this information in 

a standardized format, section 1103(b) 

requires the Secretary to develop a 

standardized format to present the 

coverage information described above. 

This format is to provide for, at a 

minimum, the inclusion of information 

on the percentage of total premium 

revenue expended on nonclinical costs 

(as reported under section 2718(a) of the 

Public Health Service Act), eligibility, 

availability, premium rates, and cost 

sharing with respect to such coverage 

options. The format must be consistent 

with the standards that are adopted for 

the uniform explanation of coverage 

under section 2715 of the Public Health 

Service Act. Defining the minimum 

content of the format required under 

section 1103(b) in effect defines what 

we will publish as the minimum 

content of the Web portal. This 

regulation, therefore, specifies the data 

that will be collected and disseminated 

through the Web portal in accordance 

with 1103(a) as amended by section 

10102(b). 

B. General Overview 

Section 1103(a) of the Affordable Care 

Act, as amended by section 10102(b) of 

the same act, requires the establishment 

of a Web portal through which 

individuals can obtain information 

about the health insurance options that 

may be available to them in their 

‘‘State.’’ Section 1304(d) of the 

Affordable Care Act defines ‘‘State’’ to 

include the fifty states and the District 

of Columbia. The territories are not 

included in this definition. We therefore 

will interpret ‘‘State’’ in the Web portal 

context to mean the 50 States and the 

District of Columbia. 

By statute, the Web portal must be 

available for public use no later than 

July 1, 2010. We will use the data 

collections and processes described in 

this rule to make the initial release of 

the Web portal available to the public 

on July 1, 2010, through a government 

sponsored Web site. We intend for the 

future development and updating of the 

Web portal to be an evolutionary 

process that involves all stakeholders, 

and we anticipate future updates, 

including annual and periodic 

revisions, to be released as the result of 

a continued refinement of the Web 

portal content. 

In the July 1, 2010 release we will 

provide summary information about 

health insurance products that are 

available in the individual and small 

business markets including issuers of 

the products, types of products, 


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location, summaries of services offered, 

links to provider networks, and contact 

information (including Web site links 

and customer service telephone contact) 

to enable interaction with specific 

issuers. In addition, the Web portal will 

provide information on eligibility, 

coverage limitations and premium 

information for existing high risk pools 

operating in the States, to the extent that 

it is provided to us by the responding 

parties. It will also provide introductory 

information on eligibility and services 

for Medicaid and CHIP. We will include 

contact information and Web site links 

for the Medicaid and CHIP programs for 

individuals who believe that they or 

family members may meet eligibility 

criteria. In addition, we will provide 

information on coverage options for 

small businesses, including reinsurance 

for early retirees under section 1102 of 

the Affordable Care Act (which is being 

administered by HHS), and tax credits 

available under section 45R of the 

Internal Revenue Code, as added by 

section 1421 of the Affordable Care Act. 

We also will include Web site links to 

these programs so that small businesses 

can obtain further information. 

We note that Section 1103(b)(1) 

requires the Secretary to present the 

Web portal information in a format that 

is consistent with the standards that are 

adopted for the uniform explanation of 

coverage under section 2715 of the 

Public Health Service Act (PHSA) as 

added by section 1001(a) of the 

Affordable Care Act. Section 2715 of the 

PHSA provides for the establishment of 

these standards within 12 months of the 

Affordable Care Act’s enactment date. 

As a result, these standards will not be 

in place for the July 1, 2010 release of 

the Web portal. We will modify the 

format used to present the initial release 

of the Web portal to ensure Web portal 

consistency with these standards in 

accordance with the implementation 

schedule that is established for these 

standards. 

In an effort to make the Web portal as 

comprehensive as possible, we will 

enhance the content over time to 

include more than the statutory 

minimum requirements that are 

discussed above. We will include any 

information that we have that we 

believe would be useful to consumers, 

such as medical loss ratios, quality and 

performance information, links to 

appropriate Web sites such as the Web 

site of the association that represents 

existing State health benefits high risk 

pools, and more State-specific 

information on Medicaid and CHIP 

eligibility and service coverage. Because 

of the complexity of pricing information 

and the need to incorporate pricing 

engines into the Web site, detailed 

pricing and benefit information will be 

provided in the second release of the 

Web portal on October 1, 2010. 

As we discuss in more detail in 

section III ‘‘Waiver of Proposed 

Rulemaking and the 30-Day Delay in the 

Effective Date,’’ the statutory 

requirement for a July 1, 2010 Web 

portal release does not allow time for 

full notice and comment rulemaking. 

While this timeframe necessitates going 

directly to final, in order to maximize 

public input we are using an interim 

final rule with comment to establish the 

categories of information that we will 

collect for inclusion in the Web portal, 

including the data production 

requirements that we impose on health 

insurance issuers, and the data 

collection requests for States, 

associations, and high risk pools. 

II. Provisions of the Interim Final Rule 

A. Definitions 

For any terms defined by the 

Affordable Care Act, including the 

definitions in section 1304, as well as 

any definitions in the Public Health 

Service Act that are incorporated by 

reference under sections 1301(b) or 1551 

of the Affordable Care Act, we adopt 

those definitions. We discuss these 

definitions below. The regulatory text 

provides cross references to these 

provisions. We also explain here how 

we are defining the terms that are not 

defined in the Affordable Care Act or 

the PHSA. These terms are ‘‘State health 

benefits high risk pool,’’ ‘‘section 1101 

high risk pool,’’ ‘‘health insurance 

product’’ and ‘‘portal plan.’’ 

Section 2791(b)(1) of the PHSA, as 

incorporated by reference into the 

Affordable Care Act, defines ‘‘health 

insurance coverage’’ as ‘‘benefits 

consisting of medical care (provided 

directly, through insurance or 

reimbursement, or otherwise and 

including items and services paid for as 

medical care) under any hospital or 

medical service policy or certificate, 

hospital or medical service plan 

contract, or health maintenance 

organization contract offered by a health 

insurance issuer.’’ Section 2791(b)(2) in 

turn defines an insurance issuer (also 

referred to here as an ‘‘issuer’’) to be an 

entity ‘‘licensed to engage in the 

business of insurance in a State and 

which is subject to State law which 

regulates insurance’’ and specifies that it 

does not include a group health plan. 

For purposes of the Affordable Care 

Act and the PHSA, a distinction is made 

between health insurance coverage sold 

to group health plans, and other health 

insurance coverage. The term ‘‘group 

health plan,’’ as defined in section 

2791(a)(1) of the PHSA, exclusively 

refers to health coverage sold to group 

health plans. Section 1304(a)(2) of the 

Affordable Care Act, which adopts the 

identical definition as section 

2791(e)(1)(A) of the PHSA, defines 

‘‘individual market’’ as the ‘‘market for 

health insurance coverage offered to 

individuals other than in connection 

with a group health plan.’’ 

Section 2791(b)(5) of the PHSA in 

turn defines ‘‘individual health 

insurance coverage’’ as health insurance 

coverage ‘‘offered to individuals in the 

individual market, but does not include 

short-term limited duration insurance.’’ 

The Affordable Care Act and the 

PHSA further divide the group health 

insurance market into coverage sold to 

large employers (the ‘‘large group 

market,’’ and coverage sold to small 

employers (the ‘‘small group market’’). 

See section 1304(a)(3) of Affordable 

Care Act. Section 1304(b)(2) of the 

Affordable Care Act defines a ‘‘small 

employer’’ as, in connection with a 

group health plan with respect to a 

calendar year and a plan year, an 

employer who employed an average at 

least 1, but not more than 100 

employees on business days during the 

preceding calendar year, and who 

employs at least 1 employee on the first 

day of the plan year. Section 1304(b)(3) 

of the Affordable Care Act allows for a 

State to elect the option to define ‘‘small 

employer’’ as an employer who 

employed on average at least 1, but not 

more than 50 employees on business 

days during the preceding calendar year 

in the case of plan years beginning 

before January 1, 2016. As such, for any 

State that elects this option, we would 

apply this alternate definition of ‘‘small 

employer’’ for their State for plan years 

beginning before January 1, 2016. 

For purposes of this regulation, we 

will refer to health insurance coverage 

offered to employees of small employers 

in the small group market as ‘‘small 

group coverage.’’ 

Sections 1103(a)(2)(D) of the 

Affordable Care Act provides for Web 

portal reporting of ‘‘State health benefits 

high risk pools.’’ For the purpose of this 

rule, we define ‘‘State health benefits 

high risk pools’’ as nonprofit 

organizations created by State law to 

offer comprehensive health coverage to 

individuals who otherwise would be 

unable to secure such coverage because 

of their health status. This language was 

adopted, with modification, from the 

National Association of Comprehensive 

Health Insurance Plans (NASCHIP) 

annual report. Our understanding is that 

this definition is generally understood 

to identify existing high risk pools. 


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Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 24473 

Section 1103(a)(2)(E) provides for 

Web portal reporting of pools 

established pursuant to section 1101 of 

the Affordable Care Act. For purposes of 

this regulation, we define ‘‘section 1101 

high risk pools’’ as any entity described 

in regulations implementing section 

1101 of the Affordable Care Act. 

The Affordable Care Act and the 

PHSA do not include the term ‘‘health 

insurance product.’’ We are creating this 

term as a short hand reference to the 

information that we will publish in the 

first release of the Web portal. This term 

is needed in order to differentiate the 

information that will be collected for the 

July 1, 2010 release and the post-July 1, 

2010 releases. We define ‘‘health 

insurance product’’ (‘‘product’’) as a 

package of benefits that an issuer offers 

that is reported to State regulators in an 

insurance filing. 

The Affordable Care Act and the 

PHSA also do not define the term 

‘‘portal plan.’’ We are creating this term 

to describe certain data that we will 

collect and disseminate in post-July 1, 

2010 releases of the Web portal. We 

understand that consumers apply for 

coverage under individual health 

insurance products that issuers develop 

and market to offer a package of 

benefits. In applying for a package of 

benefits, we further understand that 

consumers are offered a range of costsharing arrangements, including 

deductibles and copayments but not 

including premium rates or premium 

rate quotes. As a result, each package of 

benefits can be paired with a multitude 

of cost sharing options. We will use the 

word ‘‘portal plan’’ to refer to the 

discrete pairing of a package of benefits 

with a particular cost-sharing option 

(not including premium rates or 

premium rate quotes). We will collect 

portal plan information for publication 

in post-July 1, 2010 releases of the Web 

portal. We believe that portal plan 

information is precise enough to 

provide a potential consumer with 

enough information to discern the 

relative costs and benefits of selecting a 

particular coverage option. 

We welcome comments on the 

adequacy of these definitions, and, if 

applicable, suggestions to improve 

them. 

B. Individual and Small Group Market 

Data Collection and Dissemination 

In order to meet the mandate, we 

must collect information on individual 

and small group coverage from health 

insurance issuers and prepare the 

information to be presented publicly in 

a clear and concise fashion. We will 

have a two part rollout of the Web portal 

for 2010, and then annual and periodic 

updates to allow for the inclusion of 

updated data as well as consumer 

education content. 

1. Data Submission Mandate 

The Secretary currently regulates 

health insurance industry practices for 

private insurance plans offered through 

public programs such as Medicare, 

Medicaid, and CHIP. While she either 

has or has access to data on Federal 

government sponsored plans, we must 

issue regulations to mandate the 

production of the necessary information 

from issuers in order to fulfill the 

statutory mandate as it applies to 

private plans not offered through 

Federal government programs. To 

facilitate the development of a robust 

Web portal with comprehensive pricing 

and benefit information on individual 

and small group coverage, our current 

plan is to contract with a vendor that 

has a health insurance pricing engine 

and a related Web site with portal plan 

identification and comparison 

functionality through a full and open 

competition. The work on this contract 

will not be completed in time for the 

July 1, 2010 release of the Web portal. 

Accordingly, we will collect an initial 

set of data (health insurance product 

information) from issuers in order to 

present basic information on all issuers 

and health insurance products in the 

July 1, 2010 release of the Web portal. 

This release of the Web portal will only 

contain the basic information on issuers 

and their products in the individual and 

small group markets that was 

practicable to obtain in the constrained 

timeframe for meeting the statutory 

requirement that the Web portal be 

available for public use by July 1, 2010. 

We will provide a second release of the 

Web portal on October 1, 2010 with 

comprehensive pricing and benefit 

information for individual and small 

group coverage. 

We will communicate to consumers 

through the Web portal and other public 

communication processes, such as 

presentations and reports to 

stakeholders, the names of those issuers 

who fail to timely meet the reporting 

requirements or who provide 

incomplete or inaccurate information. 

a. July 1, 2010 

To meet the July 1, 2010 deadline, we 

will require issuers to provide data that 

we will use to develop introductory 

information for consumers on the 

universe of issuers and health insurance 

products in their geographic area. By 

May 21, 2010 we will require issuers to 

submit corporate and contact 

information, such as corporate 

addresses and Web sites; administrative 

information, such as enrollment codes; 

enrollment data by product; product 

names and types, such as Preferred 

Provider Organization (PPO) or Health 

Maintenance Organization (HMO); 

whether enrollment is currently open 

for each product; geographic availability 

information, such as product 

availability by zip code or county; 

customer service phone numbers; Web 

site links to the issuer Web site, 

brochure documents such as benefit 

summaries, and provider networks; and 

financial ratings, such as those offered 

by financial rating firms including AM 

Best, Standard and Poor, and Moody’s, 

if available. 

We invite comment on whether 

enrollment information is considered by 

issuers to be confidential business 

information. 

We are aware that some issuers are 

rated on their financial status and other 

performance measures. We considered 

excluding issuers with no or low 

financial ratings from firms such as AM 

Best, Standard and Poor, and Moody. 

However, it is our understanding that 

not all issuers seek financial ratings, and 

that the private firms that conduct them 

do not use standardized approaches. 

Therefore, we will instead require each 

issuer to submit information on whether 

they obtained a financial rating, from 

which firm, and what the rating is. We 

will use this information to help analyze 

whether such ratings are or could be 

useful in conveying meaningful 

differences to consumers. For the same 

purpose we will allow, but not require 

issuers to report other types of ratings 

they have received, such as ratings from 

The National Committee for Quality 

Assurance (NCQA) Accreditation. 

Certain administrative information 

that we are collecting, such as an 

issuer’s technical contact information 

(that is, the person who will work 

directly with us and our contractors to 

submit and validate data), tax 

identification number, and enrollment 

count in an issuer’s products, will be 

used to support the structure of the 

database in which this information will 

be warehoused so that the data can be 

easily retrieved to support uploading 

information to the Web portal test site, 

and so that issuers and their portal 

plans can be reliably recognized by HHS 

and issuers and counted to support 

analyses for improving the Web portal. 

This information will also be used to 

support analysis necessary to improve 

the meaningfulness and usefulness of 

the Web portal in future releases. In 

addition, certain contact information 

will allow the Federal government and 

its contractors to provide useful updates 


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24474 Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 

and reminders to issuers and to provide 

technical support. 

Data submitted under the 

requirements contained in this 

regulation must be submitted by issuers 

in accordance with instructions issued 

by the Secretary. 

b. October 1, 2010 

We will release a more 

comprehensive version of the Web 

portal on October 1, 2010. This version 

will include benefit and pricing 

information. Benefit and pricing 

information includes data such as 

premiums, cost-sharing options, types of 

services covered, coverage limitations, 

and exclusions. 

We note that for States in which 

premiums are not community rated, the 

premium data that we intend to collect 

will include manual rates that represent 

only standard risks. As a result of 

medical underwriting, issuers may 

charge individuals rates that are above 

the manual rate based on the applicant’s 

health status. We recognize that there is 

not a feasible method for collecting or 

displaying information on the rate that 

an individual who is underwritten 

might actually be charged, and in the 

absence of that are proposing to provide 

information on the manual rates with 

the understanding that they do not 

represent actual premium rates that an 

individual may be charged. 

While the initial release of the Web 

portal will list all issuers and all health 

insurance products, we believe that it 

would confuse users if we were to 

display portal plans that are not open 

for enrollment. Furthermore, we believe 

that it is inappropriate to impose a 

pricing and benefits information 

reporting burden on issuers for products 

and portal plans that are not open for 

enrollment. Therefore, we will exempt 

issuers of products and portal plans that 

are not open to new enrollments from 

additional pricing and benefits reporting 

requirements. Such issuers will be 

required to provide the data defined 

under the May 21 collection to assure 

we have the universe of issuers and 

their health insurance products. 

In the event that an issuer establishes 

new products or new portal plans under 

a product, or opens enrollment in 

products or portal plans under a 

product that was previously closed to 

enrollment, we will require the 

submission of the pricing and benefits 

information within 30 days of offering 

new, or newly re-opened to enrollment, 

products or portal plans. 

We considered excluding issuers with 

minimal market share from the benefits 

and cost sharing data collection. 

However, we believe that some of the 

portal plans offered by these issuers 

serve niche markets that would be 

particularly appealing to some 

consumers. At this time, we will 

include portal plans with minimal 

market share, but we will collect 

enrollment data for use in analyzing the 

effect, if any, of market share and our 

ability to meet consumer needs. 

The intent of the Web portal is to 

present consumers with the full range of 

meaningful insurance options available 

to them. We believe this will be best 

accomplished through providing all 

plans that have a non-de minimus 

portion of the issuer’s enrollment in an 

area and allowing for additional plans to 

be submitted based on the issuers 

perception of need. Our initial overview 

of the market indicates that most areas 

have coverage which is concentrated in 

a limited number of portal plans. One 

percent of an issuers’ enrollment in the 

service area was seen as a reasonable cut 

off balancing the consumer’s right to 

know with the burden imposed on 

issuers. Therefore, for each zip code, 

issuers will be required to submit 

information on at least all portal plans 

that are open for enrollment and that 

represent 1 percent or more of the 

issuer’s total enrollment for the 

respective individual or small group 

market within that zip code. 

We invite comments from the public 

on what information should be required 

from issuers to ensure consumer access 

to meaningful information about 

coverage options is included in the Web 

portal, and on the ways that information 

should be presented to allow for sorting 

and comparing portal plans. We are 

particularly interested in comments 

from consumers, to make certain that 

the Web portal meets the needs of those 

individuals who will use it as part of 

their health coverage decision making. 

The data submissions for the October 

1, 2010 Web portal release will be due 

by September 3, 2010. Data must be 

submitted by issuers in accordance with 

instructions issued by the Secretary. 

c. Future Updates 

After the initial data collection efforts 

described in the prior two subsections, 

we will require issuers to perform an 

annual verification and update of the 

data they submitted. In addition, we 

recognize that many issuers update 

pricing and benefit information for their 

portal plans more frequently than 

annually, and we therefore will require 

issuers to submit updated data 

whenever they change premiums, costsharing, types of services covered, 

coverage limitations, or exclusions for 

one or more of their individual or small 

group portal plans. Furthermore, we 

will require issuers that develop new 

health insurance products between 

annual verifications to submit pricing 

and benefit information for the new 

product within 30 days of opening 

enrollment. 

Finally, while not included in the 

statutory list of minimum requirements 

for the Web portal, we will collect from 

issuers and report on the Web portal in 

2011 the following performance ratings: 

percent of individual market and small 

group market policies that are 

rescinded; the percent of individual 

market policies sold at the manual rate; 

the percent of claims that are denied 

under individual market and small 

group market policies; and the number 

and disposition of appeals on denials to 

insure, pay claims and provide required 

preauthorizations. 

Updated data, including the required 

data updates previously discussed and 

annual verifications, must be submitted 

by issuers in accordance with 

instructions issued by the Secretary in 

a future Paperwork Reduction Act 

Package. 

d. Data Validation 

All data that is collected for the July 

1, 2010, October 1, 2010, and future 

releases of the Web portal will be 

validated by the issuers to assure the 

information they provided is correct. 

We will require the issuer’s CEO or CFO 

to electronically certify to the 

completeness and accuracy of the initial 

data collection for the October 1, 2010 

release of the Web portal and for any 

future updates to these requirements. 

Following the submission of the data, 

we will provide issuers with access to 

preview the data that we will publish on 

the Web portal. They will also be 

provided with access to edit their data 

submissions to update or correct 

information. 

2. Voluntary Data Submission by States 

We are requesting that States submit 

data on issuer corporate and contact 

information for licensed issuers in their 

State, such as corporate addresses and 

Web sites; underwriting status, such as 

whether or not premium rates in the 

individual market are determined based 

on medical underwriting or community 

rating; and information on any public 

Web sites administered by the State that 

provide consumer guidance on 

individual and small group health 

insurance coverage in their State. 

It is our understanding that States 

possess the issuer corporate and contact 

information we are requesting them to 

submit as a result of their filing 

requirements for regulated issuers. We 

are requesting that States voluntarily 


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submit issuer corporate and contact 

information because we believe that it is 

incumbent upon us to ensure that we 

provide information on the entire 

universe of issuers and health insurance 

products. Gathering these data from 

both States and issuers will help us in 

determining the universe and ensure 

that we are not inadvertently excluding 

an issuer or product as a result of 

incomplete data collection. 

The underwriting information and 

Web site links we are requesting from 

States will be included on the Web 

portal in an effort to develop consumer 

education content and incorporate (by 

way of linking) any State-developed 

information on insurance coverage 

options in a given State. We recognize 

that some States may have already 

developed Web portals that provide 

comprehensive information about 

health insurance coverage in their State, 

and we will link to that information if 

it is available. 

In asking States to provide the data 

identified above, we note that the 

information would improve the 

accuracy and scope of the information 

we can provide to consumers in each of 

the States. We expect that States will 

want to ensure full access to 

information about issuers, health 

insurance products and portal plans to 

their residents. We believe that doing so 

would support consumer choice and a 

more robust marketplace for insurance. 

We therefore anticipate that States will 

be responsive to this request because the 

information requested will enhance the 

ability of the citizens of each State to 

identify affordable options for 

insurance. 

3. Data Dissemination 

We will disseminate the information 

collected as a result of our data 

submission mandates as described 

above, as well as other information 

about health insurance coverage in the 

individual and small group market that 

may be useful to the public. 

a. July 1, 2010 

On July 1, 2010 the Web portal will 

include information on the data 

collected as a result of the May 21, 2010 

data submission mandate outlined 

above, including information for 

consumers on the issuers that sell 

individual and small group products in 

their area and links to benefit 

information for those products. In 

addition, we will provide some 

consumer education information on the 

individual market, including describing 

how it operates and why its offerings 

might be appropriate for a consumer, as 

well as information that will facilitate 

health insurance coverage decisionmaking and increased understanding of 

how the Web portal operates in the 

context of the Affordable Care Act. We 

also will include information for small 

businesses on the small group market, 

including information on the 

reinsurance and tax credit programs 

discussed previously. 

b. October 1, 2010 

On October 1, 2010 the Web portal 

will include expanded content that will 

incorporate the data collected as a result 

of the September 3, 2010 data 

submission mandate outlined above 

with the data collected for the May 21, 

2010 mandate previously discussed. 

Using the pricing and benefit 

information gathered as a result of the 

September 3rd collection, we will 

display portal plans as packages of 

benefits and cost sharing, with 

associated premiums, based on 

geographic availability. 

The display of portal plans will be 

driven by interactive functionality that 

accounts for geographic and personal 

demographic information such as State 

and zip code of residence, sex, family 

composition, smoking status and other 

health indicators. We intend for the 

order and layering of search results to be 

based on consumer choice parameters 

such as range of premium, high and low 

deductibles, ranges of out-of-pocket 

maximums, provider network, and 

indicators of market interest in the 

product including enrollment. We 

intend that consumers will also have the 

ability to select on all available issuers 

and portal plans and view them 

alphabetically. 

We invite comments on the sort and 

selection functionality of the Web 

portal, and on the order and layering of 

portal plans that we will display. 

Certain administrative data collected 

for the October 1 Web portal release will 

not be displayed directly on the Web 

portal but these data are important to 

the functionality of a pricing engine, 

such as input data that defines the 

geographic and demographic variables 

that affect premium price and cost 

sharing that will be displayed on the 

Web portal. 

We also will retain and enhance the 

consumer education content established 

for the July 1, 2010 Web portal release. 

c. Future Updates 

We will update the portal plan pricing 

and benefit information as frequently as 

monthly to reflect updates that issuers 

submit as a result of changes to their 

portal plans. As discussed previously, 

because issuers may update pricing and 

benefit information more frequently 

than annually, we are requiring updated 

data submissions whenever an issuer 

changes the premiums, cost-sharing, 

types of services covered, coverage 

limitations, or exclusions for one or 

more of their individual or small group 

portal plans. Our monthly updates will 

also reflect these updates. Consumer 

education content will be updated 

periodically in the event that new and 

pertinent information about either of 

these markets becomes available that 

would be beneficial for a consumer to 

know. 

In addition, we are required by 

section 1103(b)(1) to provide 

information on the percentage of total 

premium revenue expended on 

nonclinical costs, as reported under 

section 2718(a) of the Public Health 

Service Act (PHSA). We will report 

medical loss ratios to meet this 

requirement, which will provide more 

than the minimally required 

information and is believed to be more 

useful to the public. Section 2718 of the 

PHSA requires issuers to report this 

information to HHS beginning with plan 

years starting on or after September 23, 

2010, and the Secretary is promulgating 

rules on these reporting requirements. 

After the regulations for this provision 

are implemented, we anticipate 

including medical loss ratio information 

on the Web portal. 

As discussed previously, we 

anticipate including portal plan 

performance rating information, such as 

percent of individual market and small 

group market policies that are 

rescinded, the percent of individual 

market policies sold at the manual rate, 

the percent of claims that are denied 

under individual market and small 

group market policies, and the number 

and disposition of appeals, on the Web 

portal in the future. 

We also anticipate posting 

information derived from standards and 

reporting obligations that will apply to 

insurance sold under the exchanges. For 

example, we might post information on 

issuers’ financial stability, trends in 

enrollment and disenrollment, appeals 

and grievances, and other indicators of 

fiscal viability, customer service and 

policy-holder satisfaction. 

The Affordable Care Act directs the 

Secretary to develop quality measures 

and standards to inform the public 

about quality of care and to drive 

improvements in the service delivery 

system. When such measures and 

standards become available they will be 

incorporated into the Web portal. 

We invite comments on the content of 

futures updates to the Web portal, 

including the frequency of updates, the 

inclusion of performance rating 


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information, and the incorporation of 

quality measures and standards. 

C. Information to be Collected and 

Disseminated on High Risk Pool 

Coverage 

Sections 1103(a)(2)(D) and (E) of the 

Affordable Care Act requires HHS to 

include information about State health 

benefits high risk pools and high risk 

pools established under section 1101 of 

the Affordable Care Act. In order to 

fulfill this mandate, HHS must establish 

a mechanism for collecting and 

preparing this information for public 

dissemination in a clear and concise 

fashion. 

1. Data Submission Request 

Pursuant to the requirement that the 

Web portal include information on 

coverage through these high risk pools, 

this rule requests that certain 

information on State health benefits 

high risk pools and high risk pools that 

will operate under authority established 

in section 1101 of the Affordable Care 

Act be reported. 

a. July 1, 2010 

We will ask the National Association 

of State Comprehensive Health 

Insurance Plans (NASCHIP) for 

information about State health benefit 

high risk pools. This information will 

include administrative and contact 

information, such as a customer service 

phone number and a Web site for pool 

information; pool eligibility 

information, such as state residency and 

health condition requirements; pool 

coverage limitations, such as restrictive 

riders; and pool premium information, 

such as rules and restrictions for 

premium subsidy programs. We 

understand that this information is 

currently collected and maintained by 

NASCHIP, and that all of the existing 

State health benefits high risk pools are 

members of NASCHIP. As such, we 

believe that NASCHIP is strategically 

equipped to work with the State health 

benefits high risk pools to gather and 

transmit data to HHS on behalf of State 

health benefits high risk pools. 

Therefore, we will ask NASCHIP to 

provide the data as discussed above by 

May 21, 2010. 

b. Future Updates 

We understand that coverage that is 

offered by State health benefits high risk 

pools is updated on an annual calendaryear basis. We will therefore ask 

NASCHIP to provide annual updates of 

the information that we will request for 

the May 21, 2010 data collection. If 

NASCHIP is unable to provide this 

information in the future, we will ask 

State health benefits high risk pools to 

provide this information. 

Because the initial release of the Web 

portal is July 1, 2010, which is in the 

middle of a calendar-year, we will 

initiate the annual update data 

submission requests in the fall of 2010. 

In addition, we request that any State 

health benefits high risk pool that is 

established after May 21, 2010, 

including any high risk pool established 

pursuant to section 1101 of the 

Affordable Care Act, report the 

requested information within 30 days of 

when the pool begins accepting 

enrollment, and then annually 

thereafter. 

2. Data Dissemination 

a. July 1, 2010 

The July 1, 2010 release of the Web 

portal will include eligibility, coverage 

limitations and premium information as 

collected under the request as described 

above, as well as consumer education 

content that would aid consumer 

understanding about high risk pools 

generally, and whether such pools 

might offer a potential source of 

coverage for them. 

b. Future Updates 

Future updates to the high risk pool 

content of the Web portal will include 

updates to the eligibility, coverage, and 

premium information requested above. 

These updates may include data for new 

high risk pools that are established 

subsequent to the July 1, 2010 release of 

the Web portal, including those 

established pursuant to section 1101 of 

the Affordable Care Act. We understand 

NASCHIP intends to build a Web site to 

contain detailed information that today 

is only available in NASCHIP’s hard 

copy annual report. We will therefore 

also provide a link to a NASCHIP Web 

site in a future release in order to 

provide even more comprehensive 

information on those State health 

benefits high risk pools that are 

represented by NASCHIP. 

D. Information to be Disseminated on 

Medicaid and CHIP 

Sections 1103(a)(2)(B) and (C) of the 

Affordable Care Act require that 

Medicaid and CHIP information be 

included on the Web portal. Title XIX 

of the Social Security Act, the law 

governing the Medicaid program, has 

allowed States broad discretion over 

Medicaid eligibility policy and 

therefore, Medicaid eligibility varies 

widely across States. In general, 

Medicaid eligibility is dependent on 

categorical and income requirements. 

Title XXI of the Social Security Act 

outlines the eligibility rules in CHIP, 

and such eligibility requirements are 

generally based on certain income 

requirements for children under age 19. 

There are instances where pregnant 

women and parents can be eligible for 

CHIP. The Affordable Care Act 

simplifies Medicaid and CHIP income 

eligibility rules for most populations 

beginning January 2014. In the 

meantime, individuals will need to 

directly contact their State programs for 

definitive determinations of their 

eligibility or for their family members. 

However, the Web portal can serve as a 

resource to educate potential 

beneficiaries that they or their family 

members may be eligible for Medicaid 

and CHIP and provide information 

about how they can contact their State 

programs to determine eligibility and 

services available to them. The portal 

will serve as a resource for 

understanding what their State 

Medicaid and CHIP programs generally 

cover and how to apply for benefits. 

To implement sections 1103(a)(2)(B) 

and (C) we will provide information 

guiding consumers on general eligibility 

criteria for the individual State 

programs in an effort to assist them in 

assessing the need to pursue the 

application processes for these 

programs. There are no new reporting 

requirements to support implementation 

of this section. The data will come from 

existing Federal sources. The Web 

portal will also be designed to offer 

links to the various State Medicaid and 

CHIP agencies in order to facilitate 

consumers’ submission of program 

applications. 

For each eligibility category, the Web 

portal will present information 

regarding the services that are available 

to eligible applicants. General cost 

sharing requirements will also be 

presented on the Web portal, to the 

extent that they are permitted for the 

eligibility category in these programs. 

In order to provide this information, 

data are being compiled within CMS 

across all Medicaid and CHIP eligibility 

categories regarding the services 

available under each program. This 

includes both mandatory and optional 

Medicaid services for which States 

receive Federal funding as defined in 

each State Medicaid plan and any 

waiver of such plan, as well as the 

services available under each State’s 

CHIP plan and any waiver of such plan. 

Mandatory services are specific services 

States are required to cover for certain 

groups of Medicaid beneficiaries, both 

adults and children under the age of 21. 

Each required service is defined in 

Federal regulations 42 CFR part 440. 

Optional Medicaid services are defined 

as those services not required by Federal 


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law that States may elect to provide 

Medicaid beneficiaries. Optional 

services are also defined in Federal 

regulation at 42 CFR part 440. CHIP 

regulations define mandatory and 

optional services at 42 CFR part 457. 

The portal will include data elements 

for mandatory services for each 

mandatory and optional categorical 

group defined in each Medicaid State 

plan, such as: Inpatient hospital care 

(excluding inpatient services in 

institutions for mental disease for 

working age adults); outpatient hospital 

care; physician’s services; nurse 

midwife services; pediatric and family 

nurse practitioner services; laboratories 

and x-ray services; rural health clinic 

services including Federally qualified 

health centers (‘‘FQHC’’) and if 

permitted by State law, rural health 

clinic and other ambulatory services 

provided by a rural health clinic which 

are otherwise included under a State 

Medicaid plan; prenatal care and family 

planning services, skilled nursing 

facility services for persons over age 21, 

home health care services for persons 

over 21 who are eligible for skilled 

nursing services (includes medical 

supplies and equipment), early and 

periodic screening, diagnosis, and 

treatment for persons under age 21 

(‘‘EPSDT’’), necessary transportation 

services, and vaccines for children. 

If States include optional services in 

their Medicaid State plan, they must be 

provided in a manner that is consistent 

with all Federal requirements. The Web 

portal will include data elements to 

reflect the availability of optional 

services such as home health therapy 

services, rehabilitative services, case 

management services, medical or 

remedial care services or other licensed 

practitioners (chiropractors, podiatrists, 

optometrist, psychologists and nurse 

anesthetists), smoking cessation services 

and palliative care for children in each 

State Medicaid plan. Additional 

program specific service information 

will be provided with regard to 

Demonstration programs designed by 

States under the authority of section 

1115 of the Social Security Act as well 

as services provided through the 

Children’s Health Insurance Program. 

Appropriate information on a specific 

State’s Demonstration programs, 

including variations in eligibility, 

coverage and service delivery systems 

used under the Demonstrations, will 

also be provided on the portal. 

Demonstrations that are Statewide or 

high impact, meaning that they have a 

significant penetration in the market 

and serve more than a narrow coverage 

group, will also be included in the 

initial release of the Web portal. Other 

Demonstration programs in Medicaid 

and CHIP will be added in future 

releases. 

Additionally, the Web portal will 

provide information to consumers on 

the Home and Community-Based 

Waiver program (Section 1915(c) of the 

Act), including a broad range of State 

defined services that enable 

independence in a consumer’s own 

home. 

All of the above data will be derived 

from sources internal to CMS and 

include Medicaid State Plan 

Amendments, CHIP State Plans, CHIP 

annual reports, home and community 

based waivers applications and 

renewals, 1115 Demonstration 

documents, and the contacts database 

used for http://www.cms.gov which 

includes consumer contacts to state 

Medicaid and CHIP program offices. We 

are not collecting any new data 

elements for the Medicaid and CHIP 

portions of the Web portal under the 

authorities that were granted to us 

under section 1103 of the Affordable 

Care Act. All information will come 

from data that CMS already collects for 

program management and 

administration purposes. 

Certain State-based variations in 

Medicaid and CHIP programs, such as 

specific income and resource disregards, 

and variations in services, such as limits 

on the number of visits, cannot be 

presented with a high degree of detail in 

early releases of the Web portal. We 

expect to list the services and note that 

there are limitations, giving consumers 

enough information to ask questions of 

the State program if they pursue an 

application to enroll. 

Finally, while a significant amount of 

data is being compiled to populate the 

Web portal, some of the data for the 

Medicaid and CHIP portion will be 

presented in an aggregated format to 

enhance public understanding. For 

example, eligibility categories may be 

collapsed together for purposes of 

maximizing public understanding. By 

way of example, there are several 

working disabled eligibility categories 

in Medicaid that inter-relate. We would 

expect, given the complexity of these 

definitions, that consumers may have 

difficulty fully understanding these 

categories. Therefore, we are presenting 

the public with summary-level 

information, such as collapsing 

information about the working disabled 

into one category. 

III. Waiver of Proposed Rulemaking 

and the 30-Day Delay in the Effective 

Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register and invite public comment on 

the proposed rule in accordance with 5 

U.S.C. 553(b) of the Administrative 

Procedure Act (APA). The notice of 

proposed rulemaking includes a 

reference to the legal authority under 

which the rule is proposed, and the 

terms and substances of the proposed 

rule or a description of the subjects and 

issues involved. This procedure can be 

waived, however, if an agency finds 

good cause for concluding that a noticeand-comment procedure is 

impracticable, unnecessary, or contrary 

to the public interest and incorporates a 

statement of the finding and its reasons 

in the rule issued. Section 1103(a), as 

amended by section 10102(b), and 

section 1103(b) of the Affordable Care 

Act provide for the establishment by 

July 1, 2010 of a Web portal through 

which a resident or small business of 

any State may identify affordable health 

insurance coverage options in that State. 

In order to meet this mandate, we have 

to collect and prepare for dissemination 

a broad array of data on issuers, health 

insurance products, and plans, 

including administrative and product 

information for the individual and small 

group markets; information on 

eligibility and coverage limits for high 

risk pools; and information on eligibility 

and services for Medicaid and CHIP. 

This cannot be accomplished unless 

issuers are made aware of the data 

submission requirements in short order 

and States, associations and high risk 

pools are made aware of opportunities 

to aide in this information 

dissemination effort within the 

established narrow timeframes. In order 

to allow sufficient time for data 

submission and validation prior to 

public presentation, we must be in 

possession of the data that is to be 

included on the Web portal in the July 

1, 2010 release no later than May 21, 

2010. 

As a result of this data collection 

timeline, it is impracticable to issue a 

notice of proposed rulemaking prior to 

publishing a final rule that would 

implement these data production 

requirements. Therefore, we find good 

cause to waive notice and comment 

rulemaking, and we are proceeding with 

issuing this final rule on an interim 

basis. We are providing a 30-day public 

comment period. 

In addition, we ordinarily provide a 

30-day delay in the effective date of the 

provisions of an interim final rule. 

While the Administrative Procedures 

Act (5 U.S.C. 551 et seq.) generally 

requires the publication of a substantive 

rule not less than thirty days prior to its 

effective date, agencies may establish a 

shorter time frame based on good cause. 


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5 U.S.C. 553(d)(3). In accordance with 

the good cause basis explained below, 

these regulations are effective on May 

10, 2010. 

Section 1103(a) of the Affordable Care 

Act requires the public release of the 

Web portal on July 1, 2010. As shown 

below, a sequenced order of activities 

must be completed in order to meet this 

statutory deadline. 

Data will be uploaded into the 

database supporting the Web portal to 

populate the Web portal test site, and 

based on observations adjustments to 

the actual Web site may be made. Any 

problems with the actual data would be 

adjusted as well. This is a four week 

iterative process that continues until the 

test site is functioning and presenting 

data output as expected, which begins 

with the first data upload on June 3 and 

ends with the release of the Web portal 

on July 1. 

Prior to this, the data that is submitted 

must be formatted in preparation for 

upload to the database that supports the 

Web portal test site. First upload to the 

test site takes approximately two days, 

from June 1 to June 3. There can be 

subsequent uploads through June 14, as 

noted below. 

Prior to this, beginning May 21, we 

must have time to view the submitted 

data to assure it is complete and clean. 

At this same time we believe that the 

regulated parties should be offered an 

opportunity to validate the data they 

submit and resubmit any erroneous 

data. We believe that the minimum time 

required to accomplish such work is 

three weeks, which brings us to June 14, 

2010. There is a 10 day overlap between 

this process and the two processes 

described above. 

Prior to this, we must afford those 

submitting the data with adequate time 

to gather and submit the data. We 

believe that the minimum time that 

should be provided for this work is 7 

business days from May 12 through to 

May 21, 2010. 

In order to submit that data, these 

parties will need to establish accounts 

that will allow secure data entry into the 

data collection tool. This will entail 

approximately 3 business days from 

May 10 to May 12. 

Furthermore, we anticipate that these 

parties will need training and guidance 

on gathering data, obtaining an account 

and entering data. This will include a 

webinar on or about May 7 and other 

technical support through a help desk. 

This collection of activities would take 

at least 4 business days which brings us 

to May 12, 2010. 

Thus, in order to meet the statutory 

deadline of July 1, 2010, the processes 

described above must commence no 

later than May 10, 2010. 

Furthermore, certain activities had to 

occur within the agency prior to our 

being able to publish a rule to 

implement the Web portal requirements, 

or enter the contracts necessary to 

support work under this rule. The 

Affordable Care Act was enacted on 

March 23, 2010. We immediately 

established a workgroup to analyze 

policy options and the contractual and 

regulatory needs of the Web portal 

program. This work was completed on 

April 22. We then commenced taskspecific workgroups to draft the 

necessary documents, including this 

regulation, and to procure the initial 

contractors. While these activities 

would usually take at least 6 months we 

have accomplished them in just under 

six weeks. It was impossible to have 

accomplished this work any faster, and 

the brief timeframe between the 

publication of this document and the 

effective date of its provisions could not 

have been avoided through more 

diligent use of time by the individuals 

working to implement this mandate. 

To afford a full thirty days between 

publication and the effective date we 

would be have to hold the parties 

submitting the data and ourselves to 

inadequate timeframes in which to 

accomplish the necessary tasks. The 

timeframes and dates described above 

therefore establish good cause for an 

effective date that is fewer than thirty 

days after publication. 

We will accept comments on the 

content of this regulation until June 4, 

2010. This schedule will allow for a ten 

day comment period prior to the initial 

reporting requirement under these 

regulations. 

IV. Collection of Information 

Requirements 

In accordance with section 3507(j) of 

the Paperwork Reduction Act of 1995 

(44 U.S.C. 3501 et seq.), the information 

collection included in this interim rule 

have been submitted for emergency 

approval to the Office of Management 

and Budget (OMB). OMB has assigned 

control number 0938–1086 to the 

information collection requirements. 

Under the Paperwork Reduction Act 

of 1995, we are required to provide 60- 

day notice in the Federal Register and 

solicit public comment before a 

collection of information requirement is 

submitted to the Office of Management 

and Budget (OMB) for review and 

approval. In order to fairly evaluate 

whether an information collection 

should be approved by OMB, section 

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

Reduction Act of 1995 requires that we 

solicit comment on the following issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

We are soliciting public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements 

(ICRs): 

ICRs Regarding Data Submission for the 

Individual and Small Group Markets 

(§ 159.120) 

Section 159.120(a) requires health 

insurance issuers (issuers), in 

accordance with guidance issued by the 

Secretary, to submit corporate and 

contact information; administrative 

information; enrollment data by health 

insurance product; health insurance 

product name and type; whether 

enrollment is currently open for each 

health insurance product; geographic 

availability information; customer 

service phone numbers; and Web site 

links to the issuer Web site, brochure 

documents, and provider networks; and 

financial ratings on or before May 21, 

2010, and annually thereafter. The 

information must be submitted via a 

template furnished by the Secretary. 

The burden associated with these 

reporting requirements is both the time 

and effort necessary to review the 

regulations, analyze data, and train 

issuer staff and the time and effort 

necessary for an issuer to compile the 

necessary information, to download and 

complete the template, and to submit 

the required information. We estimate 

that this requirement affects 650 issuers. 

We believe it will take each issuer 30 

hours to review the regulations, analyze 

data, and train its staff on how to 

comply with the requirements. The total 

one-time burden associated with this 

requirement is 19,500 hours. The 

estimated cost associated with 

complying with this part of the 

requirement is $1,950,000. 

Based on our experience with 

Medicare Part C, we also estimate that 

each issuer will submit information on 

9 of its portal plans and that it will take 

each issuer a total of 19 minutes to 

download the information submission 

template, complete the template, and 

submit the template. The estimated 

annual burden associated with the 

requirements in § 159.120 is 206 hours. 


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Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 24479 

The estimate cost associated with 

complying with these requirements is 

$13,390. 

Section 159.120(b) requires issuers, in 

accordance with the guidance issued by 

the Secretary, to submit pricing and 

benefit data for their portal plans on or 

before September 3, 2010, and annually 

thereafter. The information must be 

submitted via a template furnished by 

the Secretary. The burden associated 

with this requirement is the time and 

effort necessary for issuers to compile 

and submit pricing and benefit 

information. We estimate that it will 

take each of the 650 issuers 533 minutes 

to comply with these requirements. The 

total annual burden associated with 

these requirements is 51,968 hours. The 

estimated cost associated with 

complying with these requirements is 

$3,377,920. 

Section 159.120(c) requires issuers to 

submit updated pricing and benefit data 

for their portal plans whenever they 

change premiums, cost-sharing, types of 

services covered, coverage limitations, 

or exclusions for one or more of their 

individual or small group portal plans. 

Section 159.120(d) requires issuers to 

submit pricing and benefit data for 

portal plans associated with products 

that are newly open or reopened for 

enrollment within 30 days of opening 

for enrollment. Each submission would 

include a certification on the 

completeness and accuracy of the 

submission. The burden associated with 

these requirements is the time and effort 

necessary for an issuer to submit the 

aforementioned data. While these 

requirements are subject to the PRA, we 

do not have sufficient data to estimate 

the associated burden. We do not know 

the frequency with which issuers will 

make the aforementioned updates. For 

that reason, we are estimating a total 

burden of 1 hour for these requirements. 

The estimate of one hour acknowledges 

that there is a burden associated with 

this requirement. The total estimated 

annual burden to industry associated 

with these updates is 13,000 hours, or 

20 hours per issuer. This estimate is 

based on a three times a year, 19 minute 

per batch response update. The total 

cost associated with this requirement is 

$845,000. 

Section 159.120(e) requires issuers to 

annually verify the data submitted 

under § 159.120(a) through (d). Section 

159.120(f) requires issuers to submit 

administrative data on product and 

performance rating information for 

future releases of the Web portal in 

accordance with guidance issued by the 

Secretary. While these requirements are 

subject to the PRA, we will seek OMB 

approval at a later date under notice and 

comment periods separate from this 

interim final rule with comment. 

TABLE 1—RECORDKEEPING AND REPORTING BURDEN

Regulation section(s) OMB control 

No. 

Respondents Responses 

Burden per 

response 

(hours) 

Total annual 

burden 

(hours) 

Hourly labor 

cost of 

reporting ($) 

Total labor 

cost of 

reporting ($) 

Total capital/maintenance costs 

($) 

Total cost 

($) 

§ 159.120(a) .............................. 0938–1086 650 650 30 19,500 100 1,950,000 0 1,950,000 

.................... 650 650 .317 206 65 13,390 0 13,390 

§ 159.120(b) .............................. 0938–1086 650 650 4 52,000 65 3,380,000 .................... 3,380,000 

§ 159.120(c) and (d) .................. 0938–1086 650 13,000 1 13,000 65 845,000 0 845,000 

Total ................................... .................... 650 14,950 .................... 84,706 .................... .................... .................... 6,188,390 

This interim final rule imposes 

information collection requirements as 

outlined in the regulation text and 

specified above. However, this interim 

final rule also makes reference to several 

associated information collections that 

are not discussed in the regulation text 

contained in this document. The 

following is a discussion of these 

information collections. 

State Data Submissions 

As previously stated in Section II.B.2 

of the preamble of this interim final 

rule, we are requesting that States, in 

accordance with guidance issued by the 

Secretary, submit issuer corporate and 

contact information, underwriting 

status, and information on any Stateadministered Web sites that provide 

consumer information on health 

insurance coverage in their State by May 

21, 2010. The information must be 

submitted via a template furnished by 

the Secretary. 

The burden associated with these 

voluntary reporting requests is both the 

time and effort necessary to review the 

regulations, analyze data, and train 

issuer staff and the time and effort 

necessary for an issuer to compile the 

necessary information, to download and 

complete the template, and to submit 

the required information. We estimate 

that this request affects all 50 States and 

the District of Columbia. We believe it 

will take each State 10 hours to review 

the preamble discussion, analyze data, 

and train its staff on how to comply 

with the request. The total one-time 

burden associated with this request is 

500 hours. The total estimated cost 

associated with complying with this 

part of the requirement is $50,000. 

We further estimate that it will take 

each State a total of 10 minutes to 

download the information submission 

template, complete the template, and 

submit the template. The estimated 

annual burden associated with this 

request is 8 hours. The estimated cost 

associated with complying with this 

request is $520. 

Data Submissions for High Risk Pools 

As discussed in section II.C.1 of the 

preamble of this interim final rule, we 

are asking the National Association of 

State Comprehensive Health Insurance 

Plans (NASCHIP) to provide data 

pertaining to the information listed in 

section II.C.1., in accordance with 

guidance issued by the Secretary, no 

later than May 21, 2010. In the event 

that NSACHIP is unable to provide this 

information, State health benefits high 

risk pools have been asked to submit it 

to HHS. While this request is subject to 

the PRA, we anticipate that this 

information will be collected from 

NASCHIP. Therefore, we are not 

assigning any burden to these entities 

within the first year of this collection. 

In section II.C.1, we also request that 

NASCHIP or State health benefits high 

risk pools submit annual updates on the 

aforementioned information. While 

these requests are subject to the PRA, 

we will seek OMB approval at a later 

date under notice and comment periods 

separate from this interim final rule 

with comment. 

Similarly, in the case of a high risk 

pool established under section 1101 of 

the Affordable Care Act, we are 

requesting that the pool submit to HHS 

the aforementioned information within 

thirty days of accepting enrollment and 

then annually thereafter. While these 

requests are subject to the PRA, we will 

seek OMB approval at a later date under 

notice and comment periods separate 


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24480 Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 

from this interim final rule with 

comment. 

All of the information collection 

requirements contained in this interim 

final rule were submitted to the Office 

of Management and Budget (OMB) for 

emergency review and approval as part 

of a single information collection 

request (ICR). As part of the emergency 

review and approval process, OMB 

waived the notification requirements. 

The ICR was approved under OMB 

control number 0938–1086 with an 

expiration date of October 31, 2010. 

However, we are still seeking public 

comments on the information collection 

requirements discussed in this interim 

final rule with comment. All comments 

will be considered as we continue to 

develop the ICR as we must resubmit 

the ICR to obtain a standard 3-year 

approval. 

If you comment on these information 

collection and recordkeeping 

requirements, please do either of the 

following: 

1. Submit your comments 

electronically as specified in the 

ADDRESSES section of this rule; or 

2. Submit your comments to the 

Office of Information and Regulatory 

Affairs, Office of Management and 

Budget, 

Attention: CMS Desk Officer, DHHS– 

9997–IFC. 

Fax: (202) 395–6974; or E-mail: 

OIRA_submission@omb.eop.gov. 

V. 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. 

VI. Regulatory Impact Statement 

We have examined the impacts of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, 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)). 

Executive Order 12866 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). A regulatory impact 

analysis (RIA) must be prepared for 

major rules with economically 

significant effects ($100 million or more 

in any 1 year). As discussed below, we 

have concluded that this rule does not 

have economic impacts of $100 million 

or more or otherwise meet the 

definitions of ‘‘significant rule’’ under 

EO 12866. 

Based primarily on data that we have 

obtained from the National Association 

of Insurance Commissioners (NAIC), we 

believe that there are about 650 

insurance firms that sell insurance in 

the individual and small group markets 

and are hence subject to this interim 

final rule. This estimate is consistent 

with other data on the size of the health 

insurance industry estimated by HHS in 

previous rulemakings. In addition, 

about 50 States and other governmental 

entities will be encouraged to provide 

voluntarily administrative data on 

Medicaid and CHIP and (as applicable) 

data on high risk pool programs. We 

estimate that on average these 

approximately 700 respondents will 

spend 40 hours of time reading this rule, 

determining what information sources 

will be used to respond, determining 

how to provide that information in the 

newly required formats, and completing 

a certification on the completeness and 

accuracy of the information. Assuming 

that high level staff (for example, 

managers, attorneys, actuaries, and 

senior IT professionals) are involved in 

these efforts, at an average 

compensation cost of $100 an hour, total 

one-time costs will be approximately $3 

million dollars. Actual provision of data 

we estimate to cost approximately $3 

million a year both in the first year and 

annually thereafter. Federal government 

planning, oversight, preparation, and 

maintenance of the portal web site we 

estimate to cost $11 million in one-time 

costs in 2010, and $12 million to 

oversee and operate in 2011 and 

annually thereafter. In total, we estimate 

costs in calendar 2010 to be 

approximately $17 million, and annual 

costs thereafter to be approximately $15 

million. Additional detail on these 

estimates can be found in the Paperwork 

Reduction Act section of this preamble 

and we welcome comment on them. 

All or virtually all of the information 

needed for the Web portal is standard 

information that is already made 

available to individuals, insurance 

agents, or existing IT contractors with 

pricing engines and other entities that 

sell or otherwise provide health 

insurance to individuals and small 

groups. For example, information on 

deductibles, coverage, cost-sharing, and 

catastrophic protection limits is 

routinely available on all or virtually all 

insurance available to individuals or 

small groups. Nothing in this rule 

requires preparation of entirely new 

information. In essence, we simply 

require that relatively comprehensive 

information be provided in standardized 

formats so that plan comparisons can be 

automated in ways that present 

comparable information in comparable 

levels of detail to facilitate consumer 

understanding of available choices. We 

believe that carriers that offer large 

numbers of plans will find that once 

they have determined how best to 

provide the data for a few of those 

plans, adding additional plans will 

involve very little if any additional cost. 

We have also limited the number of 

plans on which carriers will be required 

to provide data. Because we appreciate 

that the time schedule provided in the 

statute is extremely short, and because 

the Federal government itself needs 

time to prepare and populate its Web 

portal, we have provided for two data 

submissions in 2010, the first in May 

and a second more detailed collection in 

September. This will provide the 

Federal government with the time 

needed to competitively bid for a 

contractor that has a sophisticated 

pricing engine, as well as for issuers and 

States time to plan for and compile 

some of the more detailed information 

that we are deferring until later in the 

year. 

Nothing in this interim final rule 

prevents other parties from aggregating 

and presenting similar information. For 

example, the State of Massachusetts 

already presents essentially the entire 

set of information we will obtain, and 

more, on its Connector Web site. Several 

online firms aggregate and present 

information for some of the policies sold 

in all or most States. Many insurance 

brokers and agents, and some consumer 

organizations, present information on 

subsets of plans available to their client 

target groups in their geographic areas. 

In fact, the Web portal we will provide 

may facilitate such efforts and improve 

the scope and accuracy of information 

provided by alternative sources. 

As specified in the statute, our Web 

portal will include the range of 

insurance coverage options available to 

individuals or small businesses, 

including both public (for example, 

Medicaid, CHIP, and high risk pool) and 

private plans, and all types of plans 

including health maintenance 

organization, preferred provider 

organization and indemnity plans. To 

the best of our knowledge no web sites 

include such a broad range of health 


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Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 24481 

care coverage and specific plan 

information on a national scale, with the 

intent of serving such a broad range of 

consumers needing health insurance 

coverage. (There are, however, similarly 

broad portals for some specific 

population groups, such as Medicare 

beneficiaries and Federal employees). 

It is difficult if not impossible to 

quantify the benefits of such a broad 

expansion of consumer information. 

Moreover, the benefits of this 

information will change over time, most 

importantly as State-specific insurance 

exchanges expand their presence. We do 

believe, however, that the benefits of 

improved information will facilitate 

informed consumer choices as well as 

benefit the insurance market more 

broadly. We expect that our Web portal 

will inform State decisions on the 

design of exchanges both by positive 

example and, doubtless, through ideas 

on ways to improve on the information 

and formats and tools we provide. 

Among the likely effects of this effort 

will be increased use of State high risk 

insurance pools, increased sale of 

private policies to uninsured 

individuals, increased enrollment in 

Medicaid and CHIP, and commensurate 

reductions in spending on care for the 

uninsured. We believe, however, that 

the most important effect of the Web 

portal will be to improve health 

insurance coverage choices. For 

example, private plans that offer better 

benefit packages at lower premium costs 

are likely to benefit from improved 

consumer information. 

We have considered a range of 

alternatives to the Web portal approach 

we describe in this final rule with 

comment, including both more and less 

ambitious efforts. For example, we 

could provide less complete information 

on health insurance coverage choices, 

and rely on States and private efforts to 

provide more complete comparisons. In 

our view, however, costs would not be 

significantly less were we to require less 

plan-specific information. Moreover, the 

full range of information we specify is 

likely to facilitate other efforts. For 

example, we do not believe that any 

other service has been able to assemble 

in one source information on all 

insurance issuers and programs serving 

the individual and small group markets 

across a broad range of States. One 

specific alternative on which we request 

comment is on our proposal to limit the 

number of plan variations on which we 

present information for an issuer in a 

particular area to those that represent at 

least one percent of their total 

enrollment in that area (that is, never 

more than 100 variations, and usually 

far fewer). Without such a limitation, if 

a particular issuer offers twenty or more 

possible products and twenty 

alternative cost sharing arrangements 

applied to the products in a particular 

geographic area, the combinations and 

permutations of offerings would be 400 

for this one issuer alone. Our use of zip 

codes for plan service areas is an 

essential simplifying approach to 

reducing the number of alternative 

plans presented, by eliminating 

irrelevant plans, but does not solve this 

problem. 

We welcome comments on the likely 

costs and benefits of this rule as 

presented, on alternatives that would 

improve the consumer and small 

business purchaser information to be 

provided, and on our quantitative 

estimates of burden. Comments are 

welcome to address both regulatory 

changes and changes that might be 

made through administrative decisions 

in planning and implementing the Web 

portal. Comments on ways to design our 

Internet portal to best meet consumer 

information needs are especially 

welcome. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, if a rule has a significant 

impact on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

government jurisdictions. Small 

businesses are those with sizes below 

thresholds established by the Small 

Business Administration (SBA). We 

examined the health insurance industry 

in depth in the Regulatory Impact 

Analysis we prepared for the proposed 

rule on establishment of the Medicare 

Advantage program (69 FR 46866, 

August 3, 2004). In that analysis we 

determined that there were few if any 

insurance firms underwriting 

comprehensive health insurance 

policies (in contrast, for example, to 

travel insurance policies or dental 

discount policies) that fell below the 

size thresholds for ‘‘small’’ business 

established by the SBA. In fact, then and 

even more so now, the market for health 

insurance is dominated by a relative 

handful of firms with substantial market 

shares. For example, nationally the 

approximately 40 Blue Cross and Blue 

Shield companies account for 

approximately half of all private 

insurance sold in the United States. A 

recent GAO study focused on the small 

business market and found that the five 

largest issuers in the small group 

market, when combined, represented 

three-quarters or more of the market in 

34 of 39 States for which this 

information was available (GAO, 

February 27, 2009, Private Health 

Insurance: 2008 Survey Results on 

Number and Market Share of Issuers in 

the Small Group Health Insurance 

Market). These firms included Blue 

Cross companies, and also other major 

insurers such as United HealthCare, 

Aetna, and Kaiser. Small government 

jurisdictions do not sell insurance in the 

individual or small business markets. 

There are, however, a number of health 

maintenance organizations (HMOs) that 

are small entities by virtue of their nonprofit status, including Kaiser, even 

though few if any of them are small by 

SBA size standards. There are 

approximately one hundred such 

HMOs. These HMOs and those Blue 

Cross and Blue Shield plans that are 

non-profit organizations, like the other 

firms affected by this interim final rule, 

will be required to provide information 

on their insurance policies to the 

Department. Accordingly, this interim 

final rule will affect a ‘‘substantial 

number’’ of small entities. 

We estimate, however, that the onetime costs of this interim final rule are 

approximately $5 thousand per covered 

entity (regardless of size or non-profit 

status) and about $5 thousand annually 

both in the first year and thereafter. 

Numbers of this magnitude do not 

remotely approach the amounts 

necessary to be a ‘‘significant economic 

impact’’ on firms with revenues of tens 

of millions of dollars (usually hundreds 

of millions or billions of dollars 

annually). Moreover, the Regulatory 

Flexibility Act only requires an analysis 

for those final rules for which a Notice 

of Proposed Rule Making was required. 

Accordingly, we have determined, and 

certify, that this rule will not have a 

significant economic impact on a 

substantial number of small entities and 

that a regulatory flexibility analysis is 

not required. 

In addition, section 1102(b) of the 

Social Security Act requires us to 

prepare a regulatory impact analysis if 

a rule may have a significant economic 

impact on the operations of a substantial 

number of small rural hospitals. This 

analysis must conform to the provisions 

of section 604 of the RFA. This interim 

final rule would not affect small rural 

hospitals. Therefore, the Secretary has 

determined that this rule would not 

have a significant impact on the 

operations of a substantial number of 

small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1195 requires 

that agencies assess anticipated costs 

and benefits before issuing any rule that 

includes a Federal mandate that could 

result in expenditure in any one year by 

State, local or tribal governments, in the 

aggregate, or by the private sector, of 


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24482 Federal Register / Vol. 75, No. 86 / Wednesday, May 5, 2010 / Rules and Regulations 

$100 million in 1995 dollars, updated 

annually for inflation. That threshold 

level is currently about $135 million. 

This interim final rule contains 

reporting mandates for private sector 

firms, but these will not cost more than 

the approximately $6 million that we 

have estimated. It includes no mandates 

on State, local, or tribal governments. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule and subsequent final rule 

that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

This interim final rule does not impose 

substantial direct requirement costs on 

State and local governments, preempt 

State law, or otherwise have Federalism 

implications. 

In accordance with the provisions of 

Executive Order 12866, this interim 

final rule was reviewed by the Office of 

Management and Budget. 

List of Subjects in 45 CFR Part 159 

Administrative practice and 

procedure, Computer technology, 

Health care, Health facilities, Health 

insurance, Health records, Hospitals, 

Medicaid, Medicare, Penalties, 

Reporting and recordkeeping 

requirements. 

■ For the reasons set forth in the 

preamble, the Department of Health and 

Human Services amends 45 CFR subtitle 

A, subchapter B, by adding a new part 

159 to read as follows: 

PART 159—HEALTH CARE REFORM 

INSURANCE WEB PORTAL 

Sec. 

159.100 Basis and Scope. 

159.110 Definitions. 

159.120 Data Submission for the individual 

and small group markets. 

Authority: Section 1103 of the Patient 

Protection and Affordable Care Act (Pub. L. 

111–148). 

§ 159.100 Basis and scope. 

This part establishes provisions 

governing a Web portal that will provide 

information on health insurance 

coverage options in each of the 50 States 

and the District of Columbia. It sets 

forth data submission requirements for 

health insurance issuers. It covers the 

individual market and the small group 

market. 

§ 159.110 Definitions. 

For purposes of part 159, the 

following definitions apply unless 

otherwise provided: 

Health Insurance Coverage: We adopt 

the Public Health Service Act (PHSA) 

definition of ‘‘health insurance 

coverage’’ found at section 2791(b)(1) of 

the Public Health Service Act (PHSA). 

Health Insurance Issuer: We adopt the 

PHSA definition of ‘‘health insurance 

issuer’’ found at section 2791(b)(2) of the 

PHSA. 

Health Insurance Product: Means a 

package of benefits that an issuer offers 

that is reported to State regulators in an 

insurance filing. 

Individual Health Insurance 

Coverage: We adopt the PHSA 

definition of ‘‘individual health 

insurance coverage’’ found at section 

2791(b)(5) of the PHSA. 

Individual Market: We adopt the 

Affordable Care Act definition of 

‘‘individual market’’ found at section 

1304(a)(2) of the Affordable Care Act 

and 2791(e)(1)(A) of the PHSA. 

Portal Plan: Means the discrete 

pairing of a package of benefits and a 

particular cost sharing option (not 

including premium rates or premium 

quotes). 

Section 1101 High Risk Pools: We 

define section 1101 high risk pools as 

any entity described in regulations 

implementing section 1101 of the 

Affordable Care Act. 

Small Employer: We adopt the 

Affordable Care Act definition of ‘‘small 

employer’’ found at section 1304(b)(2) 

and (3). 

Small Group Coverage: Means health 

insurance coverage offered to employees 

of small employers in the small group 

market. 

Small Group Market: We adopt the 

Affordable Care Act definition of ‘‘small 

group market’’ found at section 

1304(a)(3). 

State Health Benefits High Risk Pools: 

Means nonprofit organizations created 

by State law to offer comprehensive 

health insurance to individuals who 

otherwise would be unable to secure 

such coverage because of their health 

status. 

§ 159.120 Data submission for the 

individual and small group markets. 

(a) Health insurance issuers 

(hereinafter referred to as issuers) must, 

in accordance with guidance issued by 

the Secretary, submit corporate and 

contact information; administrative 

information; enrollment data by health 

insurance product; product names and 

types; whether enrollment is currently 

open for each health insurance product; 

geographic availability information; 

customer service phone numbers; and 

Web site links to the issuer Web site, 

brochure documents, and provider 

networks; and financial ratings on or 

before May 21, 2010, and annually 

thereafter. 

(b) Issuers must, as determined by the 

Secretary, submit pricing and benefit 

information for their portal plans on or 

before September 3, 2010, and annually 

thereafter. 

(c) Issuers must submit updated 

pricing and benefit data for their portal 

plans whenever they change premiums, 

cost-sharing, types of services covered, 

coverage limitations, or exclusions for 

one or more of their individual or small 

group portal plans. 

(d) Issuers must submit pricing and 

benefit data for portal plans associated 

with products that are newly open or 

newly reopened for enrollment within 

30 days of opening for enrollment. 

(e) Issuers must annually verify the 

data submitted under paragraphs (a) 

through (d) of this section, and make 

corrections to any errors that are found. 

(f) Issuers must submit administrative 

data on products and portal plans, and 

these performance ratings, percent of 

individual market and small group 

market policies that are rescinded; the 

percent of individual market policies 

sold at the manual rate; the percent of 

claims that are denied under individual 

market and small group market policies; 

and the number and disposition of 

appeals on denials to insure, pay claims 

and provide required preauthorizations, 

for future releases of the Web portal in 

accordance with guidance issued by the 

Secretary. 

(g) The issuer’s CEO or CFO must 

electronically certify to the 

completeness and accuracy of all data 

submitted for the October 1, 2010, 

release of the Web portal and for any 

future updates to these requirements. 

Dated: April 29, 2010. 

Jay Angoff, 

Director, Office of Consumer Information and 

Insurance Oversight. 

Dated: April 29, 2010. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–10504 Filed 4–30–10; 4:15 pm] 

BILLING CODE 4150–03–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 660 

[Docket No. 100218107–0199–01] 

RIN 0648–AY60 

Fisheries Off West Coast States; West 

Coast Salmon Fisheries; 2010 

Management Measures 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 


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