Federal Register / Vol. 79, No. 226 / Monday, November 24, 2014 / Proposed Rules 69819 

(1) Adverse benefit determination has 

the meaning given that term in 45 CFR 

147.136(a)(2)(i). 

(2) Claim means a request for: 

(i) Payment of a health-related bill; or 

(ii) Provision of a health-related 

service or supply. 

(b) Applicability. This subpart applies 

to enrollees and to other individuals or 

entities who are acting on behalf of an 

enrollee and who have the enrollee’s 

specific written consent to pursue a 

remedy of an adverse benefit 

determination. 

§ 800.502 MSP issuer internal claims and 

appeals. 

(a) Processes. MSP issuers must 

comply with the internal claims and 

appeals processes applicable to group 

health plans and health insurance 

issuers under 45 CFR 147.136(b). 

(b) Timeframes and notice of 

determination. An MSP issuer must 

provide written notice to an enrollee of 

its determination on a claim brought 

under paragraph (a) of this section 

according to the timeframes and 

notification rules under 45 CFR 

147.136(b) and (e), including the 

timeframes for urgent claims. If the MSP 

issuer denies a claim (or a portion of the 

claim), the enrollee may appeal the 

adverse benefit determination to the 

MSP issuer in accordance with 45 CFR 

147.136(b). 

§ 800.503 External review. 

(a) External review by OPM. OPM will 

conduct external review of adverse 

benefit determinations using a process 

similar to OPM review of disputed 

claims under 5 CFR 890.105(e), subject 

to the standards and timeframes set 

forth in 45 CFR 147.136(d). 

(b) Notice. Notices to MSP enrollees 

regarding external review under 

paragraph (a) of this section must 

comply with 45 CFR 147.136(e), and are 

subject to review and approval by OPM. 

(c) Issuer obligation. An MSP issuer 

must pay a claim or provide a healthrelated service or supply pursuant to 

OPM’s final decision or the final 

decision of an independent review 

organization without delay, regardless 

of whether the plan or issuer intends to 

seek judicial review of the external 

review decision and unless or until 

there is a judicial decision otherwise. 

§ 800.504 Judicial review. 

(a) OPM’s written decision under the 

external review process established 

under § 800.503(a) will constitute final 

agency action that is subject to review 

under the Administrative Procedure Act 

in the appropriate U.S. district court. A 

decision made by an independent 

review organization under the process 

established under § 800.503(a) is not 

within OPM’s discretion and therefore 

is not final agency action. 

(b) Judicial review under paragraph 

(a) of this section is limited to the record 

that was before OPM when OPM made 

its decision. 

Subpart G—Miscellaneous 

§ 800.601 Reservation of authority. 

OPM reserves the right to implement 

and supplement these regulations with 

written operational guidelines. 

§ 800.602 Consumer choice with respect 

to certain services. 

(a) Assured availability of varied 

coverage. Consistent with § 800.104, 

OPM will ensure that at least one of the 

MSP issuers on each Exchange in each 

State offers at least one MSP option that 

does not provide coverage of services 

described in section 1303(b)(1)(B)(i) of 

the Affordable Care Act. 

(b) State opt-out. An MSP issuer may 

not offer abortion coverage in any State 

where such coverage of abortion 

services is prohibited by State law. 

(c) Notice to enrollees—(1) Notice of 

exclusion. The MSP issuer must provide 

notice to consumers prior to enrollment 

when non-excepted abortion services 

are not a covered benefit in a State 

where such coverage of such abortion 

services is permitted by State law, in the 

form, manner, and timeline prescribed 

by OPM. 

(2) Notice of coverage. If an MSP 

issuer chooses to offer an MSP option 

that covers non-excepted abortion 

services, in addition to an MSP option 

that does not provide coverage for these 

services, the MSP issuer must provide 

notice to consumers prior to enrollment 

that non-excepted abortion services are 

a covered benefit, in a manner 

consistent with 45 CFR 147.200(a)(3), to 

meet the requirements of 45 CFR 

156.280(f). OPM may provide guidance 

on the form, manner, and timeline for 

this notice. 

(3) OPM review and approval of 

notices. OPM may require an MSP 

issuer to submit to OPM such notices. 

OPM reserves the right to review and 

approve these consumer notices to 

ensure that an MSP issuer complies 

with Federal and State laws, and the 

standards prescribed by OPM with 

respect to § 800.602. 

§ 800.603 Disclosure of information. 

(a) Disclosure to certain entities. OPM 

may provide information relating to the 

activities of MSP issuers or State-level 

issuers to a State Insurance 

Commissioner or Director of a Statebased Exchange. 

(b) Conditions of when to disclose. 

OPM shall only make a disclosure 

described in this section to the extent 

that such disclosure is: 

(1) Necessary or appropriate to permit 

OPM’s Director, a State Insurance 

Commissioner, or Director of a Statebased Exchange to administer and 

enforce laws applicable to an MSP 

issuer or State-level issuer over which it 

has jurisdiction, or 

(2) Otherwise in the best interests of 

enrollees or potential enrollees in MSP 

options. 

(c) Confidentiality of information. 

OPM will take appropriate steps to 

cause the recipient of this information 

to preserve the information as 

confidential. 

[FR Doc. 2014–27793 Filed 11–21–14; 8:45 am] 

BILLING CODE 6325–63–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

RIN 0648–BE55 

Fisheries of the Caribbean, Gulf of 

Mexico and South Atlantic; SnapperGrouper Fishery Off the Southern 

Atlantic States; Amendment 29 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Notice of availability; request 

for comments. 

SUMMARY: The South Atlantic Fishery 

Management Council (Council) has 

submitted Amendment 29 to the Fishery 

Management Plan for the SnapperGrouper Fishery of the South Atlantic 

Region (FMP) for review, approval, and 

implementation by NMFS. Amendment 

29 proposes actions to update the 

Council’s acceptable biological catch 

(ABC) control rule to incorporate 

methodology for determining the ABC 

of unassessed species; adjust ABCs for 

14 unassessed snapper-grouper species 

through application of the updated ABC 

control rule; adjust annual catch limits 

(ACLs) and recreational annual catch 

targets (ACTs)for four snapper-grouper 

species and three species complexes 

based on revised ABCs; and revise 

management measures for gray 

triggerfish to modify minimum size 

limits, establish a commercial split 

season, and specify a commercial trip 

limit. 

DATES: Written comments must be 

received on or before January 23, 2015. 


asabaliauskas on DSK5VPTVN1PROD with PROPOSALS
69820 Federal Register / Vol. 79, No. 226 / Monday, November 24, 2014 / Proposed Rules 

ADDRESSES: You may submit comments 

on Amendment 29 identified by 

‘‘NOAA–NMFS–2014–0132’’ by any of 

the following methods: 

• Electronic Submissions: Submit all 

electronic public comments via the 

Federal e-Rulemaking Portal: http://

www.regulations.gov. Go to 

www.regulations.gov/

#!docketDetail;D=NOAA-NMFS-2014- 

0132, click the ‘‘Comment Now!’’ icon, 

complete the required fields, and enter 

or attach your comments. 

• Mail: Submit written comments to 

Karla Gore, Southeast Regional Office, 

NMFS, 263 13th Avenue South, St. 

Petersburg, FL 33701. 

Instructions: Comments sent by any 

other method, to any other address or 

individual, or received after the end of 

the comment period, may not be 

considered by NMFS. All comments 

received are a part of the public record 

and will generally be posted for public 

viewing on www.regulations.gov 

without change. All personal identifying 

information (e.g., name, address, etc.), 

confidential business information, or 

otherwise sensitive information 

submitted voluntarily by the sender will 

be publicly accessible. NMFS will 

accept anonymous comments (enter ‘‘N/ 

A’’ in the required fields if you wish to 

remain anonymous). Attachments to 

electronic comments will be accepted in 

Microsoft Word, Excel, or Adobe PDF 

file formats only. 

Electronic copies of Amendment 29 

may be obtained from the Southeast 

Regional Office Web site at http://

sero.nmfs.noaa.gov. Amendment 29 

includes a draft environmental 

assessment, a Regulatory Flexibility Act 

analysis, a Regulatory Impact Review, 

and a Fishery Impact Statement. 

FOR FURTHER INFORMATION CONTACT: 

Karla Gore, telephone: 727–824–5305; 

email: Karla.Gore@noaa.gov. 

SUPPLEMENTARY INFORMATION: The 

Magnuson-Stevens Fishery 

Conservation and Management Act 

(Magnuson-Stevens Act) requires each 

regional fishery management council to 

submit any FMP or amendment to 

NMFS for review and approval, partial 

approval, or disapproval. The 

Magnuson-Stevens Act also requires 

that NMFS, upon receiving a plan or 

amendment, publish an announcement 

in the Federal Register notifying the 

public that the plan or amendment is 

available for review and comment. 

The FMP being revised by 

Amendment 29 was prepared by the 

Councils and implemented through 

regulations at 50 CFR part 622 under the 

authority of the Magnuson-Stevens Act. 

Background 

The Council’s Scientific and 

Statistical Committee (SSC) has 

recommended an update of the 

Council’s ABC control rule to 

incorporate new methodology for 

species without assessments but for 

which there are reliable catch data. 

Amendment 29 updates the ABC control 

rule and includes revised ABCs for 14 

unassessed snapper-grouper species 

based on the new control rule. 

Amendment 29 also includes revisions 

to ACLs and recreational annual catch 

targets (ACTs) for four species and three 

species complexes based on the revised 

ABCs. These actions are based on the 

best scientific information available. 

A stock assessment for the South 

Atlantic stock of gray triggerfish was 

initiated in 2013 but completion of the 

assessment has been postponed to 2015. 

Meanwhile, fishermen have approached 

the Council with requests for 

management measures due to concerns 

about early closures in the commercial 

sector and the stock status of gray 

triggerfish. While the Council had 

intended to wait for the results of the 

stock assessment to make changes to 

management measures for this stock, the 

unforeseen delays in the assessment 

prompted the Council to be proactive 

and consider actions in Amendment 29. 

These actions include modifying 

minimum size limits for gray triggerfish, 

establishing a commercial split season, 

and specifying a commercial trip limit 

for gray triggerfish. 

Actions Contained in Amendment 29 

Amendment 29 includes actions to 

revise ACLs for three species complexes 

and four snapper-grouper species based 

on the revised ABC values. In addition, 

Amendment 29 includes actions to 

revise management measures for gray 

triggerfish in Federal waters of the 

South Atlantic region. 

Amendment 29 to Update the ABC 

Control Rule 

Amendment 29 modifies the ABC 

control rule to use the Only Reliable 

Catch Stocks (ORCS) approach, 

recommended by the Council’s SSC, to 

calculate ABC values for unassessed 

stocks for which there is only reliable 

catch information available. The 

approach involved selection of a ‘‘catch 

statistic’’ based on the maximum 

landings from 1999–2007, similar to the 

period of landings used in the Council’s 

Comprehensive ACL Amendment, and 

to minimize the impact of a decrease in 

landings that may have been caused by 

the economic downturn and the effect of 

recent regulations. The catch statistic 

was then multiplied by a scalar 

(number) ranging from 1.25 to 2, based 

on SSC consensus and expert judgment, 

to denote the stock’s risk of 

overexploitation (how likely the stock is 

to become overfished), and a scalar 

ranging from 0.50 to 0.90 to denote the 

stock’s management risk level. The SSC 

provided the first two criteria for each 

stock at issue and the Council 

developed the risk tolerance level. The 

amendment employed the ORCS 

approach to revise ABC values for the 

following unassessed snapper-grouper 

species: Bar jack, margate, red hind, 

cubera snapper, yellowedge grouper, 

silk snapper, Atlantic spadefish, gray 

snapper, lane snapper, rock hind, 

tomtate, white grunt, scamp, and gray 

triggerfish. 

Revise ACLs for Select Species 

Amendment 29 would revise the 

ACLs and recreational ACTs for three 

species and four species complexes of 

unassessed snapper-grouper species, 

based on the revised ABC values. In 

Amendment 29, the Council defines 

ACL = OY = ABC for the snappers 

complex, grunts complex, shallow-water 

complex, bar jack, Atlantic spadefish 

and gray triggerfish. For scamp, the 

Council chose to revise the definition to 

ACL = OY = 0.90(ABC) to provide a 

buffer between the ABC and the ACL for 

scamp due to concerns about the stock 

status of scamp. 

Amendment 29 would not change the 

specified sector allocations or the 

recreational ACT definitions for the 

snapper-grouper species contained in 

Amendment 29. 

Modify Minimum Size Limit for Gray 

Triggerfish 

Amendment 29 includes an action to 

establish a 12-inch (30.5-cm) fork length 

(FL) minimum size limit for gray 

triggerfish in Federal waters off North 

Carolina, South Carolina, and Georgia 

for both the commercial and 

recreational sectors. This action would 

also increase the minimum size limit for 

gray triggerfish off the east coast of 

Florida from 12 inches (30.5 cm), total 

length to 14 inches (35.6 cm), FL for 

both the commercial and recreational 

sectors, which is consistent with the 

commercial and recreational minimum 

size limit in place off the west coast of 

Florida, however, this is inconsistent 

with the 12-inch (30.5-cm) minimum 

size limit for gray triggerfish in state 

waters off the east coast of Florida. The 

rationale for increasing the minimum 

size limit to 14 inches (35.6 cm), FL, off 

the east coast of Florida is to implement 

consistent regulations for fishermen in 

South Florida, specifically off the 


asabaliauskas on DSK5VPTVN1PROD with PROPOSALS
Federal Register / Vol. 79, No. 226 / Monday, November 24, 2014 / Proposed Rules 69821 

Florida Keys. The Florida Fish and 

Wildlife Commission is expected to 

discuss implementing compatible 

regulations for state waters off the east 

coast of Florida. 

Establish a Commercial Split Season for 

Gray Triggerfish 

The fishing year for gray triggerfish 

begins on January 1. Weather conditions 

can be poor off North Carolina and 

South Carolina during the early part of 

the year, making fishing for gray 

triggerfish difficult. Amendment 29 

includes an action to divide the annual 

commercial fishing season for gray 

triggerfish into two 6-month fishing 

seasons, to provide opportunities to fish 

for gray triggerfish throughout the South 

Atlantic and throughout the calendar 

year. This action would allocate 50 

percent of the commercial gray 

triggerfish ACL for the time period 

January 1 through June 30, and 50 

percent for the time period July 1 

through December 31. As a result, the 

commercial ACL would be divided into 

two seasonal quotas of equal amounts of 

156,162 lb (70,834 kg), round weight. 

When the quota would be reached for a 

given season, the commercial sector 

would close. In addition, any unused 

portion of the quota from the first 

season would be added to the quota in 

the second season. Any unused portion 

of the quota specified in the second 

season, including any addition of quota 

from the first season, would become 

void and would not be added to any 

subsequent quota. 

Establish a Commercial Trip Limit for 

Gray Triggerfish 

Amendment 29 would establish a 

commercial trip limit of 1,000 lb (454 

kg), round weight, for gray triggerfish, to 

extend the commercial fishing season 

for this species. 

A proposed rule that would 

implement measures outlined in 

Amendment 29 has been drafted. In 

accordance with the Magnuson-Stevens 

Act, NMFS is evaluating the proposed 

rule to determine whether it is 

consistent with the FMP, the MagnusonStevens Act, and other applicable law. 

If that determination is affirmative, 

NMFS will publish the proposed rule in 

the Federal Register for public review 

and comment. 

Consideration of Public Comments 

The Council has submitted 

Amendment 29 for Secretarial review, 

approval, and implementation. 

Comments received by January 23, 2015, 

whether specifically directed to the 

amendment or the proposed rule, will 

be considered by NMFS in its decision 

to approve, disapprove, or partially 

approve the amendment. Comments 

received after that date will not be 

considered by NMFS in this decision. 

All comments received by NMFS on the 

amendment or the proposed rule during 

their respective comment periods will 

be addressed in the final rule. 

Authority: 16 U.S.C. 1801 et seq. 

Dated: November 19, 2014. 

Alan D. Risenhoover, 

Director, Office of Sustainable Fisheries, 

National Marine Fisheries Service. 

[FR Doc. 2014–27740 Filed 11–21–14; 8:45 am] 

BILLING CODE 3510–22–P 


asabaliauskas on DSK5VPTVN1PROD with PROPOSALS