[Federal Register Volume 76, Number 122 (Friday, June 24, 2011)]
[Proposed Rules]
[Pages 37037-37039]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-15891]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
[REG-125592-10]
RIN 1545-BJ62
Requirements for Group Health Plans and Health Insurance Issuers
Relating to Internal Claims and Appeals and External Review Processes
Under the Patient Protection and Affordable Care Act
AGENCY: Internal Revenue Service (IRS), Treasury.
ACTION: Notice of proposed rulemaking by cross-reference to temporary
regulations.
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SUMMARY: Elsewhere in this issue of the Federal Register, the IRS is
issuing an amendment to temporary regulations published July 23, 2010
under the provisions of the Patient Protection and Affordable Care Act
(the Affordable Care Act) regarding internal claims and appeals and
external review processes. The IRS is issuing the temporary regulations
at the same time that the Employee Benefits Security Administration of
the U.S. Department of Labor and the Center for Consumer Information &
Insurance Oversight of the U.S. Department of Health and Human Services
are issuing a substantially similar amendment to interim final
regulations published July 23, 2010 with respect to group health plans
and health insurance coverage offered in connection with a group health
plan under the Employee Retirement Income Security Act of 1974 and the
Public Health Service Act. The temporary regulations provide guidance
to employers, group health plans, and health insurance issuers
providing group health insurance coverage. The text of those temporary
regulations also serves as the text of these proposed regulations.
DATES: Written or electronic comments and requests for a public hearing
must be received by July 25, 2011.
ADDRESSES: Send submissions to: CC:PA:LPD:PR (REG-125592-10), Room
5205, Internal Revenue Service, P.O.
[[Page 37038]]
Box 7604, Ben Franklin Station, Washington, DC 20044. Submissions may
be hand-delivered to: CC:PA:LPD:PR (REG-125592-10), Courier's Desk,
Internal Revenue Service, 1111 Constitution Avenue, NW., Washington, DC
20224. Alternatively, taxpayers may submit comments electronically via
the Federal eRulemaking Portal at http://www.regulations.gov (IRS REG-
125592-10).
FOR FURTHER INFORMATION CONTACT: Concerning the regulations, Karen
Levin at 202-622-6080; concerning submissions of comments,
Oluwafunmilayo Taylor at 202-622-7180 (not toll-free numbers).
SUPPLEMENTARY INFORMATION:
Background and Explanation of Provisions
The temporary regulations published elsewhere in this issue of the
Federal Register amend Sec. 54.9815-2719T of the Miscellaneous Excise
Tax Regulations. The proposed and temporary regulations are being
published as part of a joint rulemaking with the Department of Labor
and the Department of Health and Human Services (the joint rulemaking).
The text of those temporary regulations also serves as the text of
these proposed regulations. The preamble to the temporary regulations
explains the temporary regulations and these proposed regulations.
Special Analyses
It has been determined that this notice of proposed rulemaking is
not a significant regulatory action as defined in Executive Order
12866. Therefore, a regulatory assessment is not required. It has also
been determined that section 553(b) of the Administrative Procedure Act
(5 U.S.C. chapter 5) does not apply to this proposed regulation. It is
hereby certified that the collections of information contained in this
notice of proposed rulemaking will not have a significant impact on a
substantial number of small entities. Accordingly, a regulatory
flexibility analysis under the Regulatory Flexibility Act (5 U.S.C.
chapter 6) is not required. Section 54.9815-2719T of the temporary
regulations, as amended, requires both group health insurance issuers
and group health plans to establish internal claims and appeals and
external review processes for adverse benefit determinations. Those
processes require the plan and issuer to disclose evidence relied upon
in making an adverse benefit determination, to disclose any new
rationale for upholding an adverse benefit determination as part of an
internal appeal, to provide notice of an adverse benefit determination
and of a final internal adverse benefit determination, and to disclose
the right to an external review. Under the temporary regulations, if a
health insurance issuer satisfies the obligations to have effective
internal claims and appeals and external review processes (including
these information collection requirements that are an inherent part of
those processes), those obligations are satisfied not just for the
issuer but also for the group health plan. For group health plans
maintained by small entities, it is anticipated that the health
insurance issuer will satisfy those obligations to have effective
internal claims and appeals and external review processes (including
these information collection requirements that are an inherent part of
those processes) for both the plan and the issuer in almost all cases.
For this reason, these information collection requirements will not
impose a significant impact on a substantial number of small entities.
Pursuant to section 7805(f) of the Internal Revenue Code, this
regulation has been submitted to the Chief Counsel for Advocacy of the
Small Business Administration for comment on its impact on small
business.
Comments and Requests for a Public Hearing
Before these proposed regulations are adopted as final regulations,
consideration will be given to any written comments (a signed original
and eight (8) copies) or electronic comments that are submitted timely
to the IRS. Comments are specifically requested on the clarity of the
proposed regulations and how they may be made easier to understand. All
comments will be available for public inspection and copying. A public
hearing may be scheduled if requested in writing by a person that
timely submits written comments. If a public hearing is scheduled,
notice of the date, time, and place for the hearing will be published
in the Federal Register.
Drafting Information
The principal author of these proposed regulations is Karen Levin,
Office of the Division Counsel/Associate Chief Counsel (Tax Exempt and
Government Entities), IRS. The proposed regulations, as well as the
temporary regulations, have been developed in coordination with
personnel from the U.S. Department of Labor and the U.S. Department of
Health and Human Services.
List of Subjects in 26 CFR Part 54
Excise taxes, Health care, Health insurance, Pensions, Reporting
and recordkeeping requirements.
Proposed Amendments to the Regulations
Accordingly, 26 CFR part 54 is proposed to be amended as follows:
PART 54--PENSION EXCISE TAXES
Paragraph 1. The authority citation for part 54 continues to read
in part as follows:
Authority: 26 U.S.C. 7805 * * *
Par. 2. Proposed Sec. 54.9815-2719 as published on July 23, 2010,
75 FR 43330, is amended by:
1. Revising paragraphs (b)(2)(ii)(B), (b)(2)(ii)(E)(1),
(b)(2)(ii)(F), (c)(2)(xi), (c)(3), (d)(1), (d)(2)(iv), and (e).
2. Redesignating (b)(2)(ii)(E)(2), (b)(2)(ii)(E)(3), and
(b)(2)(ii)(E)(4) as (b)(2)(ii)(E)(3), (b)(2)(ii)(E)(4), and
(b)(2)(ii)(E)(5), respectively.
3. Adding new paragraph (b)(2)(ii)(E)(2).
The revisions and addition read as follows:
Sec. 54.9815-2719 Internal claims and appeals and external review
processes.
* * * * *
(b) * * *
(2) * * *
(ii) * * *
(B) [The text of proposed Sec. 54.9815-2719(b)(2)(ii)(B) is the
same as the text of Sec. 54.9815-2719T(b)(2)(ii)(B) published
elsewhere in this issue of the Federal Register].
* * * * *
(E) * * *
(1) [The text of proposed Sec. 54.9815-2719(b)(2)(ii)(E)(1) is the
same as the text of Sec. 54.9815-2719T(b)(2)(ii)(E)(1) published
elsewhere in this issue of the Federal Register].
(2) [The text of proposed Sec. 54.9815-2719(b)(2)(ii)(E)(2) is the
same as the text of Sec. 54.9815-2719T(b)(2)(ii)(E)(2) published
elsewhere in this issue of the Federal Register].
* * * * *
(F) [The text of proposed Sec. 54.9815-2719(b)(2)(ii)(F) is the
same as the text of Sec. 54.9815-2719T(b)(2)(ii)(F) published
elsewhere in this issue of the Federal Register].
* * * * *
(c) * * *
(2) * * *
(xi) [The text of proposed Sec. 54.9815-2719(c)(2)(xi) is the same
as the text of Sec. 54.9815-2719T(c)(2)(xi) published elsewhere in
this issue of the Federal Register].
* * * * *
[[Page 37039]]
(3) [The text of proposed Sec. 54.9815-2719(c)(3) is the same as
the text of Sec. 54.9815-2719T(c)(3) published elsewhere in this issue
of the Federal Register].
(d) * * *
(1) [The text of proposed Sec. 54.9815-2719(d)(1) is the same as
the text of Sec. 54.9815-2719T(d)(1) published elsewhere in this issue
of the Federal Register].
* * * * *
(2) * * *
(iv) [The text of proposed Sec. 54.9815-2719(d)(2)(iv) is the same
as the text of Sec. 54.9815-2719T(d)(2)(iv) published elsewhere in
this issue of the Federal Register].
* * * * *
(e) [The text of proposed Sec. 54.9815-2719(e) is the same as the
text of Sec. 54.9815-2719T(e) published elsewhere in this issue of the
Federal Register].
* * * * *
Steven T. Miller,
Deputy Commissioner for Services and Enforcement.
[FR Doc. 2011-15891 Filed 6-22-11; 4:15 pm]
BILLING CODE 4830-01-P