Federal Register, Volume 76 Issue 149 (Wednesday, August 3, 2011)

[Federal Register Volume 76, Number 149 (Wednesday, August 3, 2011)]
[Rules and Regulations]
[Pages 46621-46626]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-19684]

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DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Part 54

[TD 9541]
RIN 1545-BJ60

DEPARTMENT OF LABOR

Employee Benefits Security Administration

29 CFR Part 2590

RIN 1210-AB44

DEPARTMENT OF HEALTH AND HUMAN SERVICES

[CMS-9992-IFC2]

45 CFR Part 147

RIN 0938-AQ07

Group Health Plans and Health Insurance Issuers Relating to
Coverage of Preventive Services Under the Patient Protection and
Affordable Care Act

AGENCIES: Internal Revenue Service, Department of the Treasury;
Employee Benefits Security Administration, Department of Labor; Centers
for Medicare & Medicaid Services, Department of Health and Human
Services.

ACTION: Interim final rules with request for comments.

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SUMMARY: This document contains amendments to the interim final
regulations implementing the rules for group health plans and health
insurance coverage in the group and individual markets under provisions
of the Patient Protection and Affordable Care Act regarding preventive
health services.

DATES: Effective date. These interim final regulations are effective on
August 1, 2011.
Comment date. Comments are due on or before September 30, 2011.
Applicability dates. These interim final regulations generally
apply to group health plans and group health insurance issuers on
August 1, 2011.

ADDRESSES: Written comments may be submitted to any of the addresses
specified below. Any comment that is submitted to any Department will
be shared with the other Departments. Please do not submit duplicates.
All comments will be made available to the public. WARNING: Do not
include any personally identifiable information (such as name, address,
or other contact information) or confidential business information that
you do not want publicly disclosed. All comments are posted on the
Internet exactly as received, and can be retrieved by most Internet
search engines. No deletions, modifications, or redactions will be made
to the comments received, as they are public records. Comments may be
submitted anonymously.
Department of Labor. Comments to the Department of Labor,
identified by RIN 1210-AB44, by one of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
E-mail: E-OHPSCA2713.EBSA@dol.gov.
Mail or Hand Delivery: Office of Health Plan Standards and
Compliance Assistance, Employee Benefits Security Administration, Room
N-5653, U.S. Department of Labor, 200 Constitution Avenue, NW.,
Washington, DC 20210, Attention: RIN 1210-AB44.
Comments received by the Department of Labor will be posted without
change to http://www.regulations.gov and http://www.dol.gov/ebsa, and
available for public inspection at the Public Disclosure Room, N-1513,
Employee Benefits Security Administration, 200 Constitution Avenue,
NW., Washington, DC 20210.
Department of Health and Human Services. In commenting, please
refer to file code CMS-9992-IFC2. Because of staff and resource
limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-9992-IFC2, P.O. Box 8010,
Baltimore, MD 21244-8010.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-9992-IFC2, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or
courier) your written comments ONLY to the

[[Page 46622]]

following addresses prior to the close of the comment period: Centers
for Medicare & Medicaid Services, Department of Health and Human
Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence
Avenue, SW., Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
call telephone number (410) 786-4492 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.
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://www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately
three 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. EST. To schedule an appointment to view public comments,
phone 1-800-743-3951.
Internal Revenue Service. Comments to the IRS, identified by REG-
120391-10, by one of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: CC:PA:LPD:PR (REG-120391-10), room 5205, Internal
Revenue Service, P.O. Box 7604, Ben Franklin Station, Washington, DC
20044.
Hand or courier delivery: Monday through Friday between
the hours of 8 a.m. and 4 p.m. to: CC:PA:LPD:PR (REG-120391-10),
Courier's Desk, Internal Revenue Service, 1111 Constitution Avenue,
NW., Washington DC 20224.
All submissions to the IRS will be open to public inspection and
copying in room 1621, 1111 Constitution Avenue, NW., Washington, DC
from 9 a.m. to 4 p.m.

FOR FURTHER INFORMATION CONTACT: Amy Turner or Beth Baum, Employee
Benefits Security Administration, Department of Labor, at (202) 693-
8335; Karen Levin, Internal Revenue Service, Department of the
Treasury, at (202) 622-6080; Robert Imes, Centers for Medicare &
Medicaid Services (CMS), Department of Health and Human Services, at
(410) 786-1565.
Customer Service Information: Individuals interested in obtaining
information from the Department of Labor concerning employment-based
health coverage laws may call the EBSA Toll-Free Hotline at 1-866-444-
EBSA (3272) or visit the Department of Labor's Web site (http://www.dol.gov/ebsa). In addition, information from HHS on private health
insurance for consumers can be found on the Centers for Medicare &
Medicaid Services (CMS) Web site (http://cciio.cms.gov) and information
on health reform can be found at http://www.HealthCare.gov.

SUPPLEMENTARY INFORMATION:

I. Background

The Patient Protection and Affordable Care Act, Public Law 111-148,
was enacted on March 23, 2010; the Health Care and Education
Reconciliation Act (the Reconciliation Act), Public Law 111-152, was
enacted on March 30, 2010 (collectively known as the ``Affordable Care
Act''). The Affordable Care Act reorganizes, amends, and adds to the
provisions of part A of title XXVII of the Public Health Service Act
(PHS Act) relating to group health plans and health insurance issuers
in the group and individual markets. The term ``group health plan''
includes both insured and self-insured group health plans.\1\ The
Affordable Care Act adds section 715(a)(1) to the Employee Retirement
Income Security Act (ERISA) and section 9815(a)(1) to the Internal
Revenue Code (the Code) to incorporate the provisions of part A of
title XXVII of the PHS Act into ERISA and the Code, and make them
applicable to group health plans, and health insurance issuers
providing health insurance coverage in connection with group health
plans. The PHS Act sections incorporated by this reference are sections
2701 through 2728. PHS Act sections 2701 through 2719A are
substantially new, though they incorporate some provisions of prior
law. PHS Act sections 2722 through 2728 are sections of prior law
renumbered, with some, mostly minor, changes.
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\1\ The term ``group health plan'' is used in title XXVII of the
PHS Act, part 7 of ERISA, and chapter 100 of the Code, and is
distinct from the term ``health plan,'' as used in other provisions
of title I of the Affordable Care Act. The term ``health plan'' does
not include self-insured group health plans.
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Subtitles A and C of title I of the Affordable Care Act amend the
requirements of title XXVII of the PHS Act (changes to which are
incorporated into ERISA section 715). The preemption provisions of
ERISA section 731 and PHS Act section 2724 \2\ (implemented in 29 CFR
2590.731(a) and 45 CFR 146.143(a)) apply so that the requirements of
part 7 of ERISA and title XXVII of the PHS Act, as amended by the
Affordable Care Act, are not to be ``construed to supersede any
provision of State law which establishes, implements, or continues in
effect any standard or requirement solely relating to health insurance
issuers in connection with group or individual health insurance
coverage except to the extent that such standard or requirement
prevents the application of a requirement'' of the Affordable Care Act.
Accordingly, State laws that impose requirements on health insurance
issuers that are stricter than the requirements imposed by the
Affordable Care Act are not superseded by the Affordable Care Act.
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\2\ Code section 9815 incorporates the preemption provisions of
PHS Act section 2724. Prior to the Affordable Care Act, there were
no express preemption provisions in chapter 100 of the Code.
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Section 2713 of the PHS Act, as added by the Affordable Care Act
and incorporated under section 715(a)(1) of ERISA and section
9815(a)(1) of the Code, specifies that a group health plan and a health
insurance issuer offering group or individual health insurance coverage
provide benefits for and prohibit the imposition of cost-sharing with
respect to:
Evidence-based items or services that have in effect a
rating of A or B in the current recommendations of the United States
Preventive Services Task Force (Task Force) with respect to the
individual involved.\3\
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\3\ Under PHS Act section 2713(a)(5), the Task Force
recommendations regarding breast cancer screening, mammography, and
prevention issued in or around November of 2009 are not to be
considered current recommendations on this subject for purposes of
PHS Act section 2713(a)(1). Thus, the recommendations regarding
breast cancer screening, mammography, and prevention issued by the
Task Force prior to those issued in or around November of 2009 (that
is, those issued in 2002) will be considered current until new
recommendations in this area are issued by the Task Force or appear
in comprehensive guidelines supported by HRSA concerning preventive
care and screenings for women, which will be commonly known as
HRSA's Women's Preventive Services: Required Health Plan Coverage
Guidelines.

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[[Page 46623]]

Immunizations for routine use in children, adolescents,
and adults that have in effect a recommendation from the Advisory
Committee on Immunization Practices of the Centers for Disease Control
and Prevention (Advisory Committee) with respect to the individual
involved. A recommendation of the Advisory Committee is considered to
be ``in effect'' after it has been adopted by the Director of the
Centers for Disease Control and Prevention. A recommendation is
considered to be for routine use if it appears on the Immunization
Schedules of the Centers for Disease Control and Prevention.
With respect to infants, children, and adolescents,
evidence-informed preventive care and screenings provided for in the
comprehensive guidelines supported by the Health Resources and Services
Administration (HRSA).
With respect to women, preventive care and screening
provided for in comprehensive guidelines supported by HRSA (not
otherwise addressed by the recommendations of the Task Force), which
will be commonly known as HRSA's Women's Preventive Services: Required
Health Plan Coverage Guidelines.
The requirements to cover recommended preventive services without
any cost-sharing do not apply to grandfathered health plans.\4\ The
Departments previously issued interim final regulations implementing
PHS Act section 2713; these interim final rules were published in the
Federal Register on July 19, 2010 (75 FR 41726). For the reasons
explained below, the Departments are now issuing an amendment to these
interim final rules.
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\4\ See 26 CFR 54.9815-1251T, 29 CFR 2590.715-1251 and 45 CFR
147.140 (75 FR 34538, June 17, 2010).
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II. Overview of the Amendment to the Interim Final Regulations

The interim final regulations provided that a group health plan or
health insurance issuer must cover certain items and services, without
cost-sharing, as recommended by the U.S. Preventive Services Task
Force, the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention, and the Health Resources and
Services Administration. Notably, to the extent not described in the
U.S. Preventive Services Task Force recommendations, HRSA was charged
with developing comprehensive guidelines for preventive care and
screenings with respect to women (i.e., the Women's Preventive
Services: Required Health Plan Coverage Guidelines or ``HRSA
Guidelines''). The interim final regulations also require that changes
in the required items and services be implemented no later than plan
years (in the individual market, policy years) beginning on or after
the date that is one year from when the new recommendation or guideline
is issued.
In response to the request for comments on the interim final
regulations, the Departments received considerable feedback regarding
which preventive services for women should be considered for coverage
under PHS Act section 2713(a)(4). Most commenters, including some
religious organizations, recommended that HRSA Guidelines include
contraceptive services for all women and that this requirement be
binding on all group health plans and health insurance issuers with no
religious exemption. However, several commenters asserted that
requiring group health plans sponsored by religious employers to cover
contraceptive services that their faith deems contrary to its religious
tenets would impinge upon their religious freedom. One commenter noted
that some religious employers do not currently cover such benefits
under their group health plan due to their religious beliefs.
The Departments note that PHS Act section 2713(a)(4) gives HRSA the
authority to develop comprehensive guidelines for additional preventive
care and screenings for women ``for purposes of this paragraph.'' In
other words, the statute contemplated HRSA Guidelines that would be
developed with the knowledge that certain group health plans and health
insurance issuers would be required to cover the services recommended
without cost-sharing, unlike the other guidelines referenced in section
2713(a), which pre-dated the Affordable Care Act and were originally
issued for purposes of identifying the non-binding recommended care
that providers should provide to patients. These HRSA Guidelines exist
solely to bind non-grandfathered group health plans and health
insurance issuers with respect to the extent of their coverage of
certain preventive services for women. In the Departments' view, it is
appropriate that HRSA, in issuing these Guidelines, takes into account
the effect on the religious beliefs of certain religious employers if
coverage of contraceptive services were required in the group health
plans in which employees in certain religious positions participate.
Specifically, the Departments seek to provide for a religious
accommodation that respects the unique relationship between a house of
worship and its employees in ministerial positions. Such an
accommodation would be consistent with the policies of States that
require contraceptive services coverage, the majority of which
simultaneously provide for a religious accommodation.
In light of the above, the Departments are amending the interim
final rules to provide HRSA additional discretion to exempt certain
religious employers from the Guidelines where contraceptive services
are concerned. The amendment to the interim final rules provides HRSA
with the discretion to establish this exemption. Consistent with most
States that have such exemptions, as described below, the amended
regulations specify that, for purposes of this policy, a religious
employer is one that: (1) Has the inculcation of religious values as
its purpose; (2) primarily employs persons who share its religious
tenets; (3) primarily serves persons who share its religious tenets;
and (4) is a non-profit organization under section 6033(a)(1) and
section 6033(a)(3)(A)(i) or (iii) of the Code. Section 6033(a)(3)(A)(i)
and (iii) refer to churches, their integrated auxiliaries, and
conventions or associations of churches, as well as to the exclusively
religious activities of any religious order. The definition of
religious employer, as set forth in the amended regulations, is based
on existing definitions used by most States that exempt certain
religious employers from having to comply with State law requirements
to cover contraceptive services. We will be accepting comments on this
definition as well as alternative definitions, such as those that have
been developed under Title 26 of the United States Code. The definition
set forth here is intended to reasonably balance the extension of any
coverage of contraceptive services under the HRSA Guidelines to as many
women as possible, while respecting the unique relationship between
certain religious employers and their employees in certain religious
positions. The change in policy effected by this amendment to these
interim final rules is intended solely for purposes of PHS Act section
2713 and the companion provisions of ERISA and the Internal Revenue
Code.
Because HRSA's discretion to establish an exemption applies only to
group health plans sponsored by certain

[[Page 46624]]

religious employers and group health insurance offered in connection
with such plans, health insurance issuers in the individual health
insurance market would not be covered under any such exemption.

III. Interim Final Regulations and Waiver of Delay of Effective Date

Section 9833 of the Code, section 734 of ERISA, and section 2792 of
the PHS Act authorize the Secretaries of the Treasury, Labor, and HHS
(collectively, the Secretaries) to promulgate any interim final rules
that they determine are appropriate to carry out the provisions of
chapter 100 of the Code, part 7 of subtitle B of title I of ERISA, and
part A of title XXVII of the PHS Act, which include PHS Act sections
2701 through 2728 and the incorporation of those sections into ERISA
section 715 and Code section 9815. The amendments promulgated in this
rulemaking carry out the provisions of these statutes. Therefore, the
foregoing interim final rule authority applies to these amendments.
Under the Administrative Procedure Act (APA) (5 U.S.C. 551, et
seq.), while a general notice of proposed rulemaking and an opportunity
for public comment is generally required before promulgation of
regulations, an exception is made when an agency, for good cause, finds
that notice and public comment thereon are impracticable, unnecessary,
or contrary to the public interest. The provisions of the APA that
ordinarily require a notice of proposed rulemaking do not apply here
because of the specific authority to issue interim final rules granted
by section 9833 of the Code, section 734 of ERISA, and section 2792 of
the PHS Act.
Even if the APA requirements for notice and comment were applicable
to these regulations, they have been satisfied. This is because the
Secretaries find that providing for an additional opportunity for
public comment is unnecessary, as the July 19, 2010 interim final rules
implementing section 2713 of the PHS Act provided the public with an
opportunity to comment on the implementation of the preventive services
requirements in this provision, and the amendments made in these
interim final rules in fact are based on such public comments.
Specifically, commenters expressed concerns that HRSA-supported
guidelines issued under section 2713(a)(4) that included coverage of
contraceptive services could impinge upon the religious freedom of
certain religious employers. The flexibility that is afforded under
these amendments is being provided to HRSA in order to allow HRSA the
discretion to accommodate, in a balanced way, as discussed above, these
commenter concerns.
In addition, the Departments have determined that an additional
opportunity for public comment would be impractical and contrary to the
public interest. The requirement in section 2713(a)(4) that preventive
services supported by HRSA be provided without cost-sharing took effect
at the beginning of the first plan or policy year beginning on or after
September 23, 2010. At that time, however, HRSA had not issued any such
guidelines. Under the July 19, 2010 interim final rules, group health
plans and insurance issuers do not have to begin covering preventive
services supported in HRSA guidelines until the first plan or policy
year that begins one year after the guidelines are issued. Thus, while
the law requiring coverage of recommended women's preventive health
services was enacted on March 23, 2010, and has been in effect since
September 23, 2010, no such guidelines have yet been issued, and it
will be at least a full year after they are issued before group health
plans and issuers will be required to start covering preventive
services recommended in the guidelines without cost sharing.
The July 19, 2010 interim final rules indicated that HRSA expected
to issue guidelines by August 1, 2011. After considering public
comments raising the issue addressed in these amendments, however, the
Departments determined that HRSA should be granted the discretion to
address the commenter concerns at issue prior to issuing guidelines
under section 2713(a)(4). Many college student policy years begin in
August and an estimated 1.5 million young adults are estimated to be
covered by such policies.\5\ Providing an opportunity for public
comment as described above would mean that the guidelines could not be
issued until after August of 2011. This delay would mean that many
students could not benefit from the new prevention coverage without
cost-sharing following from the issuance of the guidelines until the
2013-14 school year, as opposed to the 2012-13 school year. Similarly,
2008 data from the Department of Labor indicate that over 4 million
Americans have ERISA group health plan coverage that starts in August
or September; they too would experience over a year's delay in the
receipt of the new benefit if the public comment period delayed the
issuance of the guidance for over a month. The Departments have
determined that such a delay in implementation of the statutory
requirement that women receive vital preventive services without cost-
sharing would be contrary to the public interest because it could
result in adverse health consequences that may not otherwise have
occurred.
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\5\ Department of Health and Human Services, Notice of Proposed
Rulemaking on Student Health Insurance Coverage (76 FR 7767,
February 22, 2011).
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While the Departments have determined that, even if the APA were
applicable, issuing these regulations in proposed form, so they would
not become effective until after public comment, would be contrary to
the public interest in the case of these amendments, the Departments
are issuing these amendments as interim final rules so as to provide
the public with an opportunity for public comment on these amendments.
The APA also generally requires that a final rule be effective no
sooner than 30 days after the date of publication in the Federal
Register. This 30-day delay in effective date can be waived, however,
if an agency finds good cause why the effective date should not be
delayed, and the agency incorporates a statement of the findings and
its reasons in the rule issued.
As indicated above, many college student policy years begin in
August. Delaying the effective date of this amendment by 30 days would
mean that the HRSA guidelines could not be issued until after August of
2011. This delay would mean many students could not benefit from the
new prevention coverage without cost-sharing following from the
issuance of the guidelines until the 2013-14 school year, as opposed to
the 2012-13 school year. As discussed above, all other participants,
beneficiaries and enrollees in plans or policies with a plan or a
policy year beginning in the months between August 1 and whenever a
final rule would be published should the Departments provide a pre-
promulgation opportunity for public comment would face a similar one-
year delay in receiving these important health benefits. The
Departments have determined that such a delay in implementation of the
statutory requirement that women receive vital preventive services
without cost-sharing would be impracticable and contrary to the public
interest because it could result in adverse health consequences that
may not otherwise have occurred. Therefore, the Departments are waiving
the 30-day delay in effective date of these amendments.

[[Page 46625]]

IV. Economic Impact and Paperwork Burden

A. Executive Orders 13563 and 12866--Department of Labor and Department
of Health and Human Services

Executive Orders 13563 and 12866 direct 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). Executive
Order 13563 emphasizes the importance of quantifying both costs and
benefits, of reducing costs, of harmonizing rules, and of promoting
flexibility. This rule has been designated a ``significant regulatory
action,'' although not economically significant, under section 3(f) of
Executive Order 12866. Accordingly, the rule has been reviewed by the
Office of Management and Budget.
1. Need for Regulatory Action
As stated earlier in this preamble, the Departments previously
issued interim final regulations implementing PHS Act section 2713 that
were published in the Federal Register on July 19, 2010 (75 FR 41726).
Comments received in response to the interim final regulations raised
the issue of imposing on certain religious employers through binding
guidelines the requirement to cover contraceptive services that would
be in conflict with the religious tenets of the employer. The
Departments have determined that it is appropriate to amend the interim
final rules to provide HRSA the discretion to exempt from its
guidelines group health plans maintained by certain religious employers
where contraceptive services are concerned.
2. Anticipated Effects
The Departments expect that this amendment will not result in any
additional significant burden or costs to the affected entities.

B. Special Analyses--Department of the Treasury

Notwithstanding the determinations of the Department of Labor and
Department of Health and Human Services, for purposes of the Department
of the Treasury, it has been determined that this Treasury decision is
not a significant regulatory action for purposes of Executive Order
12866. Therefore, a regulatory assessment is not required. It has also
been determined that section 553(b) of the APA (5 U.S.C. chapter 5)
does not apply to these interim final regulations. For the
applicability of the RFA, refer to the Special Analyses section in the
preamble to the cross-referencing notice of proposed rulemaking
published elsewhere in this issue of the Federal Register. Pursuant to
section 7805(f) of the Code, these temporary regulations have been
submitted to the Chief Counsel for Advocacy of the Small Business
Administration for comment on their impact on small businesses.

C. Paperwork Reduction Act

As stated in the previously issued interim final regulations, this
rule is not subject to the requirements of the Paperwork Reduction Act
of 1980 (44 U.S.C. 3501 et seq.) because it does not contain a
``collection of information'' as defined in 44 U.S.C. 3502 (11).

V. Statutory Authority

The Department of the Treasury temporary regulations are adopted
pursuant to the authority contained in sections 7805 and 9833 of the
Code.
The Department of Labor interim final regulations are adopted
pursuant to the authority contained in 29 U.S.C. 1027, 1059, 1135,
1161-1168, 1169, 1181-1183, 1181 note, 1185, 1185a, 1185b, 1185c,
1185d, 1191, 1191a, 1191b, and 1191c; sec. 101(g), Pub. L. 104-191, 110
Stat. 1936; sec. 401(b), Pub. L. 105-200, 112 Stat. 645 (42 U.S.C. 651
note); sec. 512(d), Pub. L. 110-343, 122 Stat. 3881; sec. 1001, 1201,
and 1562(e), Pub. L. 111-148, 124 Stat. 119, as amended by Pub. L. 111-
152, 124 Stat. 1029; Secretary of Labor's Order 3-2010, 75 FR 55354
(September 10, 2010).
The Department of Health and Human Services interim final
regulations are adopted pursuant to the authority contained in sections
2701 through 2763, 2791, and 2792 of the PHS Act (42 U.S.C. 300gg
through 300gg-63, 300gg-91, and 300gg-92), as amended.

List of Subjects

26 CFR Part 54

Excise taxes, Health care, Health insurance, Pensions, Reporting
and recordkeeping requirements.

29 CFR Part 2590

Continuation coverage, Disclosure, Employee benefit plans, Group
health plans, Health care, Health insurance, Medical child support,
Reporting and recordkeeping requirements.

45 CFR Part 147

Health care, Health insurance, Reporting and recordkeeping
requirements, and State regulation of health insurance.

Department of the Treasury

Internal Revenue Service

26 CFR Chapter 1

Accordingly, 26 CFR part 54 is amended as follows:

PART 54--PENSION EXCISE TAXES

0
Paragraph 1. The authority citation for part 54 continues to read as
follows:

Authority: 26 U.S.C. 7805. * * *

0
Par. 2. Section 54.9815-2713T is amended by revising paragraph
(a)(1)(iv) to read as follows:

Sec. 54.9815-2713T Coverage of preventive health services
(temporary).

Department of Labor

Employee Benefits Security Administration

29 CFR Chapter XXV

29 CFR part 2590 is amended as follows:

PART 2590--RULES AND REGULATIONS FOR GROUP HEALTH PLANS

0
1. The authority citation for part 2590 continues to read as follows:

Authority: 29 U.S.C. 1027, 1059, 1135, 1161-1168, 1169, 1181-
1183, 1181 note, 1185, 1185a, 1185b, 1185c, 1185d, 1191, 1191a,
1191b, and 1191c; sec. 101(g), Pub. L. 104-191, 110 Stat. 1936; sec.
401(b), Pub. L. 105-200, 112 Stat. 645 (42 U.S.C. 651 note); sec.
512(d), Pub. L. 110-343, 122 Stat. 3881; sec. 1001, 1201, and
1562(e), Pub. L. 111-148, 124 Stat. 119, as amended by Pub. L. 111-
152, 124 Stat. 1029; Secretary of Labor's Order 3-2010, 75 FR 55354
(September 10, 2010).

Subpart C--Other Requirements

0
2. Section 2590.715-2713 is amended by revising paragraph (a)(1)(iv) to
read as follows:

Sec. 2590.715-2713 Coverage of preventive health services.

(a) * * *
(1) * * *
(iv) With respect to women, to the extent not described in
paragraph

[[Page 46626]]

(a)(1)(i) of this section, preventive care and screenings provided for
in binding comprehensive health plan coverage guidelines supported by
the Health Resources and Services Administration and developed in
accordance with 45 CFR 147.130(a)(1)(iv).
* * * * *

Department of Health and Human Services

For the reasons stated in the preamble, the Department of Health
and Human Services amends 45 CFR part 147 as follows:

PART 147--HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND
INDIVIDUAL HEALTH INSURANCE MARKETS

0
1. The authority citation for part 147 continues to read as follows:

Authority: 2701 through 2763, 2791, and 2792 of the Public
Health Service Act (42 U.S.C. 300gg through 300gg-63, 300gg-91, and
300gg-92), as amended.

0
2. Section 147.130 is amended by revising paragraph (a)(1)(iv) to read
as follows:

Sec. 147.130 Coverage of preventive health services.

(a) * * *
(1) * * *
(iv) With respect to women, to the extent not described in
paragraph (a)(1)(i) of this section, preventive care and screenings
provided for in binding comprehensive health plan coverage guidelines
supported by the Health Resources and Services Administration.
(A) In developing the binding health plan coverage guidelines
specified in this paragraph (a)(1)(iv), the Health Resources and
Services Administration shall be informed by evidence and may establish
exemptions from such guidelines with respect to group health plans
established or maintained by religious employers and health insurance
coverage provided in connection with group health plans established or
maintained by religious employers with respect to any requirement to
cover contraceptive services under such guidelines.
(B) For purposes of this subsection, a ``religious employer'' is an
organization that meets all of the following criteria:
(1) The inculcation of religious values is the purpose of the
organization.
(2) The organization primarily employs persons who share the
religious tenets of the organization.
(3) The organization serves primarily persons who share the
religious tenets of the organization.
(4) The organization is a nonprofit organization as described in
section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the
Internal Revenue Code of 1986, as amended.
* * * * *

Steven T. Miller,
Deputy Commissioner for Services and Enforcement, Internal Revenue
Service.
Approved: July 28, 2011.
Emily S. McMahon,
Acting Assistant Secretary of the Treasury (Tax Policy).
Signed this 29th day of July 2011.
Phyllis C. Borzi,
Assistant Secretary, Employee Benefits Security Administration,
Department of Labor.
OCIIO-9992-IFC2

(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

Dated: July 28, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 28, 2011.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2011-19684 Filed 8-1-11; 8:45 am]
BILLING CODE 4120-01-P