[Federal Register Volume 76, Number 168 (Tuesday, August 30, 2011)]
[Notices]
[Pages 53903-53906]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-22042]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Delegation of Authorities

    Notice is hereby given that I have delegated to the Administrator, 
Centers for Medicare & Medicaid Services (CMS), or his or her 
successor, the authorities vested in the Secretary for the following 
provisions of Titles I, II, and X of the Affordable Care Act, including 
Title XXVII of the Public Health Service Act insofar as such parts 
pertain to CMS' mission, as described in section F.00 of CMS' Statement 
of Organization, Functions, and Delegations of Authority, last 
published at 55 FR 9363 (March 13, 1990).

Title I--Quality, Affordable Health Care for All Americans

Subtitle B--Immediate Actions to Preserve and Expand Coverage

    Section 1101--The authorities pursuant to section 1101 [42 U.S.C. 
18001], as amended, to establish a temporary high risk health insurance 
pool program to provide health insurance coverage for eligible 
individuals during the period beginning on the date on which such 
program is established and ending on January 1, 2014.
    Section 1102--The authorities pursuant to section 1102 [42 U.S.C. 
18002], as amended, to establish a temporary reinsurance program to 
provide reimbursement to participating employment-based plans for a 
portion of the cost of providing health insurance coverage to early 
retirees (and to the eligible spouses, surviving spouses, and 
dependents of such retirees) during the period beginning on the date on 
which such program is established and ending on January 1, 2014. The 
authority to accept and review appeals of adverse reimbursement 
determinations under the reinsurance program is, however, delegated to 
the Chair of the Departmental Appeals Board, Office of the Secretary, 
who will designate one or more Board Members to decide each appeal. The 
Board's decision on an appeal will be final and binding unless reopened 
and revised pursuant to 45 CFR 149.610.
    Section 1103--The authorities pursuant to section 1103 [42 U.S.C. 
18003], as amended, to establish a mechanism, including an Internet Web 
site, through which a resident of any State may identify affordable 
health insurance coverage options in that State.

Subtitle C--Quality Health Insurance Coverage for All Americans

Part II--Other Provisions
    Section 1251--The authorities pursuant to section 1251 [42 USC 
18011], as amended, to preserve the right of individuals and groups to 
maintain existing health insurance coverage.
    Section 1252--The authorities pursuant to section 1252 [42 USC 
18012], as amended, to uniformly apply rate reforms to all health 
insurance issuers and group health plans.

Subtitle D--Available Coverage Choices for All Americans

Part I--Establishment of Qualified Health Plans
    Section 1301--The authorities pursuant to section 1301 [42 U.S.C. 
18021], as amended, pertaining to defining qualified health plans.
    Section 1302--The authorities pursuant to section 1302 [42 U.S.C. 
18022], as amended, pertaining to essential health benefits 
requirements, including a certification from the Chief Actuary of the 
Centers for Medicare & Medicaid Services that such essential health 
benefits meet the limitation described in Section 1302(b)(2) [42 U.S.C. 
18022(b)(2)].
    Section 1303--The authorities pursuant to section 1303 [42 U.S.C. 
18023], as amended, pertaining to State opt-out of abortion coverage, 
special rules relating to coverage of abortion services, applying State 
and Federal laws regarding abortion, and applying emergency services.
    Section 1304--The authorities pursuant to section 1304 [42 U.S.C. 
18024], as amended, pertaining to definitions related to quality, 
affordable health care for all Americans.
Part II--Consumer Choices and Insurance Competition Through Health 
Benefit Exchanges
    Section 1311--The authorities pursuant to section 1311 [42 USC 
18031], as amended, pertaining to affordable choices of health benefit 
plans, in particular, the American Health Benefit Exchanges (AHBE). CMS 
will coordinate with the Department of Labor under section 
1311(e)(3)(B) [42 USC 18031(e)(3)(B)].
    Section 1312--The authorities pursuant to section 1312 [42 USC 
18032], as amended, pertaining to consumer choice, payment of premiums 
by qualified individuals, single risk pool, enrollment through agents 
or brokers, and qualified individuals and employers (access limited to 
citizens and lawful residents).
    Section 1313(a)--The authorities pursuant to section 1313(a) [42 
USC 18033(a)], as amended, pertaining to financial integrity involving 
accounting for expenditures, investigations, audits, pattern of abuse, 
protections against fraud and abuse, and applying the False Claims Act. 
CMS will coordinate with the Office of the Inspector General to 
investigate the affairs of an AHBE, to examine the properties and 
records of an AHBE, and to require periodic reports in relation to 
activities undertaken by an AHBE under section 1313(a)(2) [42 USC 
18033(a)(2)].
Part III--State Flexibility Relating to Exchanges
    Section 1321--The authorities pursuant to section 1321 [42 U.S.C. 
18041], as amended, pertaining to the State's flexibility in operation 
and enforcement of AHBE and related requirements. CMS will consult with 
the National Association of Insurance Commissioners under section 
1321(a)(2) [42 U.S.C. 18041(a)(2)].
    Sections 1322(a)-(b)(1) and (2), (c)-(g) and (h)(1)--The 
authorities pursuant to sections 1322(a)-(b)(1) and (2), (c)-(g) [42 
USC 18042] and (h)(1) [26 U.S.C. 501(c)(29)], as amended, to establish 
the Consumer Operated and Oriented Plan Program to assist establishment 
and operation of non-profit, member-run

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health insurance issuers. CMS will coordinate with the Department of 
the Treasury to establish criteria and procedures for tax exemption 
under section 501(c)(29) of the Internal Revenue Code of 1986 [26 
U.S.C. 501(c)(29)] for qualified nonprofit health insurance issuers.
    Section 1323--The authorities pursuant to section 1323 [42 U.S.C. 
18043], as amended, to fund territories that elect to establish an 
AHBE.
    Section 1324--The authorities pursuant to section 1324 [42 U.S.C. 
18044], as amended, pertaining to health insurance coverage offered by 
a private health insurance issuer, which would not be subject to the 
Federal or State laws described in section 1324(b) [42 U.S.C. 18044(b)] 
if a qualified health plan offered under the Consumer Operated and 
Oriented Plan program under section 1322 [42 U.S.C. 18042] or a multi-
State qualified health plan under section 1334 [42 USC 18054] were not 
subject to such laws.
Part IV--State Flexibility to Establish Alternative Programs
    Section 1331--The authorities pursuant to section 1331 [42 USC 
18051], as amended, to establish basic health programs for low-income 
individuals not eligible for Medicaid, and allowing States the 
flexibility to establish alternative programs by entering into 
contracts to offer one or more standard health plans providing at least 
the essential health benefits described in section 1302(b) [42 U.S.C. 
18022(b)] to eligible individuals in lieu of offering such individuals 
coverage through an Exchange. The Chief Actuary in the Office of the 
Actuary, CMS, will certify whether the methodology used to make 
determinations pursuant to section 1331(d)(3) (A)(iii) [42 U.S.C. 
18051(d)(3)(A)(iii)], and such determinations, meet the requirements of 
section 1331(d)(3)(A)(ii) [42 U.S.C. 18051(d)(3)(A)(ii)] in 
consultation with the Office of Tax Analysis of the Department of the 
Treasury.
    Section 1332--The authorities pursuant to section 1332 [42 U.S.C. 
18052], as amended, pertaining to waivers for State innovations with 
respect to health insurance coverage within the State for plan years 
beginning on or after January 1, 2017. CMS will coordinate with the 
Department of the Treasury to publish regulations pursuant to section 
1332(a)(4)(B) [42 U.S.C. 18052(a)(4)(B)].
    Section 1333--The authorities pursuant to section 1333 [42 U.S.C. 
18053], as amended, pertaining to offering plans in more than one 
State. CMS will coordinate with the National Association of Insurance 
Commissioners to publish regulations pursuant to section 1333(a)(1) [42 
U.S.C. 18053(a)(1)].
Part V--Reinsurance and Risk Adjustment
    Section 1341--The authorities pursuant to section 1341 [42 U.S.C. 
18061], as amended, pertaining to the transitional reinsurance program 
for individual and small group markets in each State. CMS will 
coordinate with the National Association of Insurance Commissioners to 
publish regulations pursuant to section 1321(a) [42 U.S.C. 18041].
    Section 1342--The authorities pursuant to section 1342 [42 U.S.C. 
18062], as amended, to establish and administer a program of risk 
corridors under which a qualified health plan offered in the individual 
or small group market shall participate in a payment adjustment system 
based on the ratio of the allowable costs of the health plan to the 
health plan's aggregate premiums based on the program for regional 
participating provider organizations under part D of Title XVIII of the 
Social Security Act.
    Section 1343(b)--The authorities pursuant to section 1343(b) [42 
U.S.C. 18063(b)], as amended, to establish criteria and methods used in 
carrying out risk adjustment activities pursuant to section 1343 [42 
USC 18063] with respect to health insurance plans and coverage.

Subtitle E--Affordable Coverage Choices for All Americans

Part I--Premium Tax Credits and Cost-Sharing Reductions
    Subpart A--Premium Tax Credits and Cost-Sharing Reductions
    Section 1401(a)--The authorities pursuant to section 1401(a) [26 
USC 36B], as amended, pertaining to refundable credit for coverage 
under a qualified health plan. CMS will consult with the Department of 
the Treasury pursuant to the Internal Revenue Code of 1986 section 
36B(e)(3) [26 U.S.C. 36B(e)(3)] to prescribe rules setting forth the 
methods by which calculations of family size and household income are 
made, and carry out the activities set out pursuant to 26 U.S.C. 36B 
[26 U.S.C. 36B], such as determinations of premiums.
    Section 1402--The authorities pursuant to section 1402 [42 U.S.C. 
18071], as amended, pertaining to reduced cost-sharing for individuals 
enrolling in qualified health plans. CMS will consult with the 
Department of the Treasury pursuant to section 1402(e)(3) [42 U.S.C. 
18071(e)(3)].
    Section 1411--The authorities pursuant to section 1411 [42 U.S.C. 
18081], as amended, to determine eligibility for exchange 
participation, premium tax credits and reduced cost-sharing, and 
individual responsibility exemptions. CMS will consult with: (1) The 
Department of Homeland Security pursuant to section 1411(b)(2)(B) [42 
U.S.C. 18081(b)(2)(B)]; 2) the Departments of the Treasury, and 
Homeland Security, and the Social Security Administration pursuant to 
sections 1411(c)(4)(A) [42 U.S.C. 18081(c)(4)(A)] and 1411(f)(1) [42 
U.S.C. 18081(f)(1)]; and 3) the Department of the Treasury pursuant to 
section 1411(i)(1) [42 U.S.C. 18081(i)(1)].
    Section 1412--The authorities pursuant to section 1412 [42 U.S.C. 
18082), as amended, pertaining to advance determinations made pursuant 
to section 1411 [42 U.S.C. 18081] with respect to the income 
eligibility of individuals enrolling in a qualified health plan in the 
individual market through the AHBE for the premium tax credit allowable 
pursuant to section 1401(a) [26 U.S.C. 36B] and the cost-sharing 
reductions under section 1402 [42 U.S.C. 18071]. CMS will consult with 
the Department of the Treasury.
    Section 1413--The authorities pursuant to section 1413 [42 U.S.C. 
18083), as amended, to streamline procedures for enrollment through an 
AHBE and State Medicaid, CHIP, and health subsidy programs.
    Section 1414(a)(1)--The authorities pursuant to section 6103(l)(21) 
of the Internal Revenue Code of 1986 [26 U.S.C. 6103(l)(21)], as 
amended, pertaining to disclosure of taxpayer return information and 
Social Security numbers.
    Section 1414(a)(2)--The authorities pursuant to section 
205(c)(2)(C)(x) of the Social Security Act [42 U.S.C. 405(c)(2)(C)(x)], 
as amended, to collect and use the names and Social Security account 
numbers of individuals as required to administer the provisions of the 
Social Security Act and amendments made by the Affordable Care Act.
    Section 1415--The authorities pursuant to section 1415 [42 U.S.C. 
18084], as amended, pertaining to premium tax credit and cost-sharing 
reduction payments disregarded for Federal and federally-assisted 
programs.

Subtitle F--Shared Responsibility for Health Care

Part I--Individual Responsibility
    Sections 1501(a) and (b)--The authorities pursuant to section 
1501(a) [42 U.S.C. 18091(a)], as amended, and

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pursuant to section 1501(b) [26 U.S.C. 5000A], as amended, to maintain 
minimal essential coverage for health care, except for the last 
paragraph of 26 U.S.C. 5000A(e)(4).
Part II--Employer Responsibilities
    Section 1511--The authorities pursuant to 29 USC 218A, as amended, 
to automatically enroll employees of large employers that have more 
than 200 full-time employees, and that offer employees enrollment in 1 
or more health benefits plans (subject to any waiting period authorized 
by law) and to continue the enrollment of current employees in a health 
benefits plan offered through the employer.
    Section 1512--The authorities pursuant to 29 U.S.C. 218B, as 
amended, to provide notice to employees of coverage options.
    Section 1513(a)--The authorities pursuant to section 1513(a) [26 
U.S.C. 4980H], as amended, pertaining to shared responsibility for 
employers regarding health coverage. CMS will consult with the 
Department of Labor pursuant to 26 U.S.C. 4980H(c)(4)(B) to determine 
the hours of service of an employee necessary to qualify under 26 
U.S.C. 4980H(c)(4) as a ``full-time employee'' for purposes of coverage 
under the Affordable Care Act.
    Section 1514(a)--The authorities pursuant to section 6056 [26 
U.S.C. 6056] of the Internal Revenue Code of 1986, as amended, to 
review the accuracy of health insurance information provided by large 
employers who are required to report on health insurance coverage.

Subtitle G--Miscellaneous Provisions

    Section 1558--The authority pursuant to section 1558 [29 U.S.C. 
218C], as amended, to prohibit employers from discharging or in any 
manner discriminating against any employee with respect to his or her 
compensation, terms, conditions, or other privileges of employment 
because the employee (or an individual acting at the request of the 
employee) has: (1) Received a credit pursuant to section 36B of the 
Internal Revenue Code of 1986 or a subsidy pursuant to section 1402 of 
the Affordable Care Act; (2) provided, caused to be provided, or is 
about to provide or cause to be provided to the employer, the Federal 
Government, or the attorney general of a State information relating to 
any violation of, or any act or omission the employee reasonably 
believes to be a violation of, any provision of this title (or an 
amendment made by this title); (3) testified or is about to testify in 
a proceeding concerning such violation; (4) assisted or participated, 
or is about to assist or participate, in such a proceeding; or (5) 
objected to, or refused to participate in, any activity, policy, 
practice, or assigned task that the employee (or other such person) 
reasonably believed to be in violation of any provision of Title 29 of 
the United States Code (or amendment), or any order, rule, regulation, 
standard, or ban pursuant to Title 29 of the United States Code (or 
amendment).

Title II--Role of Public Programs

Subtitle C--Medicaid and CHIP Enrollment Simplification

    Section 2201--The authority pursuant to section 2201 [42 U.S.C. 
1396w-3, section 1943 of the Social Security Act], as amended, 
pertaining to enrollment simplification and coordination with State 
Health Insurance Exchanges.

Subtitle K--Protections for American Indians and Alaska Natives

    Sections 2901(a) and (b)--The authorities pursuant to section 
2901(a) and (b) [25 U.S.C. 1623(a) and (b)], as amended, pertaining to 
special rules relating to Indians. CMS will coordinate with the Indian 
Health Service pursuant to section 2901(b) [25 U.S.C. 1623(b)].

Title X--Strengthening Quality, Affordable Health Care for All 
Americans

    Section 10108(a)-(e)--The authorities under section 10108(a)-(e) 
[42 USC 18101(a)-(e)], as amended, pertaining to an offering employer 
providing free choice vouchers to each qualified employee through an 
employer-sponsored health insurance plan.
    Title XXVII of the Public Health Service Act, as amended, including 
the authority to conduct studies and demonstration projects, as 
directed by Congress, relating to Title XXVII of the Public Health 
Service Act. The delegation includes, but does not limit the authority 
to, directing performance, entering into contracts or cooperative 
agreements, making grants, approving payments for contracts, 
cooperative agreements, and grants, and approving authorized waivers of 
compliance with certain requirements of Title XXVII of the Public 
Health Service Act when such authorities are for the purpose of 
conducting studies and demonstration projects.
    This delegation of authorities excludes the authorities to issue 
regulations, to submit reports to Congress, and the following 
authorities, as amended by the indicated sections of the Affordable 
Care Act:
    (1) Section 1302(b)(2)(A) and (B)--The authority to conduct a 
survey of employer-sponsored coverage pursuant to section 1302(b)(2)(A) 
[42 U.S.C.18022(b)(2)(A)] to determine the benefits typically covered 
by employers, including multi-employer plans and the authority to 
submit a report pursuant to section 1302(b)(2)(B) [42 U.S.C. 
18022(b)(2)(B)] to the appropriate committees of Congress.
    (2) Section 1311(e)(3)(D)--The authority to update and harmonize 
rules concerning the accurate and timely disclosure to participants by 
group health plans of plan disclosure, plan terms and conditions, and 
periodic financial disclosure with the standards established pursuant 
to section 1311(e)(3)(D) [42 U.S.C. 18031(e)(3)(A)].
    (3) Sections 1322(b)(4)--The authority to appoint 15 members to the 
Consumer Operated and Oriented Plan Advisory Board pursuant to section 
1322(b)(4) [42 U.S.C. 18042(b)(4)].
    (4) Section 1332--The authorities with respect to health insurance 
coverage within the State for plan years beginning on or after January 
1, 2014, pursuant to section 1332(a)(2)(D) [42 U.S.C. 18052(a)(2)(D)] 
including sections 36B [26 U.S.C. 36B], 4980H [26 U.S.C. 4980H], and 
5000A [26 U.S.C. 5000A] of the Internal Revenue Code of 1986, 
pertaining to reports to Congress pursuant to section 1332(a)(4)(C) [42 
U.S.C. 18052(a)(4)(C)], and to notify the appropriate committees of 
Congress pursuant to section 1332(d)(2)(B) [42 U.S.C. 18052(d)(2)(B)].
    (5) Section 1411(i)(2)--The authority under section 1411(i)(2) [42 
U.S.C. 18081(i)(2)] of the Affordable Care Act to issue a report of the 
results of the study conducted under section 1411(i)(1) [42 U.S.C. 
18081(i)(1)], including any recommendations for legislative changes to 
the Committees on Finance and Health, Education, Labor, and Pensions of 
the Senate, and the Committees of Education and Labor and Ways and 
Means of the House of Representatives.
    (6) Section 1412(c)(2)--The authority under section 1412(c)(2) [42 
U.S.C. 18082(c)(2)] to make advance payments under section 1412 [42 
U.S.C. 18082] of any premium tax credit allowed under section 36B of 
the Internal Revenue Code of 1986 [26 U.S.C. 36B] to the issuer of a 
qualified health plan on a monthly basis.
    (7) Section 1414(a)(1)--The authority to prescribe regulations to 
disclose return information indicating whether the taxpayer is eligible 
for a tax credit or reduction (and the amount thereof) pursuant to 26 
U.S.C. 6103(l)(21)(A)(v).
    (8) Section 1501(b)--The authority to prescribe rules for the 
collection of the penalty imposed in cases where

[[Page 53906]]

continuous periods include months in more than one taxable year 
pursuant to the last paragraph of 26 U.S.C. 5000A(e)(4).
    This delegation of authorities supersedes the authorities delegated 
under Title XXVII of the Public Health Service Act that were published 
in the Federal Register notice on June 23, 1998 (63 FR 34190).
    This delegation of authorities is effective immediately.
    These authorities may be re-delegated.
    These authorities shall be exercised under the Department's policy 
on regulations and the existing delegation of authority to approve and 
issue regulations.
    I hereby affirm and ratify any actions taken by the Administrator, 
CMS, or his or her subordinates, which involved the exercise of the 
authorities under Titles I, II, and X of the Affordable Care Act, 
including Title XXVII of the Public Health Service Act delegated herein 
prior to the effective date of this delegation of authorities.

    Authority:  44 U.S.C. 3101.

    Dated: August 2, 2011.
Kathleen Sebelius,
Secretary.
[FR Doc. 2011-22042 Filed 8-29-11; 8:45 am]
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