[Federal Register Volume 76, Number 190 (Friday, September 30, 2011)]
[Proposed Rules]
[Pages 60788-60789]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-25202]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

45 CFR Parts 153, 155 and 156

[CMS-9989-N2]


Patient Protection and Affordable Care Act; Establishment of 
Exchanges and Qualified Health Plans, and Standards Related to 
Reinsurance, Risk Corridors and Risk Adjustment; Extension of Comment 
Period

AGENCY: Department of Health and Human Services.

ACTION: Proposed rule; extension of comment period.

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SUMMARY: This document extends the comment period for two proposed 
rules published in the Federal Register on July 15, 2011. One proposed 
rule would implement the new Affordable Insurance Exchanges 
(``Exchanges''), consistent with Title I of the Patient Protection and 
Affordable Care Act of 2010 as amended by the Health Care and Education 
Reconciliation Act of 2010, referred to collectively as the Affordable 
Care Act. The other proposed rule would implement standards for States 
related to reinsurance and risk adjustment, and for health insurance 
issuers related to reinsurance, risk corridors, and risk adjustment 
consistent with Title I of the Affordable Care Act. The comment period 
for both proposed rules, which would have ended on September 28, 2011, 
is extended to October 31, 2011.

DATES: The comment period for two proposed rules published in the 
Federal Register on July 15, 2011 (76 FR 41866 and 76 FR 41930, 
respectively), is extended from 5 p.m. Eastern Standard Time on 
September 28, 2011, to 5 p.m. Eastern Standard Time on October 31, 
2011.

ADDRESSES: In commenting, please refer to file code CMS-9989-N2. 
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 instructions under 
the ``More Search Options'' tab.
    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-9989-N2, 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-9989-N2, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    4. 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

[[Page 60789]]

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, 
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.

FOR FURTHER INFORMATION CONTACT:

Sharon Arnold, (301) 492-4415 for general information and matters 
related to reinsurance, risk adjustment, and risk corridors.
Laurie McWright, (301) 492-4372 for general information and matters 
related to Exchanges and qualified health plans.
Alissa DeBoy, (301) 492-4428 for general information and matters 
related to Exchanges and qualified health plans.

SUPPLEMENTARY INFORMATION: On July 15, 2011, we published two proposed 
rules in the Federal Register (76 FR 41866 through 41927 and 76 FR 
41930 through 41956, respectively).
    The first rule would implement the new Affordable Insurance 
Exchanges (``Exchanges''), consistent with Title I of the Patient 
Protection and Affordable Care Act of 2010 (Pub. L. 111-148) as amended 
by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 
111-152), referred to collectively as the Affordable Care Act. The 
Exchanges would provide competitive marketplaces for individuals and 
small employers to directly compare available private health insurance 
options on the basis of price, quality, and other factors. The 
Exchanges, which would become operational by January 1, 2014, would 
help enhance competition in the health insurance market, improve choice 
of affordable health insurance, and give small businesses the same 
purchasing clout as large businesses. This proposed rule, ``Patient 
Protection and Affordable Care Act; Establishment of Exchanges and 
Qualified Health Plans,'' is significant in that it proposes--(1) 
Federal requirements that States must meet if they elect to establish 
and operate an Exchange; (2) minimum requirements that health insurance 
issuers must meet to participate in an Exchange and offer qualified 
health plans (QHPs); and (3) basic standards that employers must meet 
to participate in the Small Business Health Options Program (SHOP).
    The second proposed rule would implement standards for States 
related to reinsurance and risk adjustment, and for health insurance 
issuers related to reinsurance, risk adjustment, and risk corridors 
consistent with Title I of the Affordable Care Act. Collectively, these 
programs would mitigate the impact of potential adverse selection and 
stabilize premiums in the individual and small group markets as 
insurance reforms and the Exchanges are implemented. These programs are 
significant in that--(1) The transitional reinsurance program would 
serve to reduce uncertainty of insurance risk in the individual market 
by making payments to health plan issuers for high-cost cases; (2) the 
temporary risk corridor program would serve to protect against 
uncertainty by limiting the extent of health plan issuer losses and 
gains; and (3) the permanent risk adjustment program, on an on-going 
basis, is intended to provide adequate payments to health insurance 
issuers that attract high-risk populations, such as individuals with 
chronic conditions.
    We believe that rules proposed by HHS and the Treasury on August 
17, 2011 (76 FR 51148, 76 FR 51202, and 76 FR 50931, respectively), 
about eligibility determinations by an Exchange, generate additional 
insight on the issues raised by the July 15, 2011 proposed rules. Based 
on this reason, we are extending the comment period for the July 15, 
2011 proposed rules to October 31, 2011.

    Dated: September 26, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.

    Dated: September 26, 2011.
Kathleen Sebelius,
Secretary.
[FR Doc. 2011-25202 Filed 9-27-11; 11:15 am]
BILLING CODE 4120-01-P