EBSA
Final Rules
Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act
[ 2/15/2012]
[ PDF]
Federal Register, Volume 77 Issue 31 (Wednesday, February 15, 2012)
[Federal Register Volume 77, Number 31 (Wednesday, February 15, 2012)]
[Rules and Regulations]
[Pages 8725-8730]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-3547]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
[TD 9578]
RIN 1545-BJ60
DEPARTMENT OF LABOR
Employee Benefits Security Administration
29 CFR Part 2590
RIN 1210-AB44
DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Part 147
[CMS-9992-F]
RIN 0938-AQ74
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: Final rules.
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SUMMARY: These regulations finalize, without change, interim final
regulations authorizing the exemption of group health plans and group
health insurance coverage sponsored by certain religious employers from
having to cover certain preventive health services under provisions of
the Patient Protection and Affordable Care Act.
DATES: Effective date. These final regulations are effective on April
16, 2012.
Applicability dates. These final regulations generally apply to
group health plans and group health insurance issuers on April 16,
2012.
FOR FURTHER INFORMATION CONTACT: Amy Turner or Beth Baum, Employee
Benefits Security Administration (EBSA), 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 (HHS),
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 CMS Web site (http://cciio.cms.gov), and 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 of 2010, Public Law 111-152, was enacted on March
30, 2010 (collectively, 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 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 (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.
Section 2713 of the PHS Act, as added by the Affordable Care Act
and incorporated into ERISA and the Code, requires that non-
grandfathered group health plans and health insurance issuers offering
group or individual health insurance coverage provide benefits for
certain preventive health services without the imposition of cost
sharing. These preventive health services include, with respect to
women, preventive care and screening provided for in the comprehensive
guidelines supported by the Health Resources and Services
Administration (HRSA) that were issued on August 1, 2011 (HRSA
Guidelines).\1\ As relevant here, the HRSA Guidelines require coverage,
without cost sharing, for ``[a]ll Food and Drug Administration [(FDA)]
approved contraceptive methods, sterilization procedures, and patient
education and counseling for all women with reproductive capacity,'' as
prescribed by a provider. Except as discussed below, non-grandfathered
group health plans and health insurance issuers are required to provide
coverage consistent with the HRSA Guidelines, without cost sharing, in
plan years (or,
[[Page 8726]]
in the individual market, policy years) beginning on or after August 1,
2012.\2\ These guidelines were based on recommendations of the
independent Institute of Medicine, which undertook a review of the
evidence on women's preventive services.
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\1\ The HRSA Guidelines can be found at: http://www.hrsa.gov/womensguidelines.
\2\ The interim final regulations published by the Departments
on July 19, 2010, generally provide that plans and issuers must
cover a newly recommended preventive service starting with the first
plan year (or, in the individual market, policy year) that begins on
or after the date that is one year after the date on which the new
recommendation or guideline is issued. 26 CFR 54.9815-2713T(b)(1);
29 CFR 2590.715-2713(b)(1); 45 CFR 147.130(b)(1).
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The Departments of Health and Human Services, Labor, and the
Treasury (the Departments) published interim final regulations
implementing PHS Act section 2713 on July 19, 2010 (75 FR 41726). In
the preamble to the interim final regulations, the Departments
explained that HRSA was developing guidelines related to preventive
care and screening for women that would be covered without cost sharing
pursuant to PHS Act section 2713(a)(4), and that these guidelines were
expected to be issued no later than August 1, 2011. Although comments
on the anticipated guidelines were not requested in the interim final
regulations, the Departments received considerable feedback regarding
which preventive services for women should be covered without cost
sharing. Some commenters, including some religiously-affiliated
employers, recommended that these guidelines include contraceptive
services among the recommended women's preventive services and that the
attendant coverage requirement apply to all group health plans and
health insurance issuers. Other commenters, however, recommended that
group health plans sponsored by religiously-affiliated employers be
allowed to exclude contraceptive services from coverage under their
plans if the employers deem such services contrary to their religious
tenets, noting that some group health plans sponsored by organizations
with a religious objection to contraceptives currently contain such
exclusions for that reason.
In response to these comments, the Departments amended the interim
final regulations to provide HRSA with discretion to establish an
exemption for group health plans established or maintained by certain
religious employers (and any group health insurance coverage provided
in connection with such plans) with respect to any requirement to cover
contraceptive services that they would otherwise be required to cover
without cost sharing consistent with the HRSA Guidelines. The amended
interim final regulations were issued and effective on August 1,
2011.\3\ The amended interim final regulations specified that, for
purposes of this exemption, 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 described in section 6033(a)(1) and section
6033(a)(3)(A)(i) or (iii) of the Code. Section 6033(a)(3)(A)(i) and
(iii) of the Code refers to churches, their integrated auxiliaries, and
conventions or associations of churches, as well as to the exclusively
religious activities of any religious order. In the HRSA Guidelines,
HRSA exercised its discretion under the amended interim final
regulations such that group health plans established and maintained by
these religious employers (and any group health insurance coverage
provided in connection with such plans) are not required to cover
contraceptive services.
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\3\ The amendment to the interim final regulations was published
on August 3, 2011, at 76 FR 46621.
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In the preamble to the amended interim final regulations, the
Departments explained that it was appropriate that HRSA take into
account the religious beliefs of certain religious employers where
coverage of contraceptive services is concerned. The Departments noted
that a religious exemption is consistent with the policies in some
States that currently both require contraceptive services coverage
under State law and provide for some type of religious exemption from
their contraceptive services coverage requirement. Comments were
requested on the amended interim final regulations, specifically with
respect to the definition of religious employer, as well as alternative
definitions.
II. Overview of the Public Comments on the Amended Interim Final
Regulations
The Departments received over 200,000 responses to the request for
comments on the amended interim final regulations. Commenters included
concerned citizens, civil rights organizations, consumer groups, health
care providers, health insurance issuers, sponsors of group health
plans, religiously-affiliated charities, religiously-affiliated
educational institutions, religiously-affiliated health care
organizations, other religiously-affiliated organizations, secular
organizations, sponsors of group health plans, women's religious
orders, and women's rights organizations.
Some commenters recommended that the exemption for the group health
plans of a limited group of religious organizations as formulated in
the amended interim final regulations be maintained. Other commenters
urged that the definition of religious employer be broadened so that
more sponsors of group health plans would qualify for the exemption.
Others urged that the exemption be rescinded in its entirety. The
Departments summarize below the major issues raised in the comments
that were received.
Some commenters supported the inclusion of contraceptive services
in the HRSA Guidelines and urged that the religious employer exemption
be rescinded in its entirety due to the importance of extending these
benefits to as many women as possible. For example, one provider
association commented that all group health plans and group health
insurance issuers should offer the same benefits to plan participants,
without a religious exemption for some plans, and that religious
beliefs are more appropriately taken into account by individuals when
making personal health care decisions. Others urged that the exemption
be eliminated because making contraceptive services available to all
women would satisfy a basic health care need and would significantly
reduce long-term health care costs associated with unplanned
pregnancies.
Some of the commenters supporting the elimination of the exemption
argued that section 2713 of the PHS Act does not provide any explicit
basis for exempting a subset of group health plans. One commenter
asserted that Congress's incorporation of section 2713 of the PHS Act
into ERISA and the Code indicates its intent to require coverage of
recommended preventive services under section 2713 of the PHS Act in
the broadest spectrum of group health plans possible.
Many commenters that opposed the exemption asked that, at a
minimum, the Departments not expand the definition of religious
employer. Alternatively, they asked that, if the Departments decided to
base the relevant portion of the definition of religious employer on a
Code section other than section 6033, the other portions of the
definition of religious employer be retained to limit the exemption
largely to houses of worship.
Some commenters urged the Departments not to modify the definition
of religious employer. For example, some commenters asserted that the
exemption is appropriately
[[Page 8727]]
targeted at houses of worship, rather than a larger set of religiously-
affiliated organizations. Others argued that, while the exemption
addresses legitimate religious concerns, its scope is already broader
than necessary and should not be expanded.
Commenters opposing any exemption stated that, if the exemption
were to be retained, clear notice should be provided to the affected
plan participants that their group health plans do not include benefits
for contraceptive services. In addition, they urged the Departments to
monitor plans to ensure that the exemption is not claimed more broadly
than permitted.
On the other hand, a number of comments asserted that the religious
employer exemption is too narrow. These commenters included some
religiously-affiliated educational institutions, health care
organizations, and charities. Some of these commenters expressed
concern that the exemption for religious employers will not allow them
to continue their current exclusion of contraceptive services from
coverage under their group health plans. Others expressed concerns
about paying for such services and stated that doing so would be
contrary to their religious beliefs.
Commenters also claimed that Federal laws, including the Affordable
Care Act, have provided for conscience clauses and religious exemptions
broader than that provided for in the amended interim final
regulations. Some commenters asserted that the narrower scope of the
exemption raises concerns under the First Amendment and the Religious
Freedom Restoration Act.
Other commenters, however, disputed claims that the contraceptive
coverage requirement infringes on rights protected by the First
Amendment or the Religious Freedom Restoration Act. These commenters
noted that the requirement is neutral and generally applicable. They
also explained that the requirement does not substantially burden
religious exercise and, in any event, serves compelling governmental
interests and is the least restrictive means to achieve those
interests.
Some religiously-affiliated employers warned that, if the
definition of religious employer is not broadened, they could cease to
offer health coverage to their employees in order to avoid having to
offer coverage to which they object on religious grounds.
Commenters supporting a broadening of the definition of religious
employer proposed a number of options, generally intended to expand the
scope of the exemption to include religiously-affiliated educational
institutions, health care organizations, and charities. In some
instances, in place of the definition that was adopted in the amended
interim final regulations, commenters suggested other State insurance
law definitions of religious employer. In other instances, commenters
referenced alternative standards, such as tying the exemption to the
definition of ``church plan'' under section 414(e) of the Code or to
status as a nonprofit organization under section 501(c)(3) of the Code.
III. Overview of the Final Regulations
In response to these comments, the Departments carefully considered
whether to eliminate the religious employer exemption or to adopt an
alternative definition of religious employer, including whether the
exemption should be extended to a broader set of religiously-affiliated
sponsors of group health plans and group health insurance coverage. For
the reasons discussed below, the Departments are adopting the
definition in the amended interim final regulations for purposes of
these final regulations while also creating a temporary enforcement
safe harbor, discussed below. During the temporary enforcement safe
harbor, the Departments plan to develop and propose changes to these
final regulations that would meet two goals--providing contraceptive
coverage without cost-sharing to individuals who want it and
accommodating non-exempted, non-profit organizations' religious
objections to covering contraceptive services as also discussed below.
PHS Act section 2713 reflects a determination by Congress that
coverage of recommended preventive services by non-grandfathered group
health plans and health insurance issuers without cost sharing is
necessary to achieve basic health care coverage for more Americans.
Individuals are more likely to use preventive services if they do not
have to satisfy cost sharing requirements (such as a copayment,
coinsurance, or a deductible). Use of preventive services results in a
healthier population and reduces health care costs by helping
individuals avoid preventable conditions and receive treatment
earlier.\4\ Further, Congress, by amending the Affordable Care Act
during the Senate debate to ensure that recommended preventive services
for women are covered adequately by non-grandfathered group health
plans and group health insurance coverage, recognized that women have
unique health care needs and burdens. Such needs include contraceptive
services.\5\
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\4\ Inst. of Med., Clinical Preventive Services for Women:
Closing the Gaps, Wash., DC: Nat'l Acad. Press, 2011, at p. 16.
\5\ Inst. of Med., Clinical Preventive Services for Women:
Closing the Gaps, Wash. DC: Nat'l Acad. Press, 2011, at p. 9; see
also Sonfield, A., The Case for Insurance Coverage of Contraceptive
Services and Supplies Without Cost Sharing, 14 Guttmacher Pol'y Rev.
10 (2011), available at http://www.guttmacher.org/pubs/gpr/14/1/gpr140107.html.
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As documented in a report of the Institute of Medicine, ``Clinical
Preventive Services for Women, Closing the Gaps,'' women experiencing
an unintended pregnancy may not immediately be aware that they are
pregnant, and thus delay prenatal care. They also may not be as
motivated to discontinue behaviors that pose pregnancy-related risks
(e.g., smoking, consumption of alcohol). Studies show a greater risk of
preterm birth and low birth weight among unintended pregnancies
compared with pregnancies that were planned.\6\ Contraceptives also
have medical benefits for women who are contraindicated for pregnancy,
and there are demonstrated preventive health benefits from
contraceptives relating to conditions other than pregnancy (e.g.,
treatment of menstrual disorders, acne, and pelvic pain).\7\
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\6\ Gipson, J.D., et al., The Effects of Unintended Pregnancy on
Infant, Child and Parental Health: A Review of the Literature,
Studies on Family Planning, 2008, 39(1):18-38.
\7\ Inst. of Med., Clinical Preventive Services for Women:
Closing the Gaps, Wash., DC: Nat'l Acad. Press, 2011, at p. 107.
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In addition, there are significant cost savings to employers from
the coverage of contraceptives. A 2000 study estimated that it would
cost employers 15 to17 percent more not to provide contraceptive
coverage in employee health plans than to provide such coverage, after
accounting for both the direct medical costs of pregnancy and the
indirect costs such as employee absence and reduced productivity.\8\ In
fact, when contraceptive coverage was added to the Federal Employees
Health Benefits Program, premiums did not increase because there was no
resulting
[[Page 8728]]
health care cost increase.\9\ Further, the cost savings of covering
contraceptive services have already been recognized by States and also
within the health insurance industry. Twenty-eight States now have laws
requiring health insurance issuers to cover contraceptives. A 2002
study found that more than 89 percent of insured plans cover
contraceptives.\10\ A 2010 survey of employers revealed that 85 percent
of large employers and 62 percent of small employers offered coverage
of FDA-approved contraceptives.\11\
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\8\ Testimony of Guttmacher Inst., submitted to the Comm. on
Preventive Servs. for Women, Inst. of Med., Jan. 12, 2012, p. 11
citing Bonoan, R + Gonen, JS, ``Promoting Healthy Pregnancies:
Counseling and Contraception as the First Step'', Washington
Business Group on Health, Family Health in Brief, Issue No. 3.
August 2000; see also Sonfield, A., The Case for Insurance Coverage
of Contraceptive Services and Supplies without Cost Sharing, 14
Guttmacher Pol'y Rev. 10 (2011); Mavranezouli, I., Health Economics
of Contraception, 23 Best Practice & Res. Clinical Obstetrics &
Gynaecology 187-198 (2009); Trussell, J., et al., Cost Effectiveness
of Contraceptives in the United States, 79 Contraception 5-14
(2009); Trussell, J., The Cost of Unintended Pregnancy in the United
States, 75 Contraception 168-170 (2007).
\9\ Dailard, C., Special Analysis: The Cost of Contraceptive
Insurance Coverage, Guttmacher Rep. on Public Pol'y (March 2003).
\10\ Sonfield, A., et al., U.S. Insurance Coverage of
Contraceptives and the Impact of Contraceptive Coverage Mandates,
Perspectives on Sexual and Reproductive Health 36(2):72-79, 2002.
\11\ Claxton, G., et al., Employer Health Benefits: 2010 Annual
Survey, Menlo Park, Cal.: Kaiser Family Found. and Chi., Ill.:
Health Research & Educ. Trust, 2010.
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Furthermore, in directing non-grandfathered group health plans and
health insurance issuers to cover preventive services and screenings
for women described in HRSA-supported guidelines without cost sharing,
Congress determined that both existing health coverage and existing
preventive services recommendations often did not adequately serve the
unique health needs of women. This disparity places women in the
workforce at a disadvantage compared to their male co-workers.
Researchers have shown that access to contraception improves the social
and economic status of women.\12\ Contraceptive coverage, by reducing
the number of unintended and potentially unhealthy pregnancies,
furthers the goal of eliminating this disparity by allowing women to
achieve equal status as healthy and productive members of the job
force. Research also shows that cost sharing can be a significant
barrier to effective contraception.\13\ As the Institute of Medicine
noted, owing to reproductive and sex-specific conditions, women use
preventive services more than men, generating significant out-of-pocket
expenses for women.\14\ The Departments aim to reduce these disparities
by providing women broad access to preventive services, including
contraceptive services.
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\12\ Testimony of Guttmacher Inst., submitted to the Comm. on
Preventive Servs. for Women, Inst. of Med., Jan. 12, 2012, p.6,
citing Goldin C and Katz L, Career and marriage in the age of the
pill, American Economic Review, 2000, 90(2):461-465; Goldin C and
Katz LF, The power of the pill: oral contraceptives and women's
career and marriage decisions, Journal of Political Economy, 2002,
110(4):730-770; and Bailey MJ, More power to the pill: the impact of
contraceptive freedom on women's life cycle labor supply, Quarterly
Journal of Economics, 2006, 121(1):289-320.
\13\ Postlethwaite, D., et al., A Comparison of Contraceptive
Procurement Pre- and Post-Benefit Change, 76 Contraception 360
(2007).
\14\ Inst. of Med., Clinical Preventive Services for Women:
Closing the Gaps, Wash., DC: Nat'l Acad. Press, 2011, p.19.
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The religious employer exemption in the final regulations does not
undermine the overall benefits described above. A group health plan
(and health insurance coverage provided in connection with such a plan)
qualifies for the exemption if, among other qualifications, the plan is
established and maintained by an employer that primarily employs
persons who share the religious tenets of the organization. As such,
the employees of employers availing themselves of the exemption would
be less likely to use contraceptives even if contraceptives were
covered under their health plans.
A broader exemption, as urged by some commenters, would lead to
more employees having to pay out of pocket for contraceptive services,
thus making it less likely that they would use contraceptives, which
would undermine the benefits described above. Employers that do not
primarily employ employees who share the religious tenets of the
organization are more likely to employ individuals who have no
religious objection to the use of contraceptive services and therefore
are more likely to use contraceptives. Including these employers within
the scope of the exemption would subject their employees to the
religious views of the employer, limiting access to contraceptives, and
thereby inhibiting the use of contraceptive services and the benefits
of preventive care.
The Departments note that this religious exemption is intended
solely for purposes of the contraceptive services coverage requirement
pursuant to PHS Act section 2713 and the companion provisions of ERISA
and the Code.
The Departments also note that some group health plans sponsored by
employers that do not satisfy the definition of religious employer in
these final regulations may be grandfathered health plans \15\ and thus
are not subject to any of the preventive services coverage requirements
of section 2713 of the PHS Act, including the contraceptive coverage
requirement.
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\15\ See section 1251 of the Affordable Care Act and its
implementing regulations at 26 CFR 54.9815-1251T; 29 CFR 2590.715-
1251; 45 CFR 147.140.
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With respect to certain non-exempted, non-profit organizations with
religious objections to covering contraceptive services whose group
health plans are not grandfathered health plans, guidance is being
issued contemporaneous with these final regulations that provides a
one-year safe harbor from enforcement by the Departments.
Before the end of the temporary enforcement safe harbor, the
Departments will work with stakeholders to develop alternative ways of
providing contraceptive coverage without cost sharing with respect to
non-exempted, non-profit religious organizations with religious
objections to such coverage. Specifically, the Departments plan to
initiate a rulemaking to require issuers to offer insurance without
contraception coverage to such an employer (or plan sponsor) and
simultaneously to offer contraceptive coverage directly to the
employer's plan participants (and their beneficiaries) who desire it,
with no cost-sharing. Under this approach, the Departments will also
require that, in this circumstance, there be no charge for the
contraceptive coverage. Actuaries and experts have found that coverage
of contraceptives is at least cost neutral when taking into account all
costs and benefits in the health plan.\16\ The Departments intend to
develop policies to achieve the same goals for self-insured group
health plans sponsored by non-exempted, non-profit religious
organizations with religious objections to contraceptive coverage.
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\16\ Bertko, John, F.S.A., M.A.A.A., Director of Special
Initiatives and Pricing in the Center for Consumer Information and
Insurance Oversight at the Centers for Medicare and Medicaid
Services, Glied, Sherry, Ph.D., Assistant Secretary for Planning and
Evaluation, U.S. Department of Health & Human Services (ASPE/HHS),
Miller, Erin, MPH, (ASPE/HHS), Wilson, Lee, (ASPE/HHS), Simmons,
Adelle, (ASPE/HHS), ``The Cost of Covering Contraceptives through
Health Insurance,'' (9 February 2012), available at: http://aspe.hhs.gov/health/reports/2012/contraceptives/ib.shtml.
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A future rulemaking would be informed by the existing practices of
some issuers and religious organizations in the 28 States where
contraception coverage requirements already exist, including Hawaii.
There, State health insurance law requires issuers to offer plan
participants in group health plans sponsored by religious employers
that are exempt from the State contraception coverage requirement the
option to purchase this coverage in a way that religious employers are
not obligated to fund it. It is our understanding that, in practice,
rather than charging employees a separate fee, some issuers in Hawaii
offer this coverage to plan participants at no charge. The Departments
will work with stakeholders to propose and
[[Page 8729]]
finalize this policy before the end of the temporary enforcement safe
harbor.
Nothing in these final regulations precludes employers or others
from expressing their opposition, if any, to the use of contraceptives,
requires anyone to use contraceptives, or requires health care
providers to prescribe contraceptives if doing so is against their
religious beliefs. These final regulations do not undermine the
important protections that exist under conscience clauses and other
religious exemptions in other areas of Federal law. Conscience
protections will continue to be respected and strongly enforced.
This approach is consistent with the First Amendment and Religious
Freedom Restoration Act. The Supreme Court has held that the First
Amendment right to free exercise of religion is not violated by a law
that is not specifically targeted at religiously motivated conduct and
that applies equally to conduct without regard to whether it is
religiously motivated--a so-called neutral law of general
applicability. The contraceptive coverage requirement is generally
applicable and designed to serve the compelling public health and
gender equity goals described above, and is in no way specially
targeted at religion or religious practices. Likewise, this approach
complies with the Religious Freedom Restoration Act, which generally
requires a federal law to not substantially burden religious exercise,
or, if it does substantially burden religious exercise, to be the least
restrictive means to further a compelling government interest.
III. 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, among other things, 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. Executive Order 13563 also states
that where ``appropriate and permitted by law, each agency may consider
(and discuss qualitatively) values that are difficult or impossible to
quantify, including equity, human dignity, fairness, and distributive
impacts.'' These final regulations have been designated a ``significant
regulatory action,'' although not economically significant, under
section 3(f) of Executive Order 12866. Accordingly, these final
regulations have been reviewed by the Office of Management and Budget.
1. Need for Regulatory Action
As stated earlier in this preamble, the Departments previously
issued amended interim final regulations authorizing an exemption for
group health plans and health insurance coverage sponsored by certain
religious employers from certain coverage requirements under PHS Act
section 2713 (76 FR 46621, August 3, 2011). The Departments have
determined that it is appropriate to finalize, without change, these
amended interim final regulations authorizing the exemption of group
health plans and health insurance coverage sponsored by certain
religious employers from having to cover certain preventive health
services under the Patient Protection and Affordable Care Act.
2. Anticipated Effects
The Departments expect that these final regulations will not result
in any additional significant burden or costs to the affected entities.
B. Special Analyses--Department of the Treasury
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 final
regulations, and, because these regulations do not impose a collection
of information on small entities, a Regulatory Flexibility Analysis
under the Regulatory Flexibility Act (5 U.S.C. chapter 6) is not
required.
C. Paperwork Reduction Act
These final regulations are not subject to the requirements of the
Paperwork Reduction Act (44 U.S.C. 3501 et seq.) because they do not
contain a ``collection of information'' as defined in 44 U.S.C.
3502(11).
IV. Statutory Authority
The Department of the Treasury final regulations are adopted
pursuant to the authority contained in sections 7805 and 9833 of the
Code.
The Department of Labor 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), Public Law104-191, 110 Stat. 1936; sec.
401(b), Public Law 105-200, 112 Stat. 645 (42 U.S.C. 651 note); sec.
512(d), Public Law 110-343, 122 Stat. 3881; sec. 1001, 1201, and
1562(e), Public Law 111-148, 124 Stat. 119, as amended by Public Law
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 final regulations are
adopted pursuant to the authority contained in sections 2701 through
2763, 2791, and 2792 of the PHS Act (42 USC 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 I
Accordingly, 26 CFR part 54 is amended as follows:
PART 54--PENSION EXCISE TAXES
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Paragraph 1. The authority citation for part 54 is amended by adding an
entry for Sec. 54.9815-2713 in numerical order to read in part as
follows:
Authority: 26 U.S.C. 7805. * * *
Section 54.9815-2713 also issued under 26 U.S.C. 9833. * * *
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Par. 2. Section 54.9815-2713T is amended in paragraph (a)(1)(iii) by
removing ``; and'' and adding a period in its place, and by removing
paragraph (a)(1)(iv).
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Par. 3. Section 54.9815-2713 is added to read as follows:
[[Page 8730]]
Sec. 54.9815-2713 Coverage of preventive health services.
(a) Services--(1) In general. [Reserved]
(i) [Reserved]
(ii) [Reserved]
(iii) [Reserved]
(iv) With respect to women, to the extent not described in
paragraph (a)(1)(i) of Sec. 54.9815-2713T, 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).
(2) Office visits. [Reserved]
(3) Out-of-network providers. [Reserved]
(4) Reasonable medical management. [Reserved]
(5) Services not described. [Reserved]
(b) Timing. [Reserved]
(c) Recommendations not current. [Reserved]
(d) Effective/applicability date. April 16, 2012.
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
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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), Public Law 104-191, 110 Stat. 1936;
sec. 401(b), Public Law 105-200, 112 Stat. 645 (42 U.S.C. 651 note);
sec. 512(d), Public Law 110-343, 122 Stat. 3881; sec. 1001, 1201,
and 1562(e), Public Law 111-148, 124 Stat. 119, as amended by Public
Law 111-152, 124 Stat. 1029; Secretary of Labor's Order 3-2010, 75
FR 55354 (September 10, 2010).
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2. Accordingly, the amendment to the interim final rule with comment
period amending 29 CFR 2590.715-2713(a)(1)(iv) which was published in
the Federal Register at 76 FR 46621-46626 on August 3, 2011, is adopted
as a final rule without change.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
45 CFR Subtitle A
PART 147--HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND
INDIVIDUAL HEALTH INSURANCE MARKETS
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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.
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2. Accordingly, the amendment to the interim final rule with comment
period amending 45 CFR 147.130(a)(1)(iv) which was published in the
Federal Register at 76 FR 46621-46626 on August 3, 2011, is adopted as
a final rule without change.
Steven T. Miller,
Deputy Commissioner for Services and Enforcement, Internal Revenue
Service.
Approved: February 10, 2012.
Emily S. McMahon,
Acting Assistant Secretary of the Treasury (Tax Policy).
Signed this 10th day, of February 2012.
Phyllis C. Borzi,
Assistant Secretary, Employee Benefits Security Administration,
Department of Labor.
Dated: February 10, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
Dated: February 10, 2012.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2012-3547 Filed 2-10-12; 3:45 pm]
BILLING CODE 4120-01-P
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