Approval of Information Collection Requirements for the Joint Interim Rules for Health Insurance Portability for Group Health Plans, and the Individual Market Health Insurance Reform: Portability From Group to Individual Coverage; Federal Rules for Access in the Individual Market; State Alternative Mechanisms to Federal Rules

[Federal Register Volume 62, Number 127 (Wednesday, July 2, 1997)]

[Rules and Regulations]

[Pages 35904-35906]

From the Federal Register Online via the Government Publishing Office [www.gpo.gov]

[FR Doc No: 97-17379]

[[Page 35903]]

_______________________________________________________________________

Part IV

Department of the Treasury

Internal Revenue Service

26 CFR Parts 54 and 602

Department of Labor

Pension and Welfare Benefits Administration

29 CFR Part 2590

Department of Health and Human Services

Health Care Financing Administration

45 CFR Parts 146 and 148

_______________________________________________________________________

Approval of Information Collection Requirements for the Joint Interim

Rules for Health Insurance Portability for Group Health Plans, and the

Individual Market Health Insurance Reform: Portability From Group to

Individual Coverage; Federal Rules for Access in the Individual Market;

State Alternative Mechanisms to Federal Rules; Interim Rules

Federal Register / Vol. 62, No. 127 / Wednesday, July 2, 1997 / Rules

and Regulations

[[Page 35904]]

DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Parts 54 and 602

[T.D. 8716]

RIN 1545-AV05

DEPARTMENT OF LABOR

Pension and Welfare Benefits Administration

29 CFR Part 2590

RIN 1210-AA54

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

45 CFR Parts 146 and 148

RIN 0938-AI08; RIN 0938-AH75

Approval of Information Collection Requirements for the Joint

Interim Rules for Health Insurance Portability for Group Health Plans,

and the Individual Market Health Insurance Reform: Portability From

Group to Individual Coverage; Federal Rules for Access in the

Individual Market; State Alternative Mechanisms to Federal Rules

AGENCIES: Internal Revenue Service, Department of the Treasury; Pension

and Welfare Benefits Administration, Department of Labor; Health Care

Financing Administration, Department of Health and Human Services.

ACTION: Interim rules with request for comments; approval of

information collection requirements.

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SUMMARY: On April 8, 1997, the Department of the Treasury, the

Department of Labor, and the Department of Health and Human Services

(Departments) published joint interim rules governing the access,

portability and renewability requirements for group health plans and

issuers offering group health insurance coverage in connection with a

group health plan. The rules implemented changes made to certain

provisions of the Internal Revenue Code of 1986 (Code), the Employee

Retirement Income Security Act of 1974 (ERISA), and the Public Health

Service Act (PHS Act) enacted as part of the Health Insurance

Portability and Accountability Act of 1996 (HIPAA). In the April 8

publication, the Departments submitted the group market information

collection requirements, for, among other things, establishing

creditable coverage, notice of special enrollment rights, and notice of

pre-existing condition exclusion periods, to the Office of Management

and Budget (OMB) for emergency review under the Paperwork Reduction Act

of 1995 (PRA 95). In addition, on April 8, 1997 the Department of

Health and Human Services submitted the HIPAA individual market

information collection requirements to OMB for emergency review under

PRA 1995. This document amends the April 8 Federal Register documents

to properly display the OMB control numbers.

DATES: These amendments are effective June 1, 1997.

FOR FURTHER INFORMATION CONTACT: Russ Weinheimer, Internal Revenue

Service, at 202-622-4695; Gerald Lindrew, Office of Policy and

Research, U.S. Department of Labor, Pension and Welfare Benefits

Administration, 200 Constitution Avenue, Room N-5647, Washington, DC

20210, at 202-219-4782; John Burke, Department of Health and Human

Services, Health Care Financing Administration, at 410-786-1325. (These

are not toll-free numbers.)

SUPPLEMENTARY INFORMATION: The interim regulations published on April

8, 1997 (62 FR 16894 and 16985), contained distinct information

collection requests (ICRs) for the group and individual insurance

markets. The ICRs issued by the Department of the Treasury and the

Department of Labor apply to employers and group health plans. The ICRs

issued by the Department of Health and Human Services apply to health

insurance issuers.

Department of the Treasury and Department of Labor ICRs

The ICRs on group health plans' obligations regarding Establishing

Prior Creditable Coverage and Notice of Enrollment Rights are

prescribed by the statute. The ICRs regarding the certification and

special enrollment notice obligations of health insurance issuers are

addressed separately in the Department of Health and Human Services'

ICR.

The first ICR implements statutorily prescribed requirements

necessary to establish Prior Creditable Coverage. This is accomplished

primarily through the issuance of certificates of prior coverage by

group health plans or by service providers with which the group health

plans contract in order to provide these documents. In addition this

ICR permits the use of a notice that may be used by the plans to meet

their obligations in connection with periods of coverage ending during

the transition period, October 1, 1996 through May 31, 1997, saving the

respondents both hours and cost during that period. This ICR also

covers the requests that certain plans will make regarding additional

information they require because they are using the Alternative Method

of Crediting Coverage. Finally, this ICR also includes the occasional

circumstances where a participant is unable to secure a certificate and

needs to provide some supplemental form of documentation in order to

establish prior creditable coverage.

The second ICR, Notice of Enrollment Rights, imposes disclosure

obligations on plans to inform a participant, at the time of

enrollment, of the plan's special enrollment rules.

The third ICR, Notice of Pre-existing Condition Exclusion, concerns

the disclosure requirements on those plans that contain pre-existing

condition exclusion provisions. This ICR has two components: a notice

to all participants at the time of the enrollment stating the terms of

the plan's pre-existing condition provisions, the participant's rights

to demonstrate creditable coverage, and that the plan or issuer will

assist in securing a certificate as necessary; and notice by the plan

of its determination that an exclusion period applies to an individual.

Department of Health and Human Services ICRs

The Department of Health and Human Services separately issued two

Information Collection Requirements. The first one, titled Information

Collection Requirements referenced in HIPAA for the Individual

Insurance Market, will ensure that the issuers in the individual market

will provide individuals with documentation necessary to demonstrate

prior creditable coverage. These information collection requirements

will also give the States the flexibility to implement State

alternative mechanisms to protect HIPAA eligible individuals.

The second information collection requirements, titled Information

Collection Requirements referenced in HIPAA for the Group Health Plans,

will ensure that the issuers in the group market will provide

individuals with documentation necessary to demonstrate prior

creditable coverage, and that group health plans notify individuals of

their special enrollment rights in the group health insurance market.

Approval

OMB reviewed the Department of the Treasury's collection of

information collection in accordance with the

[[Page 35905]]

Paperwork Reduction Act of 1995 (PRA 95). On May 30, 1997, under OMB

control number 1545-1537, OMB approved the information collection

requests contained in (1) 26 CFR 54.9801-3T, 54.9801-4T and 54.9801-5T

on rules relating to the notices regarding preexisting condition

exclusion periods; (2) 26 CFR 54.9801-5T on rules relating to

establishing prior coverage; and (3) 26 CFR 54.9801-6T on rules

relating to special enrollment periods. These information collection

provisions are currently approved until November 30, 1997.

OMB also reviewed the Department of Labor's collection of

information requirements in accordance with the PRA 95, 44 U.S.C.

chapter 35, and 5 CFR 1320.11. On May 30, 1997, OMB approved the

information collection requirements contained in 29 CFR 2590.701-6 for

Notice of Special Enrollment Rights under OMB control number 1210-0101.

OMB also approved the information collection requirements contained in

29 CFR 2590.701-3, 2590.701-4, and 2590.701-5 for Notice of Preexisting

Condition Exclusion under OMB clearance number 1210-0102. In addition,

OMB approved the information collection requirements contained in 29

CFR 2590.701-5 for Establishing Prior Creditable Coverage under OMB

control number 1210-0103. These information collection provisions are

currently approved until December 31, 1997.

Finally, OMB reviewed the Department of Health and Human Services'

collection of information requests in accordance with the PRA 95. On

May 30, 1997, under OMB control number 0938-0702, OMB approved the

information collection requests contained in 45 CFR 146.111, 146.115,

146.117, 146.150, 146.152, 146.160 and 146.180 for issuers in the group

market on demonstrating prior creditable coverage and notice of special

enrollment rights. On the same day, under OMB control number 0938-0703,

OMB also approved the information collection requests contained in 45

CFR 148.120, 148.122, 148.124, and 148.128 for issuers in the

individual market on demonstrating prior creditable coverage and State

alternative mechanisms. These information collection requests are

currently approved until December 31, 1997.

Statutory Authorities

The Department of the Treasury temporary rule is adopted pursuant

to the authority contained in 26 U.S.C. 7805 and in 26 U.S.C. 9806, as

added by Section 401 (Pub. L. 104-191, 101 Stat. 1936).

The Department of Labor interim final rule is adopted pursuant to

the authority contained in 29 U.S.C. 1027, 1059, 1135, 1171, 1194;

Section 101, Public L. 104-191, 101 Stat. 1936 (29 U.S.C. 1181);

Secretary of Labor's Order No. 1-87, 52 FR 13139, April 21, 1987.

The Department of Health and Human Services interim final rule is

adopted pursuant to the authority contained in Sections 2701 through

2723 of the Public Health Service Act (PHS Act, 42 U.S.C. 300gg, et.

seq.), Sections 2741 through 2763 of the PHS Act, and 2791 through 2792

of the PHS Act as amended by HIPAA.

List of Subjects

26 CFR Part 54

Excise taxes, Health insurance, Pensions, Reporting and

recordkeeping requirements.

29 CFR Part 2590

Employee benefit plans, Employee Retirement Income Security Act,

Group health plans, Health care, Health insurance, Reporting and

recordkeeping requirements, Welfare benefit plans.

45 CFR Parts 146 and 148

Health care, Health insurance, Reporting and recordkeeping

requirements, State regulation of health insurance.

Internal Revenue Service

26 CFR Chapter I

Accordingly, 26 CFR Part 602 is amended as follows:

PART 602--[AMENDED]

1. The authority citation for Part 602 continues to read as

follows:

Authority: 26 U.S.C. 7805.

2. In Sec. 602.101, paragraph (c) is amended by adding entries in

numerical order to the table to read as follows:

Sec. 602.101 OMB Control numbers.

* * * * *

(c) * * *

------------------------------------------------------------------------

Current OMB

CFR part or section where identified and described control No.

------------------------------------------------------------------------

* * * * *

54.9801-3T.............................................. 1545-1537

54.9801-4T.............................................. 1545-1537

54.9801-5T.............................................. 1545-1537

54.9801-6T.............................................. 1545-1537

* * * * *

------------------------------------------------------------------------

Dale D. Goode,

Federal Register Liaision, Assistant Chief Counsel (Corporate).

Pension and Welfare Benefits Administration

29 CFR Chapter XXV

Accordingly, 29 CFR Part 2590 is amended as follows:

PART 2590--[AMENDED]

1. The authority citation for Part 2590 continues to read as

follows:

Authority: 29 U.S.C. 1027, 1059, 1135, 1171, 1194; Sec. 101,

Pub. L. 104-191, 101 Stat. 1936 (29 U.S.C. 1181); Secretary of

Labor's Order No. 1-87, 52 FR 13139, April 21, 1987.

2. In Sec. 2590.701-3, by adding a parenthetical at the end of the

section to read as follows:

Sec. 2590.701-3 Limitations on preexisting condition exclusion period.

* * * * *

(Approved by the Office of Management and Budget under control

number 1210-0102.)

3. In Sec. 2590.701-4, by adding a parenthetical at the end of the

section to read as follows:

Sec. 2590.701-4 Rules relating to creditable coverage.

* * * * *

(Approved by the Office of Management and Budget under control

number 1210-0102.)

4. In Sec. 2590.701-5, by adding a parenthetical at the end of the

section to read as follows:

Sec. 2590.701-5 Certification and disclosure of previous coverage.

* * * * *

(Approved by the Office of Management and Budget under control

numbers 1210-0102 and 1210-0103.)

5. In Sec. 2590.701-6, by adding a parenthetical at the end of the

section to read as follows:

Sec. 2590.701-6 Special enrollment periods.

* * * * *

(Approved by the Office of Management and Budget under control

number 1210-0101.)

Signed at Washington D.C. this 24th day of June, 1997.

Alan D. Lebowitz,

Deputy Assistant Secretary for Program Operations, Pension and Welfare

Benefits Administration, Department of Labor.

Health Care Financing Administration

45 CFR Subtitle A, Subchapter B

Accordingly, 45 CFR Parts 146 and 148 are amended as follows:

[[Page 35906]]

PART 146--[AMENDED]

1. The authority citation for Part 146 continues to read as

follows:

Authority: Secs. 2701 through 2763, 2791, and 2792 of the PHS

Act, 42 U.S.C. 300gg through 300gg-63, 300gg-91 and 300gg-92.

2. In Sec. 146.111, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.111 Limitations on preexisting condition exclusion period.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

3. In Sec. 146.115, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.115 Certification and disclosure of previous coverage.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

4. In Sec. 146.117, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.117 Special enrollment periods.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

5. In Sec. 146.150, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.150 Guaranteed availability of coverage for employers in the

group market.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

6. In Sec. 146.152, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.152 Guaranteed renewability of coverage for employers in the

group market.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

7. In Sec. 146.160, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.160 Disclosure of information.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

8. In Sec. 146.180, by adding a parenthetical at the end of the

section to read as follows:

Sec. 146.180 Treatment of non-Federal governmental plans.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0702.)

PART 148--[AMENDED]

9. The authority citation for Part 148 continues to read as

follows:

Authority: Secs. 2741 through 2763, 2791, and 2792 of the Public

Health Service Act (42 U.S.C. 300gg-41 through 300gg-63, 300gg-91

and 300gg-92).

10. In Sec. 148.120, by adding a parenthetical at the end of the

section to read as follows:

Sec. 148.120 Guaranteed availability of individual health insurance

coverage to certain individuals with prior group coverage.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0703.)

11. In Sec. 148.122, by adding a parenthetical at the end of the

section to read as follows:

Sec. 148.122 Guaranteed renewability of individual health insurance

coverage.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0703.)

12. In Sec. 148.124, by adding a parenthetical at the end of the

section to read as follows:

Sec. 148.124 Certification and disclosure of coverage.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0703.)

13. In Sec. 148.128, by adding a parenthetical at the end of the

section to read as follows:

Sec. 148.128 State flexibility in individual market reforms--

alternative mechanisms.

* * * * *

(Approved by the Office of Management and Budget under control

number 0938-0703.)

Dated: June 26, 1997.

Edwin J. Glatzel,

Director, Management Analysis and Planning Staff, Office of Financial

and Human Resources, Health Care Financing Administration, Department

of Health and Human Services.

[FR Doc. 97-17379 Filed 7-1-97; 8:45 am]

BILLING CODE 4120-03-P; 4830-01-P; 4510-29-P