Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act, 43109-43110 [2010-18050]

Download as PDF Federal Register / Vol. 75, No. 141 / Friday, July 23, 2010 / Proposed Rules Dated: July 14, 2010. Todd A. Stevenson, Secretary, U.S. Consumer Product Safety Commission. CC:PA:LPD:PR (REG–125592–10), Courier’s Desk, Internal Revenue Service, 1111 Constitution Avenue, NW., Washington, DC 20224. Alternatively, taxpayers may submit comments electronically via the Federal eRulemaking Portal at http:// www.regulations.gov (IRS REG–125592– 10). FOR FURTHER INFORMATION CONTACT: Concerning the regulations, Karen Levin at 202–622–6080; concerning submissions of comments, Oluwafunmilayo Taylor at 202–622– 7180 (not toll-free numbers). SUPPLEMENTARY INFORMATION: [FR Doc. 2010–17591 Filed 7–22–10; 8:45 am] BILLING CODE 6355–01–P DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 54 [REG–125592–10] RIN 1545–BJ62 Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking by cross-reference to temporary regulations. AGENCY: Elsewhere in this issue of the Federal Register, the IRS is issuing temporary regulations under the provisions of the Patient Protection and Affordable Care Act (the Affordable Care Act) regarding internal claims and appeals and external review processes. The IRS is issuing the temporary regulations at the same time that the Employee Benefits Security Administration of the U.S. Department of Labor and the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in connection with a group health plan under the Employee Retirement Income Security Act of 1974 and the Public Health Service Act. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The text of those temporary regulations also serves as the text of these proposed regulations. WReier-Aviles on DSKGBLS3C1PROD with PROPOSALS SUMMARY: Written or electronic comments and requests for a public hearing must be received by October 21, 2010. ADDRESSES: Send submissions to: CC:PA:LPD:PR (REG–125592–10), Room 5205, Internal Revenue Service, P.O. Box 7604, Ben Franklin Station, Washington, DC 20044. Submissions may be hand-delivered to: DATES: VerDate Mar<15>2010 15:12 Jul 22, 2010 Jkt 220001 Background and Explanation of Provisions The temporary regulations published elsewhere in this issue of the Federal Register add § 54.9815–2719T to the Miscellaneous Excise Tax Regulations. The proposed and temporary regulations are being published as part of a joint rulemaking with the Department of Labor and the Department of Health and Human Services (the joint rulemaking). The text of those temporary regulations also serves as the text of these proposed regulations. The preamble to the temporary regulations explains the temporary regulations and these proposed regulations. Special Analyses It has been determined that this notice of proposed rulemaking is not a significant regulatory action as defined in Executive Order 12866. Therefore, a regulatory assessment is not required. It has also been determined that section 553(b) of the Administrative Procedure Act (5 U.S.C. chapter 5) does not apply to this proposed regulation. It is hereby certified that the collections of information contained in this notice of proposed rulemaking will not have a significant impact on a substantial number of small entities. Accordingly, a regulatory flexibility analysis under the Regulatory Flexibility Act (5 U.S.C. chapter 6) is not required. Section 54.9815–2719T of the temporary regulations requires both group health insurance issuers and group health plans to establish internal claims and appeals and external review processes for adverse benefit determinations. Those processes require the plan and issuer to disclose evidence relied upon in making an adverse benefit determination, to disclose any new rationale for upholding an adverse benefit determination as part of an internal appeal, to provide notice of an adverse benefit determination and of a PO 00000 Frm 00018 Fmt 4702 Sfmt 4702 43109 final internal adverse benefit determination, and to disclose the right to an external review. Under the temporary regulations, if a health insurance issuer satisfies the obligations to have effective internal claims and appeals and external review processes (including these information collection requirements that are an inherent part of those processes), those obligations are satisfied not just for the issuer but also for the group health plan. For group health plans maintained by small entities, it is anticipated that the health insurance issuer will satisfy those obligations to have effective internal claims and appeals and external review processes (including these information collection requirements that are an inherent part of those processes) for both the plan and the issuer in almost all cases. For this reason, these information collection requirements will not impose a significant impact on a substantial number of small entities. Pursuant to section 7805(f) of the Internal Revenue Code, this regulation has been submitted to the Chief Counsel for Advocacy of the Small Business Administration for comment on its impact on small business. Comments and Requests for a Public Hearing Before these proposed regulations are adopted as final regulations, consideration will be given to any written comments (a signed original and eight (8) copies) or electronic comments that are submitted timely to the IRS. Comments are specifically requested on the clarity of the proposed regulations and how they may be made easier to understand. All comments will be available for public inspection and copying. A public hearing may be scheduled if requested in writing by a person that timely submits written comments. If a public hearing is scheduled, notice of the date, time, and place for the hearing will be published in the Federal Register. Drafting Information The principal author of these proposed regulations is Karen Levin, Office of the Division Counsel/Associate Chief Counsel (Tax Exempt and Government Entities), IRS. The proposed regulations, as well as the temporary regulations, have been developed in coordination with personnel from the U.S. Department of Labor and the U.S. Department of Health and Human Services. E:\FR\FM\23JYP1.SGM 23JYP1 43110 Federal Register / Vol. 75, No. 141 / Friday, July 23, 2010 / Proposed Rules List of Subjects in 26 CFR Part 54 Excise taxes, Health care, Health insurance, Pensions, Reporting and recordkeeping requirements. Proposed Amendments to the Regulations Accordingly, 26 CFR part 54 is proposed to be amended as follows: PART 54—PENSION EXCISE TAXES Paragraph 1. The authority citation for part 54 is amended by adding an entry in numerical order to read in part as follows: Authority: 26 U.S.C. 7805 * * * Section 54.9815–2719 also issued under 26 U.S.C. 9833. * * * Par. 2. Section 54.9815–2719 is added to read as follows: § 54.9815–2719 Internal claims and appeals and external review processes. [The text of proposed § 54.9815–2719 is the same as the text of paragraphs (a) through (f) of § 54.9815–2719T published elsewhere in this issue of the Federal Register]. Steven Miller, Deputy Commissioner for Services and Enforcement. [FR Doc. 2010–18050 Filed 7–22–10; 8:45 am] BILLING CODE 4830–01–P Background DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 300 [REG–139343–08] RIN 1545–B171 User Fees Relating to Enrollment and Preparer Tax Identification Numbers Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking and notice of public hearing. AGENCY: This document contains proposed amendments to the regulations relating to the imposition of certain user fees on certain tax practitioners. The proposed regulations establish a new user fee for individuals who apply for or renew a preparer tax identification number (PTIN). The proposed regulations affect individuals who apply for or renew a PTIN. The charging of user fees is authorized by the Independent Offices Appropriations Act of 1952. DATES: Written or electronic comments must be received by August 23, 2010. Outlines of topics to be discussed at the WReier-Aviles on DSKGBLS3C1PROD with PROPOSALS SUMMARY: VerDate Mar<15>2010 15:12 Jul 22, 2010 public hearing scheduled for Tuesday, August 24, 2010, at 10 a.m. must be received by Monday, August 23, 2010. ADDRESSES: Send submissions to: CC:PA:LPD:PR (REG–139343–08), Room 5205, Internal Revenue Service, P.O. Box 7604, Ben Franklin Station, Washington, DC 20044. Submissions may be hand-delivered Monday through Friday between the hours of 8 a.m. and 4 p.m. to CC:PA:LPD:PR (REG–139343– 08), Courier’s Desk, Internal Revenue Service, 1111 Constitution Avenue, NW., Washington, DC, or sent electronically via the Federal eRulemaking Portal at http:// www.regulations.gov (IRS REG–139343– 08). The public hearing will be held in the Auditorium of the Internal Revenue Building, 1111 Constitution Avenue, NW., Washington, DC. FOR FURTHER INFORMATION CONTACT: Concerning the proposed regulations, Emily M. Lesniak at (202) 622–4940; concerning cost methodology, Eva J. Williams at (202) 435–5514; concerning submission of comments, the public hearing, or to be placed on the building access list to attend the public hearing, Richard A. Hurst at Richard.A.Hurst@irscounsel.treas.gov or (202) 622–7180 (not toll-free numbers). SUPPLEMENTARY INFORMATION: Jkt 220001 Section 330 of title 31 of the United States Code authorizes the Secretary of the Treasury to regulate the practice of representatives before the Treasury Department. Pursuant to section 330 of title 31, the Secretary has published regulations governing practice before the IRS in 31 CFR part 10 and reprinted the regulations as Treasury Department Circular No. 230 (Circular 230). Circular 230 is administered by the IRS Office of Professional Responsibility (OPR). User Fee for PTINs Section 6109 of the Internal Revenue Code (Code) authorizes the Secretary to prescribe regulations for the inclusion of a tax return preparer’s identifying number on a return, statement, or other document required to be filed with the IRS. Section 6109(c) further authorizes the Secretary ‘‘to require such information as may be necessary to assign an identifying number to any person.’’ As currently prescribed in regulations, the identifying number of a tax return preparer who is an individual is the tax return preparer’s social security number (SSN) or alternative number as prescribed by the IRS. Proposed regulations under section 6109 (REG–134235–08) were published in the Federal Register (75 FR 14539) on PO 00000 Frm 00019 Fmt 4702 Sfmt 4702 March 26, 2010, and provide that, for returns or claims for refund filed after December 31, 2010, the identifying number of a tax return preparer is the individual’s PTIN or such other number prescribed by the IRS in forms, instructions, or other appropriate guidance. The proposed regulations under section 6109 require a tax return preparer who prepares all or substantially all of a return or claim for refund of tax after December 31, 2010 to have a PTIN. The proposed regulations also state that the IRS will provide through other guidance (including forms and instructions) guidance regarding how to apply for a PTIN or other prescribed preparer identifying number, for the regular renewal of a PTIN or other prescribed preparer identifying number, and for the payment of a user fee. Only attorneys, certified public accountants, enrolled agents, and registered tax return preparers will be eligible to apply for a PTIN. The requirements to become a registered tax return preparer will be provided in future Circular 230 guidance. A third party vendor will administer the PTIN application and renewal process and will charge a reasonable fee that is independent of the user fee charged by the government. The vendor will develop a web-based database that individuals will use to apply for or renew a PTIN and will process paper PTIN applications. The database also will be used for applications to become registered tax return preparers, to renew the registered tax return preparers’ status, to self-certify continuing professional education credits for registered tax return preparers, and to pay applicable user fees. Proposed § 300.9 establishes a $50 user fee to apply for or renew a PTIN. The $50 user fee is based on an annual PTIN renewal period, and the procedures for renewing a PTIN will be provided in other guidance, including forms and instructions. The user fee is nonrefundable regardless of whether the applicant receives a PTIN. PTINs were previously issued to tax return preparers solely for the convenience of the tax return preparers, providing an alternative to using the tax return preparers’ social security numbers. Requiring registration through the use of PTINs will enable the IRS to better collect and track data on tax return preparers. This data will allow the IRS to track the number of persons who prepare returns, track the qualifications of those who prepare returns, track the number of returns each person prepares, and more easily locate and review returns prepared by a E:\FR\FM\23JYP1.SGM 23JYP1

Agencies

[Federal Register Volume 75, Number 141 (Friday, July 23, 2010)]
[Proposed Rules]
[Pages 43109-43110]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-18050]


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DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Part 54

[REG-125592-10]
RIN 1545-BJ62


Requirements for Group Health Plans and Health Insurance Issuers 
Relating to Internal Claims and Appeals and External Review Processes 
Under the Patient Protection and Affordable Care Act

AGENCY: Internal Revenue Service (IRS), Treasury.

ACTION: Notice of proposed rulemaking by cross-reference to temporary 
regulations.

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

SUMMARY: Elsewhere in this issue of the Federal Register, the IRS is 
issuing temporary regulations under the provisions of the Patient 
Protection and Affordable Care Act (the Affordable Care Act) regarding 
internal claims and appeals and external review processes. The IRS is 
issuing the temporary regulations at the same time that the Employee 
Benefits Security Administration of the U.S. Department of Labor and 
the Office of Consumer Information and Insurance Oversight of the U.S. 
Department of Health and Human Services are issuing substantially 
similar interim final regulations with respect to group health plans 
and health insurance coverage offered in connection with a group health 
plan under the Employee Retirement Income Security Act of 1974 and the 
Public Health Service Act. The temporary regulations provide guidance 
to employers, group health plans, and health insurance issuers 
providing group health insurance coverage. The text of those temporary 
regulations also serves as the text of these proposed regulations.

DATES: Written or electronic comments and requests for a public hearing 
must be received by October 21, 2010.

ADDRESSES: Send submissions to: CC:PA:LPD:PR (REG-125592-10), Room 
5205, Internal Revenue Service, P.O. Box 7604, Ben Franklin Station, 
Washington, DC 20044. Submissions may be hand-delivered to: 
CC:PA:LPD:PR (REG-125592-10), Courier's Desk, Internal Revenue Service, 
1111 Constitution Avenue, NW., Washington, DC 20224. Alternatively, 
taxpayers may submit comments electronically via the Federal 
eRulemaking Portal at http://www.regulations.gov (IRS REG-125592-10).

FOR FURTHER INFORMATION CONTACT: Concerning the regulations, Karen 
Levin at 202-622-6080; concerning submissions of comments, 
Oluwafunmilayo Taylor at 202-622-7180 (not toll-free numbers).

SUPPLEMENTARY INFORMATION:

Background and Explanation of Provisions

    The temporary regulations published elsewhere in this issue of the 
Federal Register add Sec.  54.9815-2719T to the Miscellaneous Excise 
Tax Regulations. The proposed and temporary regulations are being 
published as part of a joint rulemaking with the Department of Labor 
and the Department of Health and Human Services (the joint rulemaking). 
The text of those temporary regulations also serves as the text of 
these proposed regulations. The preamble to the temporary regulations 
explains the temporary regulations and these proposed regulations.

Special Analyses

    It has been determined that this notice of proposed rulemaking is 
not a significant regulatory action as defined in Executive Order 
12866. Therefore, a regulatory assessment is not required. It has also 
been determined that section 553(b) of the Administrative Procedure Act 
(5 U.S.C. chapter 5) does not apply to this proposed regulation. It is 
hereby certified that the collections of information contained in this 
notice of proposed rulemaking will not have a significant impact on a 
substantial number of small entities. Accordingly, a regulatory 
flexibility analysis under the Regulatory Flexibility Act (5 U.S.C. 
chapter 6) is not required. Section 54.9815-2719T of the temporary 
regulations requires both group health insurance issuers and group 
health plans to establish internal claims and appeals and external 
review processes for adverse benefit determinations. Those processes 
require the plan and issuer to disclose evidence relied upon in making 
an adverse benefit determination, to disclose any new rationale for 
upholding an adverse benefit determination as part of an internal 
appeal, to provide notice of an adverse benefit determination and of a 
final internal adverse benefit determination, and to disclose the right 
to an external review. Under the temporary regulations, if a health 
insurance issuer satisfies the obligations to have effective internal 
claims and appeals and external review processes (including these 
information collection requirements that are an inherent part of those 
processes), those obligations are satisfied not just for the issuer but 
also for the group health plan. For group health plans maintained by 
small entities, it is anticipated that the health insurance issuer will 
satisfy those obligations to have effective internal claims and appeals 
and external review processes (including these information collection 
requirements that are an inherent part of those processes) for both the 
plan and the issuer in almost all cases. For this reason, these 
information collection requirements will not impose a significant 
impact on a substantial number of small entities. Pursuant to section 
7805(f) of the Internal Revenue Code, this regulation has been 
submitted to the Chief Counsel for Advocacy of the Small Business 
Administration for comment on its impact on small business.

Comments and Requests for a Public Hearing

    Before these proposed regulations are adopted as final regulations, 
consideration will be given to any written comments (a signed original 
and eight (8) copies) or electronic comments that are submitted timely 
to the IRS. Comments are specifically requested on the clarity of the 
proposed regulations and how they may be made easier to understand. All 
comments will be available for public inspection and copying. A public 
hearing may be scheduled if requested in writing by a person that 
timely submits written comments. If a public hearing is scheduled, 
notice of the date, time, and place for the hearing will be published 
in the Federal Register.

Drafting Information

    The principal author of these proposed regulations is Karen Levin, 
Office of the Division Counsel/Associate Chief Counsel (Tax Exempt and 
Government Entities), IRS. The proposed regulations, as well as the 
temporary regulations, have been developed in coordination with 
personnel from the U.S. Department of Labor and the U.S. Department of 
Health and Human Services.

[[Page 43110]]

List of Subjects in 26 CFR Part 54

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

Proposed Amendments to the Regulations

    Accordingly, 26 CFR part 54 is proposed to be amended as follows:

PART 54--PENSION EXCISE TAXES

    Paragraph 1. The authority citation for part 54 is amended by 
adding an entry in numerical order to read in part as follows:

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

    Section 54.9815-2719 also issued under 26 U.S.C. 9833. * * *

    Par. 2. Section 54.9815-2719 is added to read as follows:


Sec.  54.9815-2719  Internal claims and appeals and external review 
processes.

    [The text of proposed Sec.  54.9815-2719 is the same as the text of 
paragraphs (a) through (f) of Sec.  54.9815-2719T published elsewhere 
in this issue of the Federal Register].

Steven Miller,
Deputy Commissioner for Services and Enforcement.
[FR Doc. 2010-18050 Filed 7-22-10; 8:45 am]
BILLING CODE 4830-01-P