Computation of, and Rules Relating to, Medical Loss Ratio, 27873-27877 [2013-11297]
Download as PDF
emcdonald on DSK67QTVN1PROD with PROPOSALS
Federal Register / Vol. 78, No. 92 / Monday, May 13, 2013 / Proposed Rules
The Proposal
The FAA is proposing an amendment
to Title 14 Code of Federal Regulations
(14 CFR) part 71 by modifying Class E
airspace extending upward from 700
feet above the surface at Salt Lake City
International Airport, Salt Lake City, UT
to accommodate aircraft using RNAV
(GPS) and ILS or LOC standard
instrument approach procedures the
airport. By removing the exclusion of
the Price, UT; Delta, UT; and Evanston,
UT, airspace area, and the Bonneville,
UT 1,200 foot Class E airspace area, this
action would enhance the safety and
management of aircraft operations at the
airport. The geographic coordinates of
the airport also would be adjusted in
accordance with the FAA’s aeronautical
database.
Class E airspace designations are
published in paragraph 6005, of FAA
Order 7400.9W, dated August 8, 2012,
and effective September 15, 2012, which
is incorporated by reference in 14 CFR
71.1. The Class E airspace designation
listed in this document will be
published subsequently in this Order.
The FAA has determined this
proposed regulation only involves an
established body of technical
regulations for which frequent and
routine amendments are necessary to
keep them operationally current.
Therefore, this proposed regulation; (1)
Is not a ‘‘significant regulatory action’’
under Executive Order 12866; (2) is not
a ‘‘significant rule’’ under DOT
Regulatory Policies and Procedures (44
FR 11034; February 26, 1979); and (3)
does not warrant preparation of a
regulatory evaluation as the anticipated
impact is so minimal. Since this is a
routine matter that will only affect air
traffic procedures and air navigation, it
is certified this proposed rule, when
promulgated, would not have a
significant economic impact on a
substantial number of small entities
under the criteria of the Regulatory
Flexibility Act.
The FAA’s authority to issue rules
regarding aviation safety is found in
Title 49 of the U.S. Code. Subtitle 1,
Section 106, describes the authority for
the FAA Administrator. Subtitle VII,
Aviation Programs, describes in more
detail the scope of the agency’s
authority. This rulemaking is
promulgated under the authority
described in Subtitle VII, Part A,
Subpart I, Section 40103. Under that
section, the FAA is charged with
prescribing regulations to assign the use
of the airspace necessary to ensure the
safety of aircraft and the efficient use of
airspace. This regulation is within the
scope of that authority as it would
VerDate Mar<15>2010
14:16 May 10, 2013
Jkt 229001
modify controlled airspace at Salt Lake
City International Airport, Salt Lake
City, UT.
This proposal will be subject to an
environmental analysis in accordance
with FAA Order 1050.1E,
‘‘Environmental Impacts: Policies and
Procedures’’ prior to any FAA final
regulatory action.
List of Subjects in 14 CFR Part 71
Airspace, Incorporation by reference,
Navigation (air).
The Proposed Amendment
Accordingly, pursuant to the
authority delegated to me, the Federal
Aviation Administration proposes to
amend 14 CFR part 71 as follows:
PART 71—DESIGNATION OF CLASS A,
B, C, D AND E AIRSPACE AREAS; AIR
TRAFFIC SERVICE ROUTES; AND
REPORTING POINTS
1. The authority citation for 14 CFR
part 71 continues to read as follows:
■
27873
Restricted Area R–6402B and Restricted Area
R–6406A and long. 113°00′03″ W.; that
airspace east of Salt Lake City extending
upward from 11,000 feet MSL bounded on
the northwest by the southeast edge of V–32,
on the southeast by the northwest edge of V–
235, on the southwest by the northeast edge
of V–101 and on the west by long. 111°25′33″
W.; that airspace southeast of Salt Lake City
extending upward from 13,500 feet MSL
bounded on the northeast by the southwest
edge of V–484, on the south by the north
edge of V–200 and on the west by long.
111°25′33″ W.; excluding that portion within
Restricted Area R–6403.
Issued in Seattle, Washington, on May 2,
2013.
Clark Desing,
Manager, Operations Support Group, Western
Service Center.
[FR Doc. 2013–11183 Filed 5–10–13; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF THE TREASURY
Internal Revenue Service
Authority: 49 U.S.C. 106(g), 40103, 40113,
40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959–
1963 Comp., p. 389.
26 CFR Part 1
§ 71.1
RIN 1545–BL05
[Amended]
2. The incorporation by reference in
14 CFR 71.1 of the Federal Aviation
Administration Order 7400.9W,
Airspace Designations and Reporting
Points, dated August 8, 2012, and
effective September 15, 2012 is
amended as follows:
■
Paragraph 6005 Class E airspace areas
extending upward from 700 feet or more
above the surface of the earth.
*
*
*
*
*
ANM UT E5 Salt Lake City, UT [Modified]
Salt Lake City International Airport, UT
(lat. 40°47′18″ N., long. 111°58′40″ W.)
That airspace extending upward from 700
feet above the surface bounded by a line
beginning at lat. 41°00′00″ N., long.
111°45′03″ W.; to lat. 40°22′30″ N., long.
111°45′03″ W.; to lat. 40°10′20″ N., long.
111°35′03″ W.; to lat. 40°03′30″ N., long.
111°48′33″ W.; to lat. 40°03′00″ N., long.
112°05′00″ W.; to lat. 40°25′00″ N., long.
112°06′30″ W.; to lat. 40°43′00″ N., long.
112°22′03″ W.; to lat. 41°00′00″ N., long.
112°22′03″ W., thence to the point of
beginning; that airspace extending upward
from 1,200 feet above the surface bounded on
the north by lat. 41°00′00″ N., on the east by
long. 111°25′33″ W., thence south to lat.
40°11′00″ N., thence east to lat. 40°06′00″ N.,
long. 110°15′00″ W., thence southwest to lat.
39°33′00″ N., long. 110°55′00″ W., thence
southwest to lat. 39°04′00″ N., long.
112°27′30″ W., thence northwest to lat.
39°48′00″ N., long. 112°50′00″ W., thence
west via lat. 39°48′00″ N., to the east edge of
Restricted Area R–6402A, and on the west by
the east edge of Restricted Area R–6402A,
PO 00000
Frm 00010
Fmt 4702
Sfmt 4702
[REG–126633–12]
Computation of, and Rules Relating to,
Medical Loss Ratio
Internal Revenue Service (IRS),
Treasury.
ACTION: Notice of proposed rulemaking
and notice of public hearing.
AGENCY:
SUMMARY: This document contains
proposed regulations that provide
guidance to Blue Cross and Blue Shield
organizations, and certain other health
care organizations, on computing and
applying the medical loss ratio added to
the Internal Revenue Code by the
Patient Protection and Affordable Care
Act. This document also contains a
request for comments and provides
notice of a public hearing on these
proposed regulations.
DATES: Comments must be received by
August 12, 2013. Requests to speak and
outlines of topics to be discussed at the
public hearing scheduled for Tuesday,
September 17, 2013, at 10 a.m. must be
received by August 12, 2013.
ADDRESSES: Send submissions to
CC:PA:LPD:PR (REG–126633–12),
Internal Revenue Service, P.O. Box
7604, Ben Franklin Station, Washington,
DC 20044. Submissions may be handdelivered Monday through Friday
between the hours of 8 a.m. and 4 p.m.
to CC:PA:LPD:PR (REG–126633–12),
Courier’s Desk, Internal Revenue
Service, 1111 Constitution Avenue NW.,
Washington, DC, or sent electronically
E:\FR\FM\13MYP1.SGM
13MYP1
27874
Federal Register / Vol. 78, No. 92 / Monday, May 13, 2013 / Proposed Rules
emcdonald on DSK67QTVN1PROD with PROPOSALS
via the Federal eRulemaking Portal at
www.regulations.gov (IRS REG–126633–
12). The public hearing will be held in
the IRS Auditorium of the Internal
Revenue Building, 1111 Constitution
Avenue NW., Washington, DC.
FOR FURTHER INFORMATION CONTACT:
Concerning the proposed regulations,
Graham R. Green, (202) 622–3970;
concerning the submission of
comments, the public hearing, and/or to
be placed on the business access list to
attend the hearing, Oluwafunmilayo
Taylor, (202) 622–7180 (not toll-free
numbers).
SUPPLEMENTARY INFORMATION:
Background
Section 833 of the Internal Revenue
Code (Code) provides that Blue Cross
and Blue Shield organizations, and
certain other health care organizations,
are entitled to: (1) Treatment as stock
insurance companies; (2) a special
deduction; and (3) computation of
unearned premium reserves based on
100 percent, and not 80 percent, of
unearned premiums under section
832(b)(4). This document contains
proposed amendments to 26 CFR part 1
(Income Tax Regulations) under section
833(c)(5). Section 833(c)(5) was added
to the Code by section 9016 of the
Patient Protection and Affordable Care
Act (Affordable Care Act), Public Law
111–148 (124 Stat. 119 (2010)), effective
for taxable years beginning after
December 31, 2009. Section 833(c)(5)
provides that section 833 does not apply
to any organization unless the
organization’s percentage of total
premium revenue expended on
reimbursement for clinical services
provided to enrollees under its policies
during such taxable year (as reported
under section 2718 of the Public Health
Service Act), a ratio referred to for this
purpose as the medical loss ratio (MLR),
is not less than 85 percent.
Section 2718 of the Public Health
Service Act (42 U.S.C. 300gg–18)
(PHSA) was added by section 1001 and
amended by section 10101 of the
Affordable Care Act and was
incorporated into the Code by section
9815(a)(1). Section 2718 of the PHSA is
administered by the Department of
Health and Human Services. Section
2718(a) of the PHSA requires a health
insurance issuer to submit a report for
each plan year to the Secretary of the
Department of Health and Human
Services concerning the percentage of
total premium revenue, after accounting
for collections or receipts for risk
adjustment and risk corridors and
payments of reinsurance, that the issuer
expends: (1) On reimbursement for
VerDate Mar<15>2010
14:16 May 10, 2013
Jkt 229001
clinical services provided to enrollees
under such coverage; (2) for activities
that improve health care quality; and (3)
on all other non-claims costs, excluding
Federal and State taxes and licensing or
regulatory fees.
Section 2718(b) of the PHSA requires
that a health insurance issuer offering
group or individual health insurance
coverage, with respect to each plan year,
provide an annual rebate to each
enrollee under such coverage, on a pro
rata basis, if the ratio of the amount of
premium revenue the issuer expends on
costs for reimbursement for clinical
services provided to enrollees under
such coverage and for activities that
improve health care quality to the total
amount of premium revenue (excluding
Federal and State taxes and licensing or
regulatory fees and after accounting for
payments or receipts for risk
adjustment, risk corridors, and
reinsurance under sections 1341, 1342,
and 1343 of the Affordable Care Act (42
U.S.C. 18061, 18062, and 18063)) for the
plan year is less than a prescribed
percentage. Section 2718(b)(1)(B)(ii)
provides that beginning on January 1,
2014, the medical loss ratio computed
under section 2718(b) of the PHSA shall
be based on expenses and premium
revenues for each of the previous three
years of the plan.
The Department of Health and Human
Services issued interim final regulations
on December 1, 2010, effective January
1, 2011, and December 7, 2011, effective
January 3, 2012, that were subject to
technical corrections on December 30,
2010, and May 16, 2012, and final
regulations on December 7, 2011,
effective January 3, 2012, May 16, 2012,
effective June 15, 2012, and March 11,
2013, effective April 30, 2013 under
section 2718 of the PHSA that are
codified at 45 CFR part 158 (HHS
Regulations). Relevant portions of these
HHS Regulations are described in this
preamble.
Prior Guidance
On November 23, 2010, the Treasury
Department and the IRS issued Notice
2010–79 (2010–49 IRB 809), which
provided interim guidance and
transitional relief to organizations under
section 833(c)(5). The interim guidance
applied to an organization’s first taxable
year beginning after December 31, 2009.
The interim guidance provided that
for purposes of determining whether an
organization’s percentage of total
premium revenue expended on
reimbursement for clinical services
provided to enrollees was at least 85
percent (and thus satisfied the
requirement of section 833(c)(5)),
organizations were required to use the
PO 00000
Frm 00011
Fmt 4702
Sfmt 4702
definition of ‘‘reimbursement for
clinical services provided to enrollees’’
set forth in the HHS Regulations. In
addition, the interim guidance provided
that for purposes of determining
whether the 85-percent requirement of
section 833(c)(5) was satisfied, the IRS
would not challenge the inclusion of
amounts expended for ‘‘activities that
improve health care quality’’ as
described in the HHS Regulations.
Notice 2010–79 also stated that the
consequences for an organization with
an MLR of less than 85 percent (an
insufficient MLR) were as follows: (1)
The organization would not be taxable
as a stock insurance company by reason
of section 833(a)(1) (but may have been
taxable as an insurance company if it
otherwise met the requirements of
section 831(c)); (2) the organization
would not be allowed the special
deduction set forth in section 833(b);
and (3) the organization would only take
into account 80 percent, rather than 100
percent, of its unearned premiums for
purposes of computing premiums
earned on insurance contracts under
section 832(b)(4). However, Notice
2010–79 provided that solely for the
first taxable year beginning after
December 31, 2009, the IRS would not
treat an organization as losing its status
as a stock insurance company by reason
of section 833(c)(5) provided the
following conditions were met: (1) the
organization was described in section
833(c) in the immediately preceding
taxable year; (2) the organization would
have been taxed as a stock insurance
company for the current taxable year but
for the enactment of section 833(c)(5);
and (3) the organization would have met
the requirements of section 831(c) to be
taxed as an insurance company for the
current taxable year but for its activities
in the administration, adjustment, or
settlement of claims under cost-plus or
administrative services-only contracts.
Notice 2010–79 further provided
interim guidance on whether the
application of section 833 in a taxable
year followed by nonapplication of that
provision in the subsequent taxable year
(or vice versa) could result in one or
more changes in accounting method.
Notice 2010–79 invited comments on:
(1) What further guidance, if any, was
needed under section 833(c)(5); (2)
whether specific guidance was needed
on accounting method issues that would
arise if an organization lost its status as
an insurance company; (3) whether
guidance would be needed in the future
on the appropriate Subchapter L
treatment of rebates that are paid under
section 2718 of the PHSA; and (4) how
guidance could coordinate the medical
loss ratio computation under section
E:\FR\FM\13MYP1.SGM
13MYP1
Federal Register / Vol. 78, No. 92 / Monday, May 13, 2013 / Proposed Rules
2718 of the PHSA with the computation
of MLR under section 833(c)(5).
In Notice 2011–4 (2011–2 IRB 282)
and Rev. Proc. 2011–14 (2011–4 IRB
330), the Treasury Department and the
IRS provided procedures for an
organization to obtain automatic
consent to change its method of
accounting for unearned premiums by
reason of the application of section
833(c)(5).
On June 12, 2011, the Treasury
Department and the IRS issued Notice
2011–51 (2011–27 IRB 36) extending the
interim guidance and transitional relief
provided in Notice 2010–79 to an
organization’s first taxable year
beginning after December 31, 2010. On
May 26, 2012, the Treasury Department
and the IRS issued Notice 2012–37
(2012–24 IRB 1014) extending the
interim guidance and transitional relief
provided in Notice 2010–79 and Notice
2011–51, as clarified by Notice 2011–4
and Rev. Proc. 2011–14, through an
organization’s first taxable year
beginning after December 31, 2012.
Notice 2012–37 indicated that proposed
regulations would be issued and
requested comments on all aspects of
section 833(c)(5), including how the
proposed regulations might account for
the specific reporting required under
section 2718 of the PHSA and
coordinate the computations under
section 2718 of the PHSA and section
833(c)(5).
The Treasury Department and the IRS
received four comments in response to
Notice 2010–79 and two comments in
response to Notice 2012–37 and have
considered all comments in drafting
these proposed regulations. The
comments are discussed in more detail
in this preamble.
with the definition of those same terms
and the methodology under section
2718 of the PHSA.
emcdonald on DSK67QTVN1PROD with PROPOSALS
Explanation of Provisions
a. MLR Numerator
Commenters suggested that the term
‘‘reimbursement for clinical services
provided to enrollees’’ in section
833(c)(5) has the same meaning as
provided under section 2718 of the
PHSA. Both section 833(c)(5) and
section 2718 of the PHSA include
‘‘reimbursement for clinical services
provided to enrollees’’ in the numerator.
Through the phrase ‘‘as reported under
section 2718 of the Public Health
Service Act,’’ section 833(c)(5) suggests
that the meaning of ‘‘reimbursement for
clinical services provided to enrollees’’
should be the same as the meaning of
that phrase for section 2718 of the PHSA
and the regulations issued under that
section. Accordingly, the proposed
regulations adopt this suggestion.
Commenters suggested that in
addition to amounts expended for
reimbursement for clinical services
provided to enrollees, the MLR
numerator include amounts expended
for ‘‘activities that improve health care
quality’’ as reported under section 2718
of the PHSA. The proposed regulations
do not adopt this suggestion. Unlike the
phrase ‘‘reimbursement for clinical
services provided to enrollees’’ that
appears in the description of the
numerator in both section 833(c)(5) and
section 2718 of the PHSA, ‘‘activities
that improve health care quality’’
appears only in the description of the
numerator in section 2718 of the PHSA;
it does not appear in section 833(c)(5).
Accordingly, the Treasury Department
and IRS have concluded that the MLR
numerator in section 833(c)(5) does not
include costs for ‘‘activities that
improve health care quality.’’
1. Determining the MLR
In describing the MLR computation
under section 833(c)(5), the statute
provides that the elements in the
computation are to be ‘‘as reported
under section 2718 of the Public Service
Health Act.’’ As more specifically
discussed below, commenters argued
that this cross reference indicates that
the MLR computation under section
833(c)(5) should be the same as the
medical loss ratio computation under
section 2718(b) of the PHSA. The
Treasury Department and IRS have
concluded that this cross reference
indicates that Congress intended that, to
the extent consistent with the express
language in section 833(c)(5), the
meaning of terms and the methodology
used in the MLR computation under
section 833(c)(5) should be consistent
b. MLR Denominator
Commenters suggested that term total
premium revenue in the MLR
denominator under section 833(c)(5)
should have the same exclusions as
provided for under section 2718(b) of
the PHSA. The proposed regulations
adopt this suggestion. Section 833(c)(5)
refers to total premium revenue in
describing the denominator. Section
2718(b) of the PHSA, which sets forth
the rules for computing medical loss
ratio for that section, also refers to total
premium revenue and lists specific
exclusions that should be taken from
total premium revenue, including taxes
and regulatory fees. These proposed
regulations provide that the same
exclusions that are permitted from total
premium revenue under section 2718(b)
of the PHSA are permitted exclusions
VerDate Mar<15>2010
14:16 May 10, 2013
Jkt 229001
PO 00000
Frm 00012
Fmt 4702
Sfmt 4702
27875
from total premium revenue under
section 833(c)(5) because, while these
exclusions are not expressly included in
the references to total premium revenue
in section 833(c)(5) or section 2718(a) of
the PHSA, both section 833(c)(5) and
section 2718(b) of the PHSA use the
term ‘‘total premium revenue.’’ Under
the HHS Regulations, these exclusions
include assessments and fees imposed
by the Affordable Care Act (see 45 CFR
158.221(c) and 158.240(c)). However, an
organization’s operating costs or any
administrative costs associated with
taxes or fees are not part of a State or
Federal assessment and therefore may
not be deducted from total premium
revenue for purposes of the MLR
calculation.
Accordingly, the proposed regulations
provide that the term ‘‘total premium
revenue’’ for purposes of section
833(c)(5) means the total amount of
premium revenue (excluding Federal
and State taxes and licensing or
regulatory fees and after accounting for
payments or receipts for risk
adjustment, risk corridors, and
reinsurance under sections 1341, 1342,
and 1343 of the Affordable Care Act (42
U.S.C. 18061, 18062, and 18063)) as
those terms are used for purposes of
section 2718(b) of the PHSA and the
regulations issued under that section.
c. Computation of MLR
For purposes of section 2718(b) of the
PHSA, section 2718(b)(1)(B)(ii) of the
PHSA and the HHS Regulations use a
three-year period to compute the
medical loss ratio, allowing certain
limited adjustments after the end of the
year to determine expenses and
premium revenue. (See 45 CFR
158.220(b) and 158.140.) Although
section 2718(b) of the PHSA provides
that the medical loss ratio is computed
for each ‘‘plan year,’’ the HHS
Regulations interpret the term ‘‘plan
year’’ as referring to the ‘‘MLR reporting
year.’’ The HHS regulations further
define the MLR reporting year as the
calendar year for medical loss ratio
reporting and rebating purposes under
section 2718(a) and (b) of the PHSA.
(See 45 CFR 158.103.) Section 833(c)(5)
refers to expenses and revenues for a
taxable year, which is generally a
calendar year for the organizations
described in section 833(c). See section
843.
The Treasury Department and the IRS
have concluded that, for administrative
convenience and to be consistent with
the medical loss ratio calculation under
section 2718(b)(1)(B)(ii) of the PHSA, it
is appropriate to compute the MLR for
a taxable year under section 833(c)(5)
using the same three-year period used
E:\FR\FM\13MYP1.SGM
13MYP1
27876
Federal Register / Vol. 78, No. 92 / Monday, May 13, 2013 / Proposed Rules
emcdonald on DSK67QTVN1PROD with PROPOSALS
under section 2718(b) of the PHSA.
Therefore, beginning with the effective
date of these regulations, amounts used
for purposes of section 833(c)(5) (that is,
total premium revenue and total
premium revenue expended on
reimbursement for clinical services
provided to enrollees) for each taxable
year should be determined based on
amounts reported under section 2718(a)
of the PHSA for that taxable year and
the two preceding taxable years, subject
to the same adjustments that apply for
purposes of section 2718 of the PHSA.
Comments are requested as to whether
organizations should, instead of using
the three-year period used for purposes
of section 2718(b)(1)(B)(ii) of the PHSA,
compute their expenses and total
premium revenue only for the taxable
year for which the computation is being
made under section 833(c)(5), and
whether adoption of the proposed
approach would create difficulties with
respect to the computation of the MLR
for the 2014 taxable year.
2. Nonapplication of Section 833 in
Case of an Insufficient MLR
Commenters requested that the
consequences of having an insufficient
MLR under section 833(c)(5) be limited
to losing certain benefits of section 833.
Specifically, commenters posited that
an organization that fails the MLR
requirement under section 833(c)(5)
should not lose its status as an
insurance company under section
833(a)(1). Rather, the commenters
argued that the organization should only
suffer the loss of eligibility for the
special deduction in section 833(b) and
the less favorable computation of
unearned premium reserves based on 80
percent, and not 100 percent, of its
unearned premiums under section
832(b)(4).
The proposed regulations do not
adopt this recommendation. Section
833(c)(5) provides that ‘‘this section
[833]’’ shall not apply to any
organization unless the organization
satisfies the MLR requirement in section
833(c)(5). This language does not
contemplate disallowance of some, but
not all, of the benefits associated with
treatment under section 833.
Accordingly, the proposed regulations
provide that for an organization
described in section 833(c) that fails to
satisfy the MLR requirement under
section 833(c)(5): (1) The organization is
not taxable as a stock insurance
company by reason of section 833(a)(1),
but may be taxable as an insurance
company if it otherwise meets the
requirements of section 831(c); (2) the
organization is not allowed the special
deduction set forth in section 833(b);
VerDate Mar<15>2010
14:16 May 10, 2013
Jkt 229001
and (3) if the organization qualifies as
an insurance company under section
831(c), it must take into account 80
percent, rather than 100 percent, of its
unearned premiums under section
832(b)(4) as it applies to other non-life
insurance companies.
The determination of whether an
organization’s MLR under section
833(c)(5) is at least 85 percent is made
annually. Accordingly, an organization’s
MLR may be sufficient in one year, but
not another. For this reason, the
Treasury Department and the IRS have
concluded that an organization
described in section 833(c) that has an
insufficient MLR under section 833(c)(5)
will lose the benefits of section 833 only
for the taxable year or years for which
the organization’s MLR is insufficient. If
the same organization meets the MLR
standard for a later taxable year, the
organization would be entitled to claim
the benefits of section 833 for that
taxable year and subsequent taxable
years for which its MLR is sufficient.
Comments are requested on whether
further guidance is needed for an
organization that is described in section
833 for only some taxable years because
of section 833(c)(5).
Commenters requested that the
Treasury Department and the IRS
establish a regime under which an
organization that has failed to satisfy the
MLR ratio by a de minimis amount
would have an opportunity to pay an
amount to the IRS to prevent loss of
treatment under section 833. The
proposed regulations do not adopt this
suggestion. The Treasury Department
and the IRS understand that the
consequences under section 833(c)(5)
may be severe if an organization’s MLR
is insufficient. However, the statutory
framework does not contemplate a
penalty or other payment to the IRS.
The Treasury Department and the IRS
request comments on whether there are
other possible means consistent with
the statute of mitigating these
consequences.
3. Other Comments
Commenters requested that the
Treasury Department and the IRS permit
certain nondeductible fees and taxes
imposed by the Affordable Care Act to
be taken into account for purposes of
calculating an organization’s special
deduction for items attributable to the
health-related business of the
organization under section 833(b).
Commenters also submitted comments
regarding the treatment of MLR rebates
as return premiums under section
832(b)(4), and the income and
employment tax consequences of MLR
rebates. The proposed regulations do
PO 00000
Frm 00013
Fmt 4702
Sfmt 4702
not address these issues because they
are not within the scope of the proposed
regulations.
Proposed Effective Date
These proposed regulations are
proposed to apply to taxable years
beginning after December 31, 2013.
Availability of IRS Documents
The IRS notices and revenue
procedure cited in this preamble are
published in the Internal Revenue
Cumulative Bulletin and are available at
https://www.irs.gov.
Special Analyses
It has been determined that this notice
of proposed rulemaking is not a
significant regulatory action as defined
in Executive Order 12866, as
supplemented by Executive Order
13563. Therefore, a regulatory
assessment is not required. It also has
been determined that section 553(b) of
the Administrative Procedure Act (5
U.S.C. chapter 5) does not apply to these
proposed regulations and because the
regulations do not impose an
information collection on small entities,
the Regulatory Flexibility Act (5 U.S.C.
chapter 6) does not apply. Pursuant to
section 7805(f) of the Code, this notice
of proposed rulemaking has been
submitted to the Chief Counsel for
Advocacy of the Small Business
Administration for comments on its
impact on small business.
Comments and Public Hearing
Before these proposed regulations are
adopted as final regulations,
consideration will be given to any
comments that are submitted timely to
the IRS as prescribed in this preamble
under the ADDRESSES heading. The
Treasury Department and the IRS
request comments on all aspects of the
proposed rules. Comments are
specifically requested on the
relationship between section 833(c)(5)
and section 2718 of the PHSA. All
comments will be available at
www.regulations.gov or upon request.
A public hearing has been scheduled
for Tuesday, September 17, 2013, at 10
a.m., in the IRS Auditorium of the
Internal Revenue Building, 1111
Constitution Avenue NW., Washington,
DC. Due to building security
procedures, visitors must enter at the
Constitution Avenue entrance. In
addition, all visitors must present photo
identification to enter the building.
Because of access restrictions, visitors
will not be admitted beyond the
immediate entrance more than 30
minutes before the hearing starts. For
information about having your name
E:\FR\FM\13MYP1.SGM
13MYP1
Federal Register / Vol. 78, No. 92 / Monday, May 13, 2013 / Proposed Rules
placed on the building access list to
attend the hearing, see the FOR FURTHER
INFORMATION CONTACT section of this
preamble.
The rules of 26 CFR 601.601(a)(3)
apply to the hearing. Persons who wish
to present oral comments at the hearing
must submit written (signed original
and eight (8) copies) or electronic
comments and an outline of the topics
to be discussed and the time to be
devoted to each topic by August 12,
2013. A period of 10 minutes will be
allotted to each person for making
comments. An agenda showing the
scheduling of the speakers will be
prepared after the deadline for receiving
outlines has passed. Copies of the
agenda will be available free of charge
at the hearing.
Drafting Information
The principal author of these
regulations is Graham R. Green, Office
of Associate Chief Counsel (Financial
Institutions & Products). However, other
personnel from the Treasury
Department and the IRS participated in
their development.
List of Subjects in 26 CFR Part 1
Income taxes, Reporting and
recordkeeping requirements.
Proposed Amendment to the
Regulations
Accordingly, 26 CFR part 1 is
proposed to be amended as follows:
PART 1—INCOME TAXES
Paragraph 1. The authority citation
for part 1 continues to read in part as
follows:
■
Authority: 26 U.S.C. 7805 * * *
Par. 2. Section 1.833–1 is added to
read as follows:
■
emcdonald on DSK67QTVN1PROD with PROPOSALS
§ 1.833–1 Medical loss ratio under section
833(c)(5).
(a) In general. Section 833 does not
apply to an organization unless the
organization’s medical loss ratio (MLR)
for a taxable year is at least 85 percent.
Paragraph (b) of this section provides
definitions that apply for purposes of
section 833(c)(5) and this § 1.833–1.
Paragraph (c) of this section provides
rules for computing an organization’s
MLR under section 833(c)(5). Paragraph
(d) of this section addresses the
treatment under section 833 of an
organization that has an MLR of less
than 85 percent. Paragraph (e) of this
section provides the effective/
applicability date.
(b) Definitions. The following
definitions apply for purposes of section
833(c)(5) and § 1.833–1.
VerDate Mar<15>2010
14:16 May 10, 2013
Jkt 229001
(1) Reimbursement for clinical
services provided to enrollees. The term
reimbursement for clinical services
provided to enrollees has the same
meaning as that term has in 42 U.S.C.
300gg–18 and the regulations issued
under that section (see 45 CFR 158.140).
(2) Total premium revenue. The term
total premium revenue means the total
amount of premium revenue (excluding
Federal and State taxes and licensing or
regulatory fees and after accounting for
payments or receipts for risk
adjustment, risk corridors, and
reinsurance under sections 1341, 1342,
and 1343 of the Patient Protection and
Affordable Care Act, Public Law 111–
148 (124 Stat. 119 (2010)) (42 U.S.C.
18061, 18062, and 18063)) as those
terms are used for purposes of 42 U.S.C.
300gg–18(b) and the regulations issued
under that section (see 45 CFR part 158).
(c) Computation of MLR under section
833(c)(5)—(1) In general. An
organization’s MLR with respect to a
taxable year is the ratio, expressed as a
percentage, of the MLR numerator, as
described in paragraph (c)(2) of this
section, to the MLR denominator, as
described in paragraph (c)(3) of this
section.
(2) MLR numerator. The numerator of
an organization’s MLR is the total
premium revenue expended on
reimbursement for clinical services
provided to enrollees under its policies
for the taxable year, computed in the
same manner as those expenses are
computed for the plan year for purposes
of 42 U.S.C. 300gg–18(b) and regulations
issued under that section (see 45 CFR
part 158).
(3) MLR denominator. The
denominator of an organization’s MLR
is the organization’s total premium
revenue for the taxable year, computed
in the same manner as the total
premium revenue is computed for the
plan year for purposes of 42 U.S.C.
300gg–18(b) and regulations issued
under that section (see 45 CFR part 158).
(d) Failure to qualify under section
833(c)(5). If, for any taxable year, an
organization’s MLR is less than 85
percent, then beginning in that taxable
year and for each subsequent taxable
year for which the organization’s MLR
remains less than 85 percent,
paragraphs (d)(1) through (d)(3) of this
section apply.
(1) Automatic stock insurance
company status. The organization is not
taxable as a stock insurance company by
reason of section 833(a)(1), but may be
taxable as an insurance company if it
otherwise meets the requirements of
section 831(c);
(2) Special deduction. The
organization is not allowed the special
PO 00000
Frm 00014
Fmt 4702
Sfmt 4702
27877
deduction set forth in section 833(b);
and
(3) Premiums earned. The
organization must take into account 80
percent, rather than 100 percent, of its
unearned premiums under section
832(b)(4) as it applies to other non-life
insurance companies, provided the
organization qualifies as an insurance
company by meeting the requirements
of section 831(c).
(e) Effective/applicability date. This
section applies to taxable years
beginning after December 31, 2013.
Steven T. Miller,
Deputy Commissioner for Services and
Enforcement.
[FR Doc. 2013–11297 Filed 5–10–13; 8:45 am]
BILLING CODE 4830–01–P
DEPARTMENT OF HOMELAND
SECURITY
Coast Guard
33 CFR Part 165
[Docket No. USCG–2013–0165]
RIN 1625–AA00
Safety Zone; McAloon Wedding
Fireworks, Catawba Island Club,
Catawba Island, OH
Coast Guard, DHS.
Notice of proposed rulemaking
AGENCY:
ACTION:
SUMMARY: The Coast Guard proposes to
establish a safety zone for a fireworks
display located in the Captain of the
Port Detroit Zone. This action is
necessary to provide for the safety of life
and property on navigable waters during
this event. This action is intended to
restrict vessel traffic in a portion of the
Captain of the Port Detroit Zone.
DATES: Comments and related material
must be received by the Coast Guard on
or before June 12, 2013.
ADDRESSES: You may submit comments
identified by docket number USCG–
2013–0165 using any one of the
following methods:
(1) Federal eRulemaking Portal:
https://www.regulations.gov.
(2) Fax: 202–493–2251.
(3) Mail: Docket Management Facility
(M–30), U.S. Department of
Transportation, West Building Ground
Floor, Room W12–140, 1200 New Jersey
Avenue SE., Washington, DC 20590–
0001.
(4) Hand delivery: Same as mail
address above, between 9 a.m. and 5
p.m., Monday through Friday, except
Federal holidays. The telephone number
is 202–366–9329.
E:\FR\FM\13MYP1.SGM
13MYP1
Agencies
[Federal Register Volume 78, Number 92 (Monday, May 13, 2013)]
[Proposed Rules]
[Pages 27873-27877]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-11297]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 1
[REG-126633-12]
RIN 1545-BL05
Computation of, and Rules Relating to, Medical Loss Ratio
AGENCY: Internal Revenue Service (IRS), Treasury.
ACTION: Notice of proposed rulemaking and notice of public hearing.
-----------------------------------------------------------------------
SUMMARY: This document contains proposed regulations that provide
guidance to Blue Cross and Blue Shield organizations, and certain other
health care organizations, on computing and applying the medical loss
ratio added to the Internal Revenue Code by the Patient Protection and
Affordable Care Act. This document also contains a request for comments
and provides notice of a public hearing on these proposed regulations.
DATES: Comments must be received by August 12, 2013. Requests to speak
and outlines of topics to be discussed at the public hearing scheduled
for Tuesday, September 17, 2013, at 10 a.m. must be received by August
12, 2013.
ADDRESSES: Send submissions to CC:PA:LPD:PR (REG-126633-12), 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-126633-12),
Courier's Desk, Internal Revenue Service, 1111 Constitution Avenue NW.,
Washington, DC, or sent electronically
[[Page 27874]]
via the Federal eRulemaking Portal at www.regulations.gov (IRS REG-
126633-12). The public hearing will be held in the IRS Auditorium of
the Internal Revenue Building, 1111 Constitution Avenue NW.,
Washington, DC.
FOR FURTHER INFORMATION CONTACT: Concerning the proposed regulations,
Graham R. Green, (202) 622-3970; concerning the submission of comments,
the public hearing, and/or to be placed on the business access list to
attend the hearing, Oluwafunmilayo Taylor, (202) 622-7180 (not toll-
free numbers).
SUPPLEMENTARY INFORMATION:
Background
Section 833 of the Internal Revenue Code (Code) provides that Blue
Cross and Blue Shield organizations, and certain other health care
organizations, are entitled to: (1) Treatment as stock insurance
companies; (2) a special deduction; and (3) computation of unearned
premium reserves based on 100 percent, and not 80 percent, of unearned
premiums under section 832(b)(4). This document contains proposed
amendments to 26 CFR part 1 (Income Tax Regulations) under section
833(c)(5). Section 833(c)(5) was added to the Code by section 9016 of
the Patient Protection and Affordable Care Act (Affordable Care Act),
Public Law 111-148 (124 Stat. 119 (2010)), effective for taxable years
beginning after December 31, 2009. Section 833(c)(5) provides that
section 833 does not apply to any organization unless the
organization's percentage of total premium revenue expended on
reimbursement for clinical services provided to enrollees under its
policies during such taxable year (as reported under section 2718 of
the Public Health Service Act), a ratio referred to for this purpose as
the medical loss ratio (MLR), is not less than 85 percent.
Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18)
(PHSA) was added by section 1001 and amended by section 10101 of the
Affordable Care Act and was incorporated into the Code by section
9815(a)(1). Section 2718 of the PHSA is administered by the Department
of Health and Human Services. Section 2718(a) of the PHSA requires a
health insurance issuer to submit a report for each plan year to the
Secretary of the Department of Health and Human Services concerning the
percentage of total premium revenue, after accounting for collections
or receipts for risk adjustment and risk corridors and payments of
reinsurance, that the issuer expends: (1) On reimbursement for clinical
services provided to enrollees under such coverage; (2) for activities
that improve health care quality; and (3) on all other non-claims
costs, excluding Federal and State taxes and licensing or regulatory
fees.
Section 2718(b) of the PHSA requires that a health insurance issuer
offering group or individual health insurance coverage, with respect to
each plan year, provide an annual rebate to each enrollee under such
coverage, on a pro rata basis, if the ratio of the amount of premium
revenue the issuer expends on costs for reimbursement for clinical
services provided to enrollees under such coverage and for activities
that improve health care quality to the total amount of premium revenue
(excluding Federal and State taxes and licensing or regulatory fees and
after accounting for payments or receipts for risk adjustment, risk
corridors, and reinsurance under sections 1341, 1342, and 1343 of the
Affordable Care Act (42 U.S.C. 18061, 18062, and 18063)) for the plan
year is less than a prescribed percentage. Section 2718(b)(1)(B)(ii)
provides that beginning on January 1, 2014, the medical loss ratio
computed under section 2718(b) of the PHSA shall be based on expenses
and premium revenues for each of the previous three years of the plan.
The Department of Health and Human Services issued interim final
regulations on December 1, 2010, effective January 1, 2011, and
December 7, 2011, effective January 3, 2012, that were subject to
technical corrections on December 30, 2010, and May 16, 2012, and final
regulations on December 7, 2011, effective January 3, 2012, May 16,
2012, effective June 15, 2012, and March 11, 2013, effective April 30,
2013 under section 2718 of the PHSA that are codified at 45 CFR part
158 (HHS Regulations). Relevant portions of these HHS Regulations are
described in this preamble.
Prior Guidance
On November 23, 2010, the Treasury Department and the IRS issued
Notice 2010-79 (2010-49 IRB 809), which provided interim guidance and
transitional relief to organizations under section 833(c)(5). The
interim guidance applied to an organization's first taxable year
beginning after December 31, 2009.
The interim guidance provided that for purposes of determining
whether an organization's percentage of total premium revenue expended
on reimbursement for clinical services provided to enrollees was at
least 85 percent (and thus satisfied the requirement of section
833(c)(5)), organizations were required to use the definition of
``reimbursement for clinical services provided to enrollees'' set forth
in the HHS Regulations. In addition, the interim guidance provided that
for purposes of determining whether the 85-percent requirement of
section 833(c)(5) was satisfied, the IRS would not challenge the
inclusion of amounts expended for ``activities that improve health care
quality'' as described in the HHS Regulations.
Notice 2010-79 also stated that the consequences for an
organization with an MLR of less than 85 percent (an insufficient MLR)
were as follows: (1) The organization would not be taxable as a stock
insurance company by reason of section 833(a)(1) (but may have been
taxable as an insurance company if it otherwise met the requirements of
section 831(c)); (2) the organization would not be allowed the special
deduction set forth in section 833(b); and (3) the organization would
only take into account 80 percent, rather than 100 percent, of its
unearned premiums for purposes of computing premiums earned on
insurance contracts under section 832(b)(4). However, Notice 2010-79
provided that solely for the first taxable year beginning after
December 31, 2009, the IRS would not treat an organization as losing
its status as a stock insurance company by reason of section 833(c)(5)
provided the following conditions were met: (1) the organization was
described in section 833(c) in the immediately preceding taxable year;
(2) the organization would have been taxed as a stock insurance company
for the current taxable year but for the enactment of section
833(c)(5); and (3) the organization would have met the requirements of
section 831(c) to be taxed as an insurance company for the current
taxable year but for its activities in the administration, adjustment,
or settlement of claims under cost-plus or administrative services-only
contracts.
Notice 2010-79 further provided interim guidance on whether the
application of section 833 in a taxable year followed by nonapplication
of that provision in the subsequent taxable year (or vice versa) could
result in one or more changes in accounting method.
Notice 2010-79 invited comments on: (1) What further guidance, if
any, was needed under section 833(c)(5); (2) whether specific guidance
was needed on accounting method issues that would arise if an
organization lost its status as an insurance company; (3) whether
guidance would be needed in the future on the appropriate Subchapter L
treatment of rebates that are paid under section 2718 of the PHSA; and
(4) how guidance could coordinate the medical loss ratio computation
under section
[[Page 27875]]
2718 of the PHSA with the computation of MLR under section 833(c)(5).
In Notice 2011-4 (2011-2 IRB 282) and Rev. Proc. 2011-14 (2011-4
IRB 330), the Treasury Department and the IRS provided procedures for
an organization to obtain automatic consent to change its method of
accounting for unearned premiums by reason of the application of
section 833(c)(5).
On June 12, 2011, the Treasury Department and the IRS issued Notice
2011-51 (2011-27 IRB 36) extending the interim guidance and
transitional relief provided in Notice 2010-79 to an organization's
first taxable year beginning after December 31, 2010. On May 26, 2012,
the Treasury Department and the IRS issued Notice 2012-37 (2012-24 IRB
1014) extending the interim guidance and transitional relief provided
in Notice 2010-79 and Notice 2011-51, as clarified by Notice 2011-4 and
Rev. Proc. 2011-14, through an organization's first taxable year
beginning after December 31, 2012. Notice 2012-37 indicated that
proposed regulations would be issued and requested comments on all
aspects of section 833(c)(5), including how the proposed regulations
might account for the specific reporting required under section 2718 of
the PHSA and coordinate the computations under section 2718 of the PHSA
and section 833(c)(5).
The Treasury Department and the IRS received four comments in
response to Notice 2010-79 and two comments in response to Notice 2012-
37 and have considered all comments in drafting these proposed
regulations. The comments are discussed in more detail in this
preamble.
Explanation of Provisions
1. Determining the MLR
In describing the MLR computation under section 833(c)(5), the
statute provides that the elements in the computation are to be ``as
reported under section 2718 of the Public Service Health Act.'' As more
specifically discussed below, commenters argued that this cross
reference indicates that the MLR computation under section 833(c)(5)
should be the same as the medical loss ratio computation under section
2718(b) of the PHSA. The Treasury Department and IRS have concluded
that this cross reference indicates that Congress intended that, to the
extent consistent with the express language in section 833(c)(5), the
meaning of terms and the methodology used in the MLR computation under
section 833(c)(5) should be consistent with the definition of those
same terms and the methodology under section 2718 of the PHSA.
a. MLR Numerator
Commenters suggested that the term ``reimbursement for clinical
services provided to enrollees'' in section 833(c)(5) has the same
meaning as provided under section 2718 of the PHSA. Both section
833(c)(5) and section 2718 of the PHSA include ``reimbursement for
clinical services provided to enrollees'' in the numerator. Through the
phrase ``as reported under section 2718 of the Public Health Service
Act,'' section 833(c)(5) suggests that the meaning of ``reimbursement
for clinical services provided to enrollees'' should be the same as the
meaning of that phrase for section 2718 of the PHSA and the regulations
issued under that section. Accordingly, the proposed regulations adopt
this suggestion.
Commenters suggested that in addition to amounts expended for
reimbursement for clinical services provided to enrollees, the MLR
numerator include amounts expended for ``activities that improve health
care quality'' as reported under section 2718 of the PHSA. The proposed
regulations do not adopt this suggestion. Unlike the phrase
``reimbursement for clinical services provided to enrollees'' that
appears in the description of the numerator in both section 833(c)(5)
and section 2718 of the PHSA, ``activities that improve health care
quality'' appears only in the description of the numerator in section
2718 of the PHSA; it does not appear in section 833(c)(5). Accordingly,
the Treasury Department and IRS have concluded that the MLR numerator
in section 833(c)(5) does not include costs for ``activities that
improve health care quality.''
b. MLR Denominator
Commenters suggested that term total premium revenue in the MLR
denominator under section 833(c)(5) should have the same exclusions as
provided for under section 2718(b) of the PHSA. The proposed
regulations adopt this suggestion. Section 833(c)(5) refers to total
premium revenue in describing the denominator. Section 2718(b) of the
PHSA, which sets forth the rules for computing medical loss ratio for
that section, also refers to total premium revenue and lists specific
exclusions that should be taken from total premium revenue, including
taxes and regulatory fees. These proposed regulations provide that the
same exclusions that are permitted from total premium revenue under
section 2718(b) of the PHSA are permitted exclusions from total premium
revenue under section 833(c)(5) because, while these exclusions are not
expressly included in the references to total premium revenue in
section 833(c)(5) or section 2718(a) of the PHSA, both section
833(c)(5) and section 2718(b) of the PHSA use the term ``total premium
revenue.'' Under the HHS Regulations, these exclusions include
assessments and fees imposed by the Affordable Care Act (see 45 CFR
158.221(c) and 158.240(c)). However, an organization's operating costs
or any administrative costs associated with taxes or fees are not part
of a State or Federal assessment and therefore may not be deducted from
total premium revenue for purposes of the MLR calculation.
Accordingly, the proposed regulations provide that the term ``total
premium revenue'' for purposes of section 833(c)(5) means the total
amount of premium revenue (excluding Federal and State taxes and
licensing or regulatory fees and after accounting for payments or
receipts for risk adjustment, risk corridors, and reinsurance under
sections 1341, 1342, and 1343 of the Affordable Care Act (42 U.S.C.
18061, 18062, and 18063)) as those terms are used for purposes of
section 2718(b) of the PHSA and the regulations issued under that
section.
c. Computation of MLR
For purposes of section 2718(b) of the PHSA, section
2718(b)(1)(B)(ii) of the PHSA and the HHS Regulations use a three-year
period to compute the medical loss ratio, allowing certain limited
adjustments after the end of the year to determine expenses and premium
revenue. (See 45 CFR 158.220(b) and 158.140.) Although section 2718(b)
of the PHSA provides that the medical loss ratio is computed for each
``plan year,'' the HHS Regulations interpret the term ``plan year'' as
referring to the ``MLR reporting year.'' The HHS regulations further
define the MLR reporting year as the calendar year for medical loss
ratio reporting and rebating purposes under section 2718(a) and (b) of
the PHSA. (See 45 CFR 158.103.) Section 833(c)(5) refers to expenses
and revenues for a taxable year, which is generally a calendar year for
the organizations described in section 833(c). See section 843.
The Treasury Department and the IRS have concluded that, for
administrative convenience and to be consistent with the medical loss
ratio calculation under section 2718(b)(1)(B)(ii) of the PHSA, it is
appropriate to compute the MLR for a taxable year under section
833(c)(5) using the same three-year period used
[[Page 27876]]
under section 2718(b) of the PHSA. Therefore, beginning with the
effective date of these regulations, amounts used for purposes of
section 833(c)(5) (that is, total premium revenue and total premium
revenue expended on reimbursement for clinical services provided to
enrollees) for each taxable year should be determined based on amounts
reported under section 2718(a) of the PHSA for that taxable year and
the two preceding taxable years, subject to the same adjustments that
apply for purposes of section 2718 of the PHSA. Comments are requested
as to whether organizations should, instead of using the three-year
period used for purposes of section 2718(b)(1)(B)(ii) of the PHSA,
compute their expenses and total premium revenue only for the taxable
year for which the computation is being made under section 833(c)(5),
and whether adoption of the proposed approach would create difficulties
with respect to the computation of the MLR for the 2014 taxable year.
2. Nonapplication of Section 833 in Case of an Insufficient MLR
Commenters requested that the consequences of having an
insufficient MLR under section 833(c)(5) be limited to losing certain
benefits of section 833. Specifically, commenters posited that an
organization that fails the MLR requirement under section 833(c)(5)
should not lose its status as an insurance company under section
833(a)(1). Rather, the commenters argued that the organization should
only suffer the loss of eligibility for the special deduction in
section 833(b) and the less favorable computation of unearned premium
reserves based on 80 percent, and not 100 percent, of its unearned
premiums under section 832(b)(4).
The proposed regulations do not adopt this recommendation. Section
833(c)(5) provides that ``this section [833]'' shall not apply to any
organization unless the organization satisfies the MLR requirement in
section 833(c)(5). This language does not contemplate disallowance of
some, but not all, of the benefits associated with treatment under
section 833. Accordingly, the proposed regulations provide that for an
organization described in section 833(c) that fails to satisfy the MLR
requirement under section 833(c)(5): (1) The organization is not
taxable as a stock insurance company by reason of section 833(a)(1),
but may be taxable as an insurance company if it otherwise meets the
requirements of section 831(c); (2) the organization is not allowed the
special deduction set forth in section 833(b); and (3) if the
organization qualifies as an insurance company under section 831(c), it
must take into account 80 percent, rather than 100 percent, of its
unearned premiums under section 832(b)(4) as it applies to other non-
life insurance companies.
The determination of whether an organization's MLR under section
833(c)(5) is at least 85 percent is made annually. Accordingly, an
organization's MLR may be sufficient in one year, but not another. For
this reason, the Treasury Department and the IRS have concluded that an
organization described in section 833(c) that has an insufficient MLR
under section 833(c)(5) will lose the benefits of section 833 only for
the taxable year or years for which the organization's MLR is
insufficient. If the same organization meets the MLR standard for a
later taxable year, the organization would be entitled to claim the
benefits of section 833 for that taxable year and subsequent taxable
years for which its MLR is sufficient. Comments are requested on
whether further guidance is needed for an organization that is
described in section 833 for only some taxable years because of section
833(c)(5).
Commenters requested that the Treasury Department and the IRS
establish a regime under which an organization that has failed to
satisfy the MLR ratio by a de minimis amount would have an opportunity
to pay an amount to the IRS to prevent loss of treatment under section
833. The proposed regulations do not adopt this suggestion. The
Treasury Department and the IRS understand that the consequences under
section 833(c)(5) may be severe if an organization's MLR is
insufficient. However, the statutory framework does not contemplate a
penalty or other payment to the IRS. The Treasury Department and the
IRS request comments on whether there are other possible means
consistent with the statute of mitigating these consequences.
3. Other Comments
Commenters requested that the Treasury Department and the IRS
permit certain nondeductible fees and taxes imposed by the Affordable
Care Act to be taken into account for purposes of calculating an
organization's special deduction for items attributable to the health-
related business of the organization under section 833(b). Commenters
also submitted comments regarding the treatment of MLR rebates as
return premiums under section 832(b)(4), and the income and employment
tax consequences of MLR rebates. The proposed regulations do not
address these issues because they are not within the scope of the
proposed regulations.
Proposed Effective Date
These proposed regulations are proposed to apply to taxable years
beginning after December 31, 2013.
Availability of IRS Documents
The IRS notices and revenue procedure cited in this preamble are
published in the Internal Revenue Cumulative Bulletin and are available
at https://www.irs.gov.
Special Analyses
It has been determined that this notice of proposed rulemaking is
not a significant regulatory action as defined in Executive Order
12866, as supplemented by Executive Order 13563. Therefore, a
regulatory assessment is not required. It also has been determined that
section 553(b) of the Administrative Procedure Act (5 U.S.C. chapter 5)
does not apply to these proposed regulations and because the
regulations do not impose an information collection on small entities,
the Regulatory Flexibility Act (5 U.S.C. chapter 6) does not apply.
Pursuant to section 7805(f) of the Code, this notice of proposed
rulemaking has been submitted to the Chief Counsel for Advocacy of the
Small Business Administration for comments on its impact on small
business.
Comments and Public Hearing
Before these proposed regulations are adopted as final regulations,
consideration will be given to any comments that are submitted timely
to the IRS as prescribed in this preamble under the ADDRESSES heading.
The Treasury Department and the IRS request comments on all aspects of
the proposed rules. Comments are specifically requested on the
relationship between section 833(c)(5) and section 2718 of the PHSA.
All comments will be available at www.regulations.gov or upon request.
A public hearing has been scheduled for Tuesday, September 17,
2013, at 10 a.m., in the IRS Auditorium of the Internal Revenue
Building, 1111 Constitution Avenue NW., Washington, DC. Due to building
security procedures, visitors must enter at the Constitution Avenue
entrance. In addition, all visitors must present photo identification
to enter the building. Because of access restrictions, visitors will
not be admitted beyond the immediate entrance more than 30 minutes
before the hearing starts. For information about having your name
[[Page 27877]]
placed on the building access list to attend the hearing, see the FOR
FURTHER INFORMATION CONTACT section of this preamble.
The rules of 26 CFR 601.601(a)(3) apply to the hearing. Persons who
wish to present oral comments at the hearing must submit written
(signed original and eight (8) copies) or electronic comments and an
outline of the topics to be discussed and the time to be devoted to
each topic by August 12, 2013. A period of 10 minutes will be allotted
to each person for making comments. An agenda showing the scheduling of
the speakers will be prepared after the deadline for receiving outlines
has passed. Copies of the agenda will be available free of charge at
the hearing.
Drafting Information
The principal author of these regulations is Graham R. Green,
Office of Associate Chief Counsel (Financial Institutions & Products).
However, other personnel from the Treasury Department and the IRS
participated in their development.
List of Subjects in 26 CFR Part 1
Income taxes, Reporting and recordkeeping requirements.
Proposed Amendment to the Regulations
Accordingly, 26 CFR part 1 is proposed to be amended as follows:
PART 1--INCOME TAXES
0
Paragraph 1. The authority citation for part 1 continues to read in
part as follows:
Authority: 26 U.S.C. 7805 * * *
0
Par. 2. Section 1.833-1 is added to read as follows:
Sec. 1.833-1 Medical loss ratio under section 833(c)(5).
(a) In general. Section 833 does not apply to an organization
unless the organization's medical loss ratio (MLR) for a taxable year
is at least 85 percent. Paragraph (b) of this section provides
definitions that apply for purposes of section 833(c)(5) and this Sec.
1.833-1. Paragraph (c) of this section provides rules for computing an
organization's MLR under section 833(c)(5). Paragraph (d) of this
section addresses the treatment under section 833 of an organization
that has an MLR of less than 85 percent. Paragraph (e) of this section
provides the effective/applicability date.
(b) Definitions. The following definitions apply for purposes of
section 833(c)(5) and Sec. 1.833-1.
(1) Reimbursement for clinical services provided to enrollees. The
term reimbursement for clinical services provided to enrollees has the
same meaning as that term has in 42 U.S.C. 300gg-18 and the regulations
issued under that section (see 45 CFR 158.140).
(2) Total premium revenue. The term total premium revenue means the
total amount of premium revenue (excluding Federal and State taxes and
licensing or regulatory fees and after accounting for payments or
receipts for risk adjustment, risk corridors, and reinsurance under
sections 1341, 1342, and 1343 of the Patient Protection and Affordable
Care Act, Public Law 111-148 (124 Stat. 119 (2010)) (42 U.S.C. 18061,
18062, and 18063)) as those terms are used for purposes of 42 U.S.C.
300gg-18(b) and the regulations issued under that section (see 45 CFR
part 158).
(c) Computation of MLR under section 833(c)(5)--(1) In general. An
organization's MLR with respect to a taxable year is the ratio,
expressed as a percentage, of the MLR numerator, as described in
paragraph (c)(2) of this section, to the MLR denominator, as described
in paragraph (c)(3) of this section.
(2) MLR numerator. The numerator of an organization's MLR is the
total premium revenue expended on reimbursement for clinical services
provided to enrollees under its policies for the taxable year, computed
in the same manner as those expenses are computed for the plan year for
purposes of 42 U.S.C. 300gg-18(b) and regulations issued under that
section (see 45 CFR part 158).
(3) MLR denominator. The denominator of an organization's MLR is
the organization's total premium revenue for the taxable year, computed
in the same manner as the total premium revenue is computed for the
plan year for purposes of 42 U.S.C. 300gg-18(b) and regulations issued
under that section (see 45 CFR part 158).
(d) Failure to qualify under section 833(c)(5). If, for any taxable
year, an organization's MLR is less than 85 percent, then beginning in
that taxable year and for each subsequent taxable year for which the
organization's MLR remains less than 85 percent, paragraphs (d)(1)
through (d)(3) of this section apply.
(1) Automatic stock insurance company status. The organization is
not taxable as a stock insurance company by reason of section
833(a)(1), but may be taxable as an insurance company if it otherwise
meets the requirements of section 831(c);
(2) Special deduction. The organization is not allowed the special
deduction set forth in section 833(b); and
(3) Premiums earned. The organization must take into account 80
percent, rather than 100 percent, of its unearned premiums under
section 832(b)(4) as it applies to other non-life insurance companies,
provided the organization qualifies as an insurance company by meeting
the requirements of section 831(c).
(e) Effective/applicability date. This section applies to taxable
years beginning after December 31, 2013.
Steven T. Miller,
Deputy Commissioner for Services and Enforcement.
[FR Doc. 2013-11297 Filed 5-10-13; 8:45 am]
BILLING CODE 4830-01-P