On April 14, 2010, the Department of Health and Human Service (HHS), along with the Internal Revenue Service and the Employee Benefits Security Administration, published a notice soliciting comments on sections 1001 and 10101 of the PPACA. These provisions added section 2718 of the Public Health Service Act (PHS Act), which, among other things, requires health insurance issuers offering individual or group coverage to submit annual reports to the Secretary on the percentages of premiums spent on reimbursement for clinical services and activities that improve health care quality, and to provide rebates to enrollees if this spending does not meet minimum standards for a given year. Section 1562 of PPACA also added section 715 of the Employee Retirement Income Security Act of 1974 and section 9815 of the Internal Revenue Code of 1986, which effectively incorporate by reference section 2718 and other amendments to the PHS Act. The notice invites public comments in advance of future rulemaking, with particular emphasis on specific questions regarding: actual medical loss ratio (MLR) experience and minimum MLR standards; uniform definitions and calculation methodologies; level of aggregation; data submission and public reporting; rebates; federal income tax; enforcement; and economic analysis. Comments will be accepted until May 14, 2010.  

In addition, HHS published a second notice on April 14 requesting comments regarding Section 1003 of the PPACA, which requires the HHS Secretary to work with states to establish an annual review of unreasonable rate increases, monitor premium increases, and award grants to states for their rate review process. Specific areas in which HHS seeks comments include: rate filings and review of rate increases; defining unreasonable premium rate increases; public disclosure; exclusion from the health insurance exchange; and grant allocation. Comments will be accepted until May 14.