Obtained via FOIA by Judicial Watch, Inc.

From: Eilipic. Anne (OS)

To: Wakefield. Mary (HRSA); Weayer. Donald L. (HRSA); Carter. Demetda (CMS); Eemuson. Dorothy A CCMS);
Monroe. Judith A, (CDeIODlOCPHP); petty. Madorle (HHSDGA); Brand Marcia (HRSA); Cheatham JJna
lliBSAl; Arias. I leana (COD; Brooks. Bill p (eMS); Weeden. C'Reda (oS>; Laine Vicki D. (CDC)
Subject: New Orleans update
Date: Sunday, April 11, 2010 7:38 :21 AM
Attachments: 3scheduieNew Orleans Working Meeting (3) (2)[ll.docx
fwneworleansupdate .zip

Good morning,
Please see below.

From: Anne Filipic <annefilipic@gmail.com>

To: Filipic, Anne (HHS/OS/IGA)
Sent: Sun Apr 11 07:23:142010
Subject: New Orleans update

Good morning, all:

Last night we received updated documents from the White House in regards to the
New Orleans working session taking place today and tomorrow.

Attached, please find:

A zip file with the following documents:

o Draft federal participant list - a list of federal participants who will be
attending each breakout session
o Monday Session Descriptions
o FEMA Handouts - these documents will be handed out on Monday. These
include: Public Assistance Process 040910.doc City of New
Orleans Education Fact Sheet Final r2.doc City of New Orleans
Overview Fact Sheet 4 08 10 tw ew edits 3.doc City of New
Orleans Public Safety and Criminal Justice Fact Sheet 4 8 10tw
edits.doc> > < <Orleans Healthcare and Veterans Affairs Fact Sheet Final
r2.doc Orleans Parish Overview Fact Sheet 4 08 10 tw ew edits
3.doc
o Overall Fact Sheet -The latest Katrina Fact Sheet, which recounts the
Obama administration's efforts in the Gulf. This will be handed out on
Monday as well.
Katrina Fact Sheet Final 3.23.2010.pdf
An updated schedule for the two-day session. This includes an updated list of
participants in the health care session. For easy reference, I've cut and pasted
them here. Please note the representation from the state of Louisiania, which
we asked be included.

Dr. Karen DeSalvo, Vice Dean, Community Affairs and Health Policy, Tulane

University, Health Care Task Force, Co-Chair

Dr.Terry Fontham, Dean, LSU Health Sciences Center, School of Public
Health,
Health Care Task Force, Co-Chair
Dr. Joia Crear Perry, Director of Clinical Services, N. O. Health Department
Dr. Ben Sachs, Senior Vice-President and Dean, Tulane University School of
 Obtained via FOIA by Judicial Watch, Inc.

Medicine
Joe Kimbrell, CEO, Louisiana Public Health Institute
Marsha Broussard, Director of School Health Connections, Louisiana Public
Health
Inst
Alan Levine, Secretary, Louisiana Department of Health and Hospitals
Tony Keck, Deputy Secretary, La. Department of Health and Hospitals
Don Gregory, Medicaid Director, La. Department of Health and Hospitals
Jerry Phillips, Undersecretary, La. Department of Health and Hospitals

Please let me know if there are any questions.

Thanks,

Anne
 Obtained via FOIA by Judicial Watch, Inc.

DRAFT Schedule

Monday, April 12, 2010

Location:
InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Federal Staff Lead
Raul Alvillar (HUD)
Raul.M.Alvillar@hud.gov
Cell 202-341-6898
Mayor Elect Landrieu Transition
Aimee Quirk
Cell 50421-5409

8:30 AM -9:00 AM Opening Welcome (Closed Press)

Location: Pelican I, 3rd Floor
Lead Staff
Raul Alvillar and Aimee Quirk
8:30 AM-8:35AM Welcome Judy Reese Morse
8:35 AM-8:45AM Mayor Elect Landrieu
Speaks
8:45AM-8:55 AM Deputy Secretary Tony
Miller Dept. of Education Speaks
8:55AM-9:00AM Close Judy Reese Morse
Will Congressman Cao be Speaking?

9:00 AM-ll:00 AM Breakout Sessions (closed press)

Session A: ' cosystem Recovery (NOAA. Army Corps, EPA and FEMA)
Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Acadian I

Federal Principals: Mike Boots, (CEQ)

Sally Yozell, (NOAA)
Janet Woodka (EPA)
Don Jodrey (DOl)
Rock Salt (USACE)
Rob Verchick (EPA)

Federal Staff Lead Raul Alvillar (HUD)

Raul.M.Alvillar@hud.gov
Cell 202-341-6898
 Obtained via FOIA by Judicial Watch, Inc.

Federal Staff Present: Jainey Bavishi, NOAA

Jean Cowan, NOAA
Shoshana Lew, Adviser, Office of Management
and Budget

Local IState Participants:

Mark Davis, Senior Research Fellow & Director of the Institute on Water Resources
Law and Policy, Tulane University Law School, acting co-chair
Stephen Rosenthal, Chairman, Strategic Comp; Founding Member, Flood Protection
Alliance, co-chair
John Barry, Former Distinguished Scholar, Center for Bioenvironmental Research for
Tulane and Xavier Universities
Timothy Doody, President, Southeast Louisiana Flood Protection Authority East
Garret Graves, Director, Office of Louisiana Coastal Activities
Mark Schexnayder, Regional Coastal Advisor, LSU AgCenter / Louisiana Sea Grant

Mitch Landrieu Contact: Aimee Quirk

504-621-5409 (cell)
aimee@transitionneworleans.com

Agenda:

15 min. Welcome and Introductions (Woodka)

20 min (l0@) Opening remarks from Federal and local leaders (Davis, Yozell)
20 min Presentation of the Roadmap recommendations and Q & A (Boots)
45 min Discussion with introduction by Mark Davis to highlight the themes
and issues of greatest importance to New Orleans.

~ Among the actions that are priorities for New Orleans area,
what are the key considerations for the Working Group moving
forward to implement the Roadmap?
~ What role will the leadership in New Orleans play in Louisiana
coastal restoration?
15 min Wrap up key points of discussion (tbd)
10 min Concluding thoughts (Davis, Y ozell)

Session B: Justice and Crime Control (DOJ)

Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Acadian II

Federal Principals:
Obtained via FOIA by Judicial Watch, Inc.

Federal Staff Lead Raul Alvillar (HUD)

Raul.M.AI vi II ar@hud.gov
Cell 202-341-6898
Federal Staff Present: Jim Letten - US Attorney
Roy Austin - Department of Justice
William Nolan- Department of Justice, Special
Litigation Section
Jon Finer - White House Office of Chief of
Staff
Juliette Kayyem- (DHS HQ)
Beth Zimmerman- (FEMA HQ)
Mike McCloskey- (FEMA TRO)
Al Armendez- (EPA)
Carlos Monje- Senior Policy Advisor, White
House Domestic Policy Council

Local IState Participants: Seung Hong - Transition New Orleans

Dana Kaplan - Juvenile Justice Project of
Louisiana
Judge Ed Lombard - 4th Circuit State Court of
Appeals
Chief Justice Pascal Calogero - State Supreme
Court of Louisiana (retired)
Judy Morse - Transition New Orleans
Tania Tetlow - Tulane University Law School
Jon Wool- Vera Institute of Justice
Marlin Gusman - Orleans Parish Criminal
Sheriff
Leon Cannizzaro - Orleans Parish District
Attorney
Derwyn Bunton - Orleans Public Defender
Judge Keva Landrum-Johnson - Orleans Parish
Criminal Court
Mayor-Elect Mitch Landrieu

Mitch Landrieu Contact: Seung Hong

seung@transitionneworleans.com

Agenda:
9:00-9:10 - Welcome and Introductions
9:10-9:20 - Opening Remarks by Local and
Federal Leaders
9:20-9:30 - Local System Assessment and
Overview (Jon Wool)
 Obtained via FOIA by Judicial Watch, Inc.

9:30 -10:00 - Discussion of System Design and

Incentive Structure
10:00-10: 15- Federal Programs Briefing (Roy
Austin)
Community Oriented Policing
Gathering Statistical Information
Use of Force Policy
Pre-trial Release
Infrastructure
Role of Courts
Citation program/arrest policy
10:15-10:45 - Discussion of Federal Programs
and Local Opportunities
10:45-10:50 - Wrap Up, Summary, and Next
Steps
10:50-11 :00 - Closing Statements by Local and
Federal Leaders

11:00 AM-12:15PM: Lunch Panel Discussion Sustainable Communities (closed press)

Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Pelican I
Federal Staff Lead
Raul Alvillar (RUD)
Raul.M.Alvillar@hud.gov
Cell 202-341-6898
Mayor Elect Landrieu Transition
Aimee Quirk
Cell 50421-5409

Run of show: Xav Briggs

Sustainable Communities (EPA. ME, HUD, DOT. F MA)

Federal Principals: EPA Administrator Lisa Jackson (invited)
OMB Associate Director Xavier Briggs

Federal Staff Present: Beth Osborne -DOT

Shelly Poticha -HUD
Tracy Wareing-FEMA
Janet Woodka-EPA
Rob Verchick-EPA
Jon Finer - White House Office of Chief of
Staff
Carlos Monje- Senior Policy Advisor, White
House Domestic Policy Council
Shoshana Lew, Adviser, Office of Management
and Budget
 Obtained via FOIA by Judicial Watch, Inc.

Local IState Participants: TBD Transition

Mitch Landrieu Contact: Seung Hong

seung@transitionneworleans.com

Agenda: 11 :00-11: 15. Buffet opens for participants

11: 15-11 :25. Introduction - Rob Vircheck
11 :25:-11 :35. Briefpresentations by DOT and
HUD (Shelley Potichia) on their role in the
partnership
11 :35-11 :45. Other comments from Federal
agency participants (XAV Briggs OMB, Tony
FEMA)
11:45-:12-15. Q and A; Discussion.

12:30 PM-2:30 PM Breakout Sessions

Session A: Education (Ed and FEMA

Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Acadian I

Federal Principals: Ed Deputy Secretary Tony Miller

Federal Staff Lead Taryn Benarroch

202-436-0789 (m)
Taryn.Benarroch@ed.gov

Federal Staff Present: Taryn Benarroch

Beth Zimmerman
Al Arrnendariz-EP A
Shoshana Lew, Adviser, Office of Management
and Budget
Jon Finer - White House Office of Chief of
Staff

Local IState Participants:

Andre Perry - Co-Chair, Education Task Force
Sharon Latten Clark - Co-Chair, Education Task Force
Paul Pastorek - Louisiana State Superintendent
Paul Vallas, Superintendent, Recovery School
District of Louisiana
Robin Keegan - Deputy Director, Louisiana Recovery Authority
 Obtained via FOIA by Judicial Watch, Inc.

Daryl C. Kilbert - Superintendent, Orleans Parish School District

Ramsey Green - Deputy Superintendent, Recovery School District of
Louisiana
Kathy Riedlinger - CEO, Lusher Charter Schools

Mitch Landrieu Contact: Scott Hutcheson

504-458-0972 (cell)
scott@transitionneworleans.com

Agenda:

Introductions - 10 minutes

12:30-12:35 Welcome/Introductions (Co-Chairs introduce participants, then intro

Deputy Secretary Miller)
12:35-12:40 Opening Remarks (Deputy Secretary Miller)

Overviews - 35 minutes

12:40-12:55 ED Agenda Update (Deputy Secretary Miller)

12:55-1 :15 Initial Recommendations of the Task Force (Andre Perry)

Round Table Discussion - 60 minutes (facilitated by Dep Sec. Miller)

1:15-1:45 FEMA Lump Sum (Mark Landry)
1:45-2: 15 Charter school management - Best practices, turning around failing charters

Wrap up, discussion

2:15-2:20 Closing(Task force members TBD)

2:20-2:25 Wrap Up (Dep Sec Miller)

*There is 5 minutes allotted for run over.

Session B: Health Care and VA Hospital eHHS, VA. and FEMA

Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Acadian II

Federal Staff Lead Raul Alvillar CHUD)

Raul.M.Alvillar@hud.gov
 Obtained via FOIA by Judicial Watch, Inc.

Cell 202-341-6898

Federal, Local/State Participants:

Carlos Monje- Senior Policy Advisor, White House Domestic Policy Council
HHS Representatives
Dr. Mary Wakefield, Administrator, Health Resources and Services
Administration
Marjorie Petty, HHS Region VI Regional Director
Dr. Judy Monroe, Deputy Director for State, Tribal, Local and
Territorial Support, Centers for Disease Control
Rear Admiral Don Weaver, Health Resources and Services
Administration
Dorothy Ferguson, Centers for Medicare and Medicaid Services
Demetria Carter, Centers for Medicare and Medicaid Services

VA Representatives
Julie Catellier, Director, Southeast Louisiana Veterans Health Care
System
Mark Brideweser, Project Executive, Office of Construction and
Facilities Management

DHS/FEMA Representatives
Tracy Wareing (DHS/FEMA HQ)
Cynthia Teeter (FEMA - TRO)
Mike McCloskey (FEMA - TRO)

Local officials/Members of the Health Care Task Force for the Transition
Dr. Karen DeSalvo, Vice Dean, Community Affairs and Health Policy, Tulane
University, Health Care Task Force, Co-Chair
Dr. Terry Fontham, Dean, LSD Health Sciences Center, School of Public Health,
Health Care Task Force, Co-Chair
Dr. Joia Crear Perry, Director of Clinical Services, N. 0. Health Department
Dr. Ben Sachs, Senior Vice-President and Dean, Tulane University School of
Medicine
Joe Kimbrell, CEO, Louisiana Public Health Institute
Marsha Broussard, Director of School Health Connections, Louisiana Public Health
Inst
Alan Levine, Secretary, Louisiana Department of Health and Hospitals
Tony Keck, Deputy Secretary, La. Department of Health and Hospitals
Don Gregory, Medicaid Director, La. Department of Health and Hospitals
Jerry Phillips, Undersecretary, La. Department of Health and Hospitals

Mitch Landrieu Contact: Scott Hutcheson

 Obtained via FOIA by Judicial Watch, Inc.

504-458-0972 (cell)
scott@transitionneworleans.com

Agenda:
12:30 - 12:40 - Welcome and Introductions
Marjorie Petty, HHS Region VI Regional Director

12:40 - 1:05 - Overview of Health Care Taskforce and Priorities

Dr. Karen DeSalvo and Dr. Terry Fontham, Co-Chairs, Mayor-Elect Landrieu's Transition Task
Force on Health Care

1:05 - 1:20 - Community Health Care Delivery: HHS Successes to Date and Developments under
Health
Care Reform
Dr. Mary Wakefield, Administrator, Health Resources and Services Administration

1:20 - 2:20: Moderated Discussion

1:20 -1:40:
Community Based Care
HHS Representatives: Dr. Mary Wakefield and RADM Don Weaver, HRSA
Mayor-Elect Landrieu Representative: Dr. Karen DeSalvo

1:40 - 2:00:
Public Health and Prevention:
HHS: Dr. Judy Monroe, Deputy Director for State, Tribal, Local and Territorial
Support, CDC
Mayor-Elect Landrieu Representative: Dr. Terry Fontham

2:00 -2:20:
V A and Charity Hospital:
Mark Brideweser and Julie Catellier, (VA)
Tracy Wareing and Cynthia Teeter, (DHS/FEMA)
Mayor-Elect Landrieu Representative: Drs. Karen DeSalvo and Terry Fontham

2:20 - 2:30: Wrap-Up and Final Comments

2:45-3:30 Closing Session and Lessons Learned from Working Sessions (closed
press)
Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Pelican I

Lead Staff Shoshanna Lew:

 Obtained via FOIA by Judicial Watch, Inc.

WE will need designated people from each of the agencies to run this
session. They will present at this time outcomes from their breakout sessions.
Mayor Elect Landrieu will be present at this even as will Congressman Cao.
 Obtained via FOIA by Judicial Watch, Inc.

From: CQhen, Rima (OS)

To: Fjlioic, Anne (05); Brand Marcia (HRSA)
Cc: Eswein, Darci (HRSA); Cheatham, Ijna (HRSA); Weeden , C"Reda (oS)
Subject: RE : NQte tQ Anne Fllipic
Date: Sunday, April 11, 2010 10:03:03 AM

I think the testimony looks great. You may want to consider that some in the group to whom Mary will
be speaking may not know (?) that the PCASG grants were the result of a special congressional
appropriation that HHS cannot renew on its own,

From: Filipic, Anne (HHS/OS/IGA)

Sent: Sun 4/11/2010 7:40 AM
To: Brand, Marcia (HRSA)
Cc: Eswein, Darci (HRSA); Cheatham, Tina (HRSA); Cohen, Rima (HHS/IOS); Weeden, C'Reda
(HHS/IOS)
Subject: Re: Note to Anne Filipic

Hi Marcia,
Thanks for this. I do not have any edits. I am also looping in Rima and C'Reda who were reviewing the
comments on Friday, in case they have any suggestions.
Thanks,
Anne

From: Brand, Marcia (HRSA)

To: Filipic, Anne (HHS/OS/IGA)
Cc: Eswein, Darci (HRSA); Cheatham, Tina (HRSA)
Sent: Fri Apr 09 17:11:452010
Subject: FW: Note to Anne Filipic

Good Evening Anne,

I have attached Dr, Wakefield's talking points for Monday's Health Care Session in New Orleans.
Dr. Wakefield would like to be sure that she has adequately covered HHS's successes to date and
developments under health care reform in her remarks on community health care delivery. Please
let us know if there are any activities and talking points from other agencies that we need to
include .

Thank you for your help.

Marcia
 Obtained via FOIA by Judicial Watch, Inc.

From: Eilipie Anne (aS)

To: Brand Marcia (HRSA)
Cc: Eswein. Darei (HRSA); Cheatham. Jjna (HRSA); Cohen. Rima (aS); Weeden. C"Reda (aS)
Subject: Re: Note to Anne Eilipie
Date: Sunday, April 11, 2010 7:42:16 AM

Hi Marcia,
Thanks for this. I do not have any edits. I am also looping in Rima and C'Reda who were reviewing the
comments on Friday, in case they have any suggestions.
Thanks,
Anne

From: Brand, Marcia (HRSA)

To: Filipic, Anne (HHS/OS/IGA)
Cc: Eswein, Darci (HRSA); Cheatham, Tina (HRSA)
Sent: Fri Apr 09 17:11:452010
Subject: FW: Note to Anne Filipic

Good Evening Anne,

I have attached Dr. Wakefield's talking points for Monday's Health Care Session in New Orleans.
Dr. Wakefield would like to be sure that she has adequately covered HHS's successes to date and
developments under health care reform in her remarks on community health care delivery. Please
let us know if there are any activities and talking points from other agencies that we need to
include.

Thank you for your help.

Marcia
 Obtained via FOIA by Judicial Watch, Inc.

From: Empie. Anne (OS)

To: B@nd. Marcia (HRSA)
Cc: Cheatham. Tina CHRSA); Eswein. Darci CHRSA); Wakefield. Mary CHRSA); Shoushtarj. Christiana (HRSA)
Subject: Re: Note to Anne Filipie
Date: Sunday, April 11, 2010 7:54:33 AM

It would be great if Don could attend that part but Dr. Wakefield had said earlier in the week that she
would likely miss this section due to flight schedule, so we do not have her playing an active role.
Marge Petty, Region VI Regional Director, will report back to the group on the health care session.

----- Original Message -----

From: Brand, Marcia (HRSA)
To: Filipic, Anne (HHS/OS/IGA)
Cc: Cheatham, Tina (HRSA); Eswein, Darci (HRSA); Wakefield, Mary (HRSA); Shoushtari, Christiana
(HRSA)
Sent: Sun Apr 11 07:47:32 2010
Subject: RE: Note to Anne Filipic

Anne, the last item on the agenda is a closing session. Perhaps I missed this before, but what is the
expectation for Drs. Wakefield and Weaver?

Closing Session and Lessons Learned from Working Sessions (closed press)
Location: InterContinental Hotel
444 Saint Charles Avenue, New Orleans
(504) 525-5566
Room: Pelican I

Lead Staff Shoshanna Lew:

WE will need designated people from each of the agencies to run this session. They will present at this
time outcomes from their breakout sessions. Mayor Elect Landrieu will be present at this even as will
Congressman Cao.

From: Filipic, Anne (OS)

Sent: Sunday, April 11, 2010 7:40 AM
To: Brand, Marcia (HRSA)
Cc: Eswein, Darci (HRSA); Cheatham, Tina (HRSA); Cohen, Rima (OS); Weeden, C'Reda (OS)
Subject: Re: Note to Anne Filipic

Hi Marcia,
Thanks for this. I do not have any edits. I am also looping in Rima and C'Reda who were reviewing the
comments on Friday, in case they have any suggestions.
Thanks,
Anne

From: Brand, Marcia (HRSA)

To: Filipic, Anne (HHS/OS/IGA)
Cc: Eswein, Darci (HRSA); Cheatham, Tina (HRSA)
Sent: Fri Apr 09 17:11:452010
Subject: FW: Note to Anne Filipic

Good Evening Anne,

 Obtained via FOIA by Judicial Watch, Inc.

I have attached Dr. Wakefield's talking points for Monday's Health care Session in New Orleans. Dr.
Wakefield would like to be sure that she has adequately covered HHS's successes to date and
developments under health care reform in her remarks on community health care delivery. Please let
us know if there are any activities and talking points from other agencies that we need to include.

Thank you for your help.

Marcia
 Obtained via FOIA by Judicial Watch, Inc.

From: Wakefield Mary CHRSA)

To: Cheatham, Tina CHRSA)
Subject: Fw: HHS Health Reform Direct Hire Authority Guidance
Date: Monday, May 03, 2010 7:58:45 PM
Attachments: HHS OHR Health RefOrm Direct Hire AuthQrlty Gllidance Memo 05032010,pdf
HHS DHA HR Operations Guidance OS032010,pdf
OPM DHA Approval Memo 03232010,pdf

Just fyi

From: Wells, Denise (OS)

To: Holland, Ned (OS); Nazario, Carmen R (ACF); Hansell, David (ACF); Hardy, Tony L (ACF); Clancy,
Carolyn M (AHRQ); Kendrick, Kathleen (AHRQ); Greenlee, Kathy (AoA); Berger, Dan P (AoA); Wren,
John (AoA); Noonan, Robert (OS); Pereira, Segundo (OS); Kelsey, Howard D (OS); Bartley, PaulS
(PSC); Wells, Denise (OS); Harris, Antonia T (OS); Hurst, Terry (PSC); Carleton, Michael (OS); Teeter,
John (OS); Novy, Steve (OS); Seshamani, Meena (OS); Murray, Ellen (HHS/ASFR/IO)
<Ellen,Murray@hhs,gov>; Turman, Richard (OS); Cochran, Norris (OS); Cash, Lester (OS); Williams,
Dennis (OS); Gunderson, Nancy J (OS); Ridgely, Debbie H, (OS); Palm, Andrea (OS); Clark, Barbara
(OS); Engel, Elizabeth (OS); Sorian, Richard (HHS/ASPA/IO) <Richard.Sorian@hhs.gov>; Backus, Jenny
(OS); Kohan, Behnaz (OS); Moulds, Donald (OS); Scanlon, Jim (OS); Lurie, Nicole (OS); Parker, Gerald
(OS); Trent, Brian (OS); Frieden, Thomas (CDC); Nichols, William p, (CDC); Kelley, Alexia (OS);
Tavenner, Marilyn (CMS/OA) <Marilyn.Tavenner@cms.hhs.gov>; Frizzera, Charlene (CMS); Weber,
James W (CMS); Tobias, Constance (OS); Hamburg, Margaret A (FDA); Sharfsteln, Joshua (FDA);
Abbott, Russell J (FDA); Holden, Kimberly A (FDA); Wakefield, Mary (HRSA); Morford, Tom (HRSA);
Brand, Marcia (HRSA); Dioguardi, Paul (OS); Filipic, Anne (OS); Wolff, Kate (OS); BratCher-Bowman,
Nikki (OS); Roubideaux, Yvette (IHS); Grinnell, Randy E (IHS); McSwain, Robert G. (IHS); Annette,
Kathleen R (IHS); Corr, Bill (OS); Petrou, Laura (OS); Mitchell, Samuel (OS); Lambrew, Jeanne (OS);
Cohen, Rima (OS); Hughes, Dora (OS); Monahan, John (OS); Smalls, Dawn (OS); Barson, Emily (OS);
McCauley, Mike (OS); Collins, Francis (NIH/OD) [E); Barros, Colleen (NIH/OD) [E); Major, Chris
(NIH/OD) [E); Carver, Galen P. (CDC); Verdugo, Georgina (OS); Steinberg, Gary A (OS); Claypool, Henry
(OS); Cade, David (OS); Choe, Ken (OS); Daulaire, Nils (HHS/OGHA) <Nils,Daulaire@hhs.gov>; Serrano,
Christina (OS); Trevino, Eben H (OS); Levinson, Dan R (OIG); Chiedi, Joanne (OS); Goldberg, Larry J
(OIG); Cummings, Abigail L (OIG); Griswold, Nancy (HHS/OMHA HQ) <Nancy,Griswold@hhs.gov>;
Price-Detherage, Maria (OS); Velasco, Robert (OS); Blumenthal, David (OS); Handley, Elisabeth (OS);
Koh, Howard (OS); Kretschmaier, Michon (OS); Jones, Wanda K (OS); Benjamin, Regina M (OS);
Lawrence, Arthur J (OS); Hyde, Pam (SAMHSA/IOA) <Pam,Hyde@SAMHSA.hhs.gov>; Broderick, Eric
(SAMHSA); Parry, Elaine (SAMHSA); Hovencamp, Jennifer A. (IHS)
Cc: Sellers, Angela (ACF) (CTR) <Angela.Sellers@ACF.hhs.gov>; Industrious, Shenlka L (ACF); Yates,
Michelle L (ACF); Kirkland, Sheryl A (ACF); Henry, Diana (AHRQ); Toven, Jay P (AHRQ); Green, Timothy
M (AoA); Munz, Jennifer (HHS/ASA) <Jennifer.Munz@hhs.gov>; Bennett, Jean M (OS); Duncan,
Constance (OS); Randall, Clarence (OS); White, Helen (OS); DLlckett, Rose M (OS); Reiser, Margaret
(OS); Bridges, Alyce (OS); Williams, Teresa (CDC); Citron, Jamison (OS); Kim, Theodore (OS); Ramos,
Merly (FDA); Burns, Kathleen J (FDA); Ponton, Wendy (HRSA); Gazdik, Tanya (HRSA); Harper, Bernice
(OS); Hoppman, Sharon K, (IHS); Hsu, Irene (OS); Lapan, Jarel (OS); Lusi, Rose (OS); Williams,
Rasheed (OS); Flowers, Susan (NIH/OD) [E); Allen, Gail (NIH/OD) [E); Irby, Gwendolyn (OS); Solkowski,
Lauren (OS); Collick, Vontina (OS); Niakan, Bahar (OS); Graham, Duwayne 5 (OS); Wright, Natarsha
(OS); Pad berg , Jo Anne 5 (OlG); Diggs, Patricia (OS); Bembo, Dinah (OS); Bonome, Tomas A (OS);
Gershman, Debbie (OS); Crump, Debbie (SAMHSA); Formoso, Paula (OS)
Sent: Mon May 03 19:39:45 2010
Subject: HHS Health Reform Direct Hire Authority Guidance

HHS Leadership Team,

The attached memorandum and supporting documentation provide guidance on the use of the Health
Reform Direct Hire Authority, Please
let me or Toni know if you need additional information or assistance, The HR Service Center staff are
prepared to handle customer inquiries as well.
 Obtained via FOIA by Judicial Watch, Inc.

Have a great evening,

Denise

Denise L. Wells
Deputy Assistant Secretary
Office of Human Resources
u.s. Department of Health and Human Services
Assistant Secretary for Administration
Hubert H. Humphrey Building, Ste 801 Rm 22
200 Independence Ave, S.W.
Washington, D.C. 20201-0001
(202) 690-6191 - office
Denjse,Wells@hhs goy
 Obtained via FOIA by Judicial Watch, Inc.

Office ofthe Secretary

Assistant Secretary for Admlnlstratlo/l

Office of Human Resources

May 3,2010

MEMORANDuM

To: Operating and Staff Division Heads

. ...
Subject: Health Refonp. Direct Hire Authority Guidance
~'

o~ March 23, 2010, the Office of Personnel Management (OPM) approved the Depllrtment's
,request for direct-hire authority (DHA) to support the Adm.inistration's Health Care Rt?form .
initiative. The DHA ~san extremely valuable human capital recruitment tool which allows the
agency to make offers to candidates outSIde of the traditiqnai hiring process. OPM approved the
use of-this autMrity through September 30, "2010 to meet our immediate critical hiring needs.

Effective immediately, Operating and Staff Divisions are approved to use the DIlA in filling
:positions;directly related to Health Reform operations. For auditing purpo~es, OPM has mandated
that all Health Reform hires be coded separately in the Departni'ent's personnel database. To
ensure full co~pliance in the .imp~ementation of the DHA: please Communicate to ~~l hir~ng
managers the tmportance oflumt1tlg the (JS~ ofthe authorIty to Health Reform pOSItions only;

,Please note the,Office of Human Resources will be tracking th~ Departmental hires acr!Jss the
various series and grades to ensure we don't exceed the OPM approved allocations by position. As
we monitor the DHA hiring pr()Cess, we will alert OPM if additional allocations are required for a
partieuJar approved position. Since OHR is tracking all hires .at the Departnientallevel, OPDIVS
and ~TAFFDIVS will not receive separate BHA.allocations by position, but may proceed/with
.hiring
, across.a11 DHA. position categories as appropdate. . .

As'y~u quickiy move forward to address human capital needs within your respective organizations,
please keep in mind ~e Secretary's two percent goal to incre~e the num~er of persons with
. targeted disabilities in the workforce by December'31,.2010artd the shared commitment across the.
Dep.artment to biring veterans. Also, in keeping with diversity. goals, managers are encouraged to
expand efforts in term.s ofID.spailic hires.

Attached you yviU fmd a copy of the DHA approval from OPM and operational guidance on how
, DHA will be implemented: l \

'- If you have any questions regarding the memo, please contact me or Antonia Harris at (202) 690-
6191. Inquiries regarding open announcements should be directed to youf servicing human
resources office. .

<
 Obtained via FOIA by Judicial Watch, Inc.

Department ofHealth and Human Services

Office ofHuman Resources
Client Services Center (CSC)
Direct Hire Authority (DHA) for Health Care Reform

Iposition Descriptions

Standard position descriptions or position descriptions that have already been established will be
used to fill the positions at GS-9-13 grade levels. If necessary, additional position descriptions
will be established to accommodate new or unique GS-14 and GS-15 non-supervisory technical
positions.

IPublic Notice

Vacancy Announcements:

Use of the DHA requires we provide public notice. Vacancy Announcements for the approved
occupations are posted with a closing date to include a cut-off period established for each
specific vacancy announcement.

Note: Public notice or simply posting a vacancy announcement is not a substitute for a strategic
recruitment effort that may be undertaken to fill positions with highly qualified applicants.
Managers are encouraged to utilize a variety of recruitment options and hiring tools when filling
positions.

Supporting Documentation:

All applicants are required to submit supporting documentation as described in the vacancy
announcement. Copies of academic transcripts are required for applicants desiring to substitute
education for specialized experience and for those positions having a positive education
requirement.

ICandidate/Resume Review and Selection

The Human Resources (HR) Specialists will provide hiring managers and/or designated subject
matter experts with applicant resumes for their review and selection. Applicants must meet the
minimum qualification requirements as outlined by the OPM Qualifications Standards. The
Client Services Center staff will determine basic eligibility. Once the Hiring Manager concludes
the interview process and makes their final selections, the HR Specialist will make tentative
offers to the selected candidates and negotiate potential start dates.
 Obtained via FOIA by Judicial Watch, Inc.

Health Care Reform

IName Requests

The primary method of consideration for direct hire appointments is through the electronic
application process. Although use of the electronic staffing system is strongly encouraged,
there may be situations involving critical hiring needs that warrant an exception to the online
application process and require the acceptance of a hard copy application and supporting
documentation. These exceptions may be approved on a case by case basis by the staffing Team
Lead when management has identified candidates or "name requests" who have submitted
resumes. In those instances, the resume and related documentation should be forwarded to your
HR Specialist for review and processing.

IFor more information

Please contact your servicing HR Specialist to request the appropriate list ofDHA candidates
based on your organization's hiring needs. They can also provide you with information on
additional recruitment efforts you may wish to consider in conjunction with the DHA.
 Obtained via FOIA by Judicial Watch, Inc.

UNITED STATES OFFICE OF PERSONNEL MANAGEMENT

Washington, DC 20415

The Director MAR 2 3 2010

Ms. Denise L. Wells

Deputy Assistant Secretary for
Human Resources
Department of Health and I luman Services
Washington, DC 20201

Dear Ms. Wells:

By this letter, the Office of Personnel Management (OPM) is approving direct-hire

appointing authority (DHA) for positions at the Department of Health and Human
Services (HHS) necessary to support the Hea lth Care and Education Affordability
Reconciliation Act of2010 (the Aet). This DHA is authorized for the remainder ofFY
2010 to assist HHS in meeting urgent staffing and implementation needs resulting fl'om
enactment of the Act.

By regulation, aPM may decide independently that a critical hiring need exists. Upon
review of the Act and in consultation with HHS, I have determined that DHA is
warranted under the criteria of 5 CFR 337 .20S(b), as set forth below, for the remainder of
this fiscal year in connection with HHS's work in support of the Act.

(1) Idenf(/icalion of the positions that musl be filled. HHS has a critical need to fill
1,814 positions this fiscal year to implement the Act, as described below:

Title Series/Grade Positions

Level
Social Science Analyst/Specialist GS-J 01-9115 59
Health Insurance Specialist GS-l 07 -9115 350
Administrative and Program Specialist GS-301-9/J5 55
Program AnalystiManallement Analyst GS-343-9/15 235
Accountant GS-SI0-9/15 40
Dental Officer GS-680-11/14 90
Public Health Advisor/Analyst GS-68S-91l4 291
Consumer Safety Officer GS-696-9/13 261
Grants Management Specialist GS-IIOI-9/15 92
Criminal Investigator GS-1811-9/13 50
Information Technology Specialist GS-2210-9/1S 291
Total: 1814

(2) Description oj the event or circumstance that created the need to fill the positions.
HHS is charged with carrying out the President's top Administration priority, as

www.opm .gov Our mission is 10 ensure the Federal Governmenthas an effective civilian workforce www.usajobs.gov
 Obtained via FOIA by Judicial Watch, Inc.

Ms. Denise L. Wells 2

described in the Act. The Act has greatly expanded the mission at HI-IS. To put
in place the infrastructure needed to meet the mission requirements that result
from the new law, HHS must fill 1,814 positions in FY 20 10.

HHS must hire quickly in order to execute the President's directive with respect
to implementing health care refOlm. HHS is required to execute the following
statutory obligations in the short-term :

Improvements to Medicare Part D for Prescription Drug Plans - The Secretary

makes determinations July I, 20 I O-December 31, 2010; Sec. 3301, page 923-
924, line 20.

Making Senior Housing Facility Demonstration Pemlanent - demonstration

project established by the Secretary effective January 1,20 I aand applicable
to plan years beginning on or after such date. Sec. 3208, page 920, line 12.

Hospital Wage lndex Improvement (extension of Section 508 Hospital

Reclassifications). The Secretary must use particular wage index during fiscal
year 2010. Sec. 3137, page 858-859, line 8.

Health Care Quality Improvement. The Secretary shall provide for the
transfer, from Federal Hospital Insurance Trust Fund to the Centers for
Medicare and Medicaid Services Program Management for each fiscal year
2010 through 2014; Sec. 931, page 702-717, line 17.

Interagency Working Group on Health Care Quality to collaborate, cooperate,

and consult between Federal departments and agencies with respect to
developing and disseminating strategies, goals, models, and timetables that are
consistent with national priorities. Report to Congress NLT December 31,
2010. Sec. 3012, page 699-701, line 21.

Other requirements, for which HHS needs additional staffimmediately include:

Tax changes related to health insurance and to financing health reform;

Long-term care; extending Medicaid fiscal funds for a demonstration
program upon enactment through September 2016;
Changes to private insurance through the establishment of an internet
website portal with standard format to help state residents identify and
compare coverage options as well as expand to include small business, and
the establishment of a temporary high-risk pool with option to provide
through provision of funds to states for health coverage to individuals with
preexisting conditions;
Provide dependent coverage for children up to age 26 for all individual and
group policies;
 Obtained via FOIA by Judicial Watch, Inc.
... - -. . . . .. . .

Ms. Denise L. Wells 3

Prohibit pre-existing condition exclusion for children; and

Prohibil individual and group health plans from placing lifetime limits or
unreasonable annual limits and prohibit rescission.
Establish a national strategy to improve the delivery of health care services,
patient health outcomes, and population health. This work must be
completed on an annual basis.
Increase work force supply and support training of health professionals
through scholarship and loans. Support primary care, establish public
health workforce loan repayment program, promote training of a diverse
workforce, and promote cultural competence training of health care
professional s
Establish community health insurance options. This \vork must be
completed annually, a study must be conducted, and a report made to
Congress.
Identify lllTent State practices (hat proltibit payment for health care
acquired conditions and incorporat the practices identified or lements of
stich practices which 1he Secretar determines appropriut ror application
to the Medi aid program in regulations effective July 1 2011' e ec.
2702, page 520, line 21 of the Act.
The Secretary of HHS must develop and maintain a complaint system that
is widely known, easy to use, to collect, and maintain infom1ation on
prescription drug complaints; Secretary must develop a complaint form and
place on the HHS website, as well as, submit arumal reports to Congress;
see Sec. 3311, page 945, line 12 of the Act.

HHS will also oversee initiatives where required for all individuals to have
insurance, establish a ne\-v health insurance exchange, require most employers to
provide insurance, and ban insurance companies from denying coverage because
of pre-existing conditions and more.

(3) Spec!ficafion of/he duration for "t'hieh the critical hiring need is expected fo exist.
OPM anticipates this critical hiring need will exist through September 30,2010.
OPM expects HHS to use other hiring authorities to meet staffing needs in support
of the Act in FY 20 II and beyond.

(4) Evidence that demonstrates why the use of other hiring authorities is impractical
or ineifective. Use of traditional hiring authorities is impractical given the scope of
the changes to current law that need to be implemented and HHS's need to begin
implementing the provisions of the Act immediately.

HHS continues to make use of the following appointment authorities: Career and
Career-Conditional Appointments, Excepted Service Appointments, Veterans
Recruitment Appointments, Veterans Employment Opportunity Authority,
 Obtained via FOIA by Judicial Watch, Inc.
- .... - -- _. . . -

Ms. Denise L. Wells 4

Disabled Appointing Authority, and the 30% DisabJed Veterans Appointing

Authority. Even with the availability of these authorities, HHS needs DHA in
order to meet this critical hiring need during the remainder of FY 2010 in support
of the Act.

Based on the above, your authority reads:

HHS-OOI issued on the date of this letter to fill 1,814 mission critical positions at the
GS-9 through GS-IS grade levels (or equivalent) as depicted above natiomvide. This
authority is based on a critical hiring need in support of the Health Care and Education
Affordability Reconciliation Act 01'2010. This authority expires on September 30,
2010.

Using this DHA

For the remainder of this fiscal year, HHS may give individuals in the occupational series
shown above competitive service career, career-conditional, tenn, or temporary
appointments. as appropriate, without regard to provisions of 5 U .S.c. 3309-3318 or 5
CFRpart 211 and part 337, subpart A.

These appointments are subject to public notice requirements in 5 U.S.c. 3327, 3330 and
5 CFR 330, subpart G, and requirements in 5 CFR 332.402.

In addition, HHS must comply with all relevant laws unless HHS is exempted from sllch
laws pursuant to 5 U.S.C. 3304a(3). Qualified candidates with veterans' preference
should be selected as they are found, just as any qualified non-preference eligible
candidate would be. I recommend you take particular care in conducting pre-
employment background investigations to ensure candidates are suitable for Federal
employment, may be credentialed in accordance with Govenmlentwide credentialing
standards and can hold a security clearance at the appropriate level (if required for the
particular position).

OPM Oversight

HHS must use two authority codes when documenting personnel actions using the direct
hire authority. The first code "A YM" automatically fills in "Reg. 337.201" on the
Notification of Personnel Action, Standard Form 50. The second authority code "BYO"
identifies HHS use of this agency-specific authority. Using these two authority codes
will help OPM evaluate the use of these authorities without requiring agency reports.

On a periodic basis aPM will determine if continued use is supportable. OPM will
monitor HHS use of this authority as well as the continued need for it, and may modify or
telminate this authority as appropriate.
 Obtained via FOIA by Judicial Watch, Inc.

Ms. Denise 1. Wells 5

I am confident this authority will help you to fill the mission critical positions identified
for the Department of Health and Human Services to comply with the Health Care and
Education Affordability Reconciliation Act of201 O. This authority will provide HHS
with the means to meet hiring needs in support of the Act. Please contact Ms. Darlene
Phelps at (202) 606~ 1730 for any additional questions or assistance.

Sincerely,

\ev ~
d r
J hn Berry
ireclor

Wt r1:-w-fJ. ~\ ~
~~~
~~~f~ '
 Obtained via FOIA by Judicial Watch, Inc.

From: Wakefield Mary (HRSA)

To: Cheatham TIna (HRSA)
Subject: Fw: Health Reform: Dependent Coverage Reg
Date: Monday, May 10, 2010 9:47:50 AM
Attachments: FACT SHEET. pdf
o AND A pdf

From: Santillo, Jessica (OS)

To: Adelman, Rebecca (OS); Angoff, Jay (HHS/OCIIO) <Jay.Angoff@hhs.gov>; Backus, Jenny (OS);
Baker, Judy (HHS/IGA); Barson, Emily (OS); Belton, Ben F. (SAMHSA) <Ben.Belton@SAMHSA.hhs.gov>;
Benjamin, Regina M (OS); Blum, Jonathan D (CMS); Blumenthal, David (OS); Brooks-laSure, Chiquita
(HHS/OHR) <Chiquita.Brooks-LaSure@hhs.gov>; Buchanan, Keagan (AoA); Budetti, Peter (CMS/OA)
<Peter.Budetti@CMS.hhs.gov>; Childress, Mark (HHS/OGC) <Mark.Chiidress@hhs.gov>; Choe, Ken
(OS); Choucair, Jordana (OS); Clancy, carolyn M (AHRQ); Claypool, Henry (OS); Cohen, Rima (OS);
Collins, Francis (NIH/OD) [E]; Corr, Bill (OS); Cruz, Gustavo (HHS/IOS) <Gustavo.Cruz@hhs.gov>;
Cuevas, Fatima (OS); Daulaire, Nils (HHS/OGHA) <Nils.Daulaire@hhs.gov>; Davis, Damon (OS); Davis,
Daniel (OS); Dioguardi, Paul (OS); Drobac, Krista (HHS/OCIIO) <Krista.Drobac@hhs.gov>; Eisman, Julia
(HHS/ASPA) <Julia.Eisman@hhs.gov>; Elmer, Stacy (OS); Engel, Elizabeth (OS); Filipic, Anne (OS);
Fischer, Mariestella (OS); Fitzgerald, Erin (OS); Fluker, Dean (OS); Frank, Richard (OS); Frieden, Thomas
(CDC); Gosselin, Peter (HHS/ASPE) <Peter.Gosselin@hhs.gov>; Granholm, 11m (OS); Greenberg, Mark H
(ACF); Greenlee, Kathy (AoA); Greenlee1, Kathy (AoA); Grossi, Joanne (HHS/IGA)
<Joanne.Grossi@hhs.gov>; Hager, Christie (HHS/IGA/ORD) <Christie.Hager@hhs.gov>; Hall, Amy
(CMS); Hallberg, Berit (OS); Halle, Michael (OS); Hansell, David (ACF); Harris, David (HHS/ASPE/HSP)
<David.Harris@hhs.gov>; Holland, Ned (OS); Horowitz, David (HHS/OGC); Howard, Sally (OS); Hsu,
Irene (OS); Hughes, Dora (OS); Hunter, Sarah (ACF); Hyde, Pam (SAMHSA/IOA)
<Pam.Hyde@SAMHSA.hhs.gov>; Jackson, Nat (OS); jmsharf1 <jmsharf1@fda.hhs.gov>; Johnson,
Susan (HHS/IGA) <SusanJohnson@hhs.gov>; Kelley, Alexia (OS); Kelley, Jeffrey (ACF); Kidwell, Lauren
K (OS); Koh, Howard (OS); Kriss, carolyn (ACF); Kronick, Richard (HHS/ASPE/HP)
<Richard.Kronick@hhs.gov>; Lambrew, Jeanne (OS); Lapan, Jarel (OS); Lewis, caya B. (CMS/OA)
<Caya.Lewis@CMS.hhs.gov>; Lewis, Sharon (ACF/ ADD) <Sharon.Lewis@ACF.hhs.gov>; Lombardi, Joan
(ACF); Lurie, Nicole (OS); Mann, Cynthia (CMS); Mart~ no, Bethany R. (FDA)
<beth.martino@fda.hhs.gov>; McCall, Jessica (OS); McCauley, Mike (OS); McNearney, Joe (OS);
Mitchell, Samuel (OS); Monahan, John (OS); Moore, Jesse (ACF); Morales, Esther F (ACF); Moulds,
Donald (OS); Mulligan, Jaime E (CMS); Murray, Ellen (HHS/ASFR/IO) <ElIen.Murray@hhs.gov>; Nazario,
carmen R (ACF); Negash, Eskinder (ACF); Nino, Teresa (CMS); Noonan, John (ACF); Nowinski, Juleigh
(HHS/OS/OPHS/ASH) <Juleigh.Nowinski@hhs.gov>; Padilla, Cindy (AoA/IOAS); Palm, Andrea (OS);
Papas, Nicholas W (OS); Parisi, Julie (OS); Park, Todd (OS); Parrott, Sharon (OS); Petrou, Laura (OS);
Petty, Marjorie (HHS/IGA) <Marjorie.Petty@hhs.gov>; pfohl, Shellie (HHS/OPHS/PCPS)
<Shellie.pfohl@hhs.gov>; Pollitz, Karen (HHS/OCIIO) <Karen. Pollitz@hhs.gov>; Rivas-Vazquez, Vicki A
(OS); Rodgers, Anthony D. (CMS/OA) <Anthony.Rodgers@CMS.hhs.gov>; Rosero, Luis (OS);
Roubideaux, Yvette (IHS); Rudisill, Shannon (ACF); Salatti, Acacia (OS); Salazar, Marguerite (HHS/IGA)
<Marguerite.Salazar@hhs.gov>; Salcido, Dori (OS); Samuels, Bryan (ACF); Sanchez Fuentes, Yvette
(ACF); Santillo, Jessica (OS); Sarver, Justine (OS); Schoen holtz, Ari (HHS/CFBNP)
<ArLSchoenholtz@hhs.gov>; Schultz, Herb (HHS/IGA/ORD) <Herb.Schultz@hhs.gov>; Seshamani,
Meena (OS); Shapiro, Jonathan (OS); Simon, Michael (OS); Smalls, Dawn (OS); Smith, Barbara (OS);
Smolonsky, Marc (OS); Sorian, Richard (HHS/ASPA/IO) <Richard.Sorian@hhs.gov>; Sparks, Ullfan
(ACF/OC/ANA) <Lll lian.Sparks@ACF.hhs.gov>; Springfield, Aprilt (OS); Steiger, Douglas (OS); Suvor,
Daniel (OS); Tavenner, Marilyn (CMS/OA) <Marilyn.Tavenner@CMS.hhs.gov>; Taylor, Bridgett (OS);
Teater, Duncan (OS); Thomas, Cristal (HHS/IGA/ORD) <CristaI.Thomas@hhs.gov>; Tobias, Barbara
(HHS/IOS) <Barbara.Tobias@hhs.gov>; Torres, Jaime (HHS/IGA/ORD) <Jaime.Torres@hhs.gov>;
Turetsky, Vicki (ACF); Verdugo, Georgina (OS); Wakefield, Mary (HRSA); Weeden, C'Reda (OS); Widger,
Ann (HHS/IGA) <Ann.Widger@hhs.gov>; Wolff, Kate (OS); Yu, Wil (OS)
Sent: Mon May 10 09:36:37 2010
Subject: Health Reform: Dependent Coverage Reg

Attached please find a fact sheet and q and a on the dependent coverage regulation released today
(allowing young adults under 26 to stay on their parents coverage). These documents can also be
 Obtained via FOIA by Judicial Watch, Inc.

found on HealthReform.gov. The reg can be found at: http:lLwww.hhs gov/ocjjo/regulatjons/jndex html

Jessica Santillo
Communications Director for Strategy and Policy
U.S. Department of Health and Human Services
202-690-7263 (0)
202-573-1119 (c)
Jessjca.Santillo@hhs goy
 Obtained via FOIA by Judicial Watch, Inc.

Young Adults and the Affordable Care Act:

Protecting Young Adults and Eliminating Burdens on Businesses and Families

Q: How does the Affordable Care Act help young adults?

A: Before the President signed the Affordable Care Act into law, many health plans and issuers could remove
adult children from their parents' policies because of their age, whether or not they were a student or where
they lived. The Affordable Care Act requires plans and issuers that offer dependent coverage to make the
coverage available until the adult child reaches the age of 26. Many parents and their children who worried
about losing health insurance after they graduated from college no longer have to worry.

Q: What plans are required to extend dependent coverage up to age 26?

A: The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage
available until a child reaches the age of 26. Both married and unmarried children qualify for this coverage.
This rule applies to all plans in the individual market and to new employer plans. It also applies to existing
employer plans unless the adult child has another offer of employer-based coverage (such as through his or
her job). Beginning in 2014, children up to age 26 can stay on their parent's employer plan even if they have
another offer of coverage through an employer.

Q: I'm a young adult under the age of 26 and I'm on my parents plan now, but I'm scheduled to lose
coverage soon. How can I keep my health insurance?

A: You have a number of options. Firstcheck with your insurance company. Private health insurance
companies that cover the majority of Americans have volunteered to provide coverage for young adults losing
coverage as a result of graduating from college or aging out of dependent coverage on a family policy. This
stop-gap coverage, in many cases, is available now. Second, watch for open enrollment. Young adults may
qualify for an open enrollment period to join their parents' family plan or policy on or after September 23, 2010.
Insurers and employers are required to provide notice for this special open enrollment period. Watch for it or
ask about it. Finally, expect an offer of continued enrollment for plans that begin on or after September 23,
2010. Insurers and employers that sponsor health plans will inform young adults of continued eligibility for
coverage until the age of 26. Young adults and their parents need not do anything but sign up and pay for this
option.

Q: I'm under the age of 26, and I used to be on my parents' plan, but I recently lost this coverage
because I graduated from college. Can I get coverage?
 Obtained via FOIA by Judicial Watch, Inc.

A: Yes. Check with your insurance company to see if they will provide that coverage to you now. If not, watch
for the special open enrollment period and sign up then .

Q: Now that the regulation is published, are plans required to immediately enroll eligible young adults
in their parents' plan?

A: No. The law says that the extension of dependent coverage for children is effective for plan years
beginning on or after 6 months after the enactment of the law - that means plan years beginning on or after
September 23,2010. However, the Administration has urged insurance companies and employers to prevent
a gap in coverage for young adults aging off of their parents' policy prior to this effective date. To date, over
65 insurers have volunteered to do so. You should check with your insurance company or employer to see if
they are offering this coverage option.

Q: Will young adults be given a special chance to enroll after September 23, 2010?

A. Yes. For plan or policy years beginning on or after September 23,2010, plans and issuers must give
children who qualify an opportunity to enroll that continues for at least 30 days regardless of whether the plan
or coverage offers an open enrollment period. This enrollment opportunity and a written notice must be
provided not later than the first day of the first plan or policy year beginning on or after September 23,2010.
Some plans may provide the opportunity before September 23,2010

Q: Will young adults have to pay more for coverage or accept a different benefit package?

A: Any qualified individual must be offered all of the benefit packages available to children who did not lose
coverage because of loss of dependent status. The qualified young adult cannot be required to pay more for
coverage than similarly situated individuals who did not lose coverage due to the loss of dependent status.

Q: Can plans or issuers who offer dependent coverage continue to impose limits on who qualifies
based upon financial dependency, marital status, enrollment in school, residency or other factors?

A: No. Plans and issuers that offer dependent coverage must provide coverage until a child reaches the age
of 26. There is one exception for group plans in existence on March 23, 2010. Those group plans may
exclude adult children who are eligible to enroll in an employer-sponsored health plan, unless it is the group
health plan of their parent. This exception is no longer applicable for plan years beginning on or after January
1, 2014.

Q: Does the adult child have to purchase an individual policy?

A: No. Eligible adult children wishing to take advantage of the new coverage will be included in the parents'
family policy.

Q: Will Medicare cover adult children in the same way that private health insurance will?

A: No. The provision does not apply to Medicare.

Q: Are both married and unmarried young adults covered?

A: Yes
 Obtained via FOIA by Judicial Watch, Inc.

Q: Are plans or issuers required to provide coverage for children of children receiving the extended
coverage?

A:No

Q: Why is there a special exception for group plans in existence on March 23, 2010?

A: Our goal is to cover as many young adults under the age of 26 as possible with the least amount of burden.
If a young adult is eligible to purchase other employer-based health insurance such as through her job, the law
does not require the parent or parents' plan to enroll that child if the parents' plan is a grandfathered health
plan (Le., in existence on March 23, 2010) . Of course, all group plans have the option to cover all adult
children until the age of 26 or beyond. In 2014, this exception will no longer apply.

Q: What happens if a young adult under the age of 26 is not eligible for employer-sponsored
insurance and both parents have separate plans that offer dependent coverage?

A: Neither parent's plan can deny coverage.

Q: Does the law apply to plans or issuers that do not provide dependent coverage?

A: No. There is no federal requirement compelling a plan or issuer to offer dependent coverage at this time.
However, the vast majority of group health plans offer dependent coverage and many family policies exist in
the individual market.

Q: Are insurers doing anything to help young adults prior to the September 23 rd implementation date?

A: Secretary Kathleen Sebelius called on leading insurance companies to begin covering young adults
voluntarily before the September 23rd implementation date required by the Affordable Care Act. Early
implementation would avoid gaps in coverage for new college graduates and other young adults and save on
insurance company administrative costs of dis-enrolling and re-enrolling them between May 2010 and
September 23,2010. Many companies have responded including:

Blue Cross and Blue Shield of Alabama

Blue Cross Blue Shield of Delaware
Blue Cross and Blue Shield of Arizona, Inc.
Blue Cross and Blue Shield of Florida
Arkansas Blue Cross and Blue Shield
Blue Cross and Blue Shield of Hawaii
Blue Shield of California
Blue Cross of Idaho Health Service
Regence Blue Shield of Idaho
Well mark Blue Cross and Blue Shield of Iowa
Health Care Service Corporation
Blue Cross and Blue Shield of Kansas
Blue Cross Blue Shield Association
Blue Cross and Blue Shield of Louisiana
WeliPoint, Inc.
 Obtained via FOIA by Judicial Watch, Inc.

CareFirst BlueCross and BlueShield

Blue Cross and Blue Shield of Massachusetts
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Michigan
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Nebraska
Blue Cross &Blue Shield of Mississippi
Horizon Blue Crass and Blue Shield of New Jersey, Inc.
HealthNow New York, Inc.
The Regence Group
Excellus Blue Cross and Blue Shield
Capital BlueCross
Blue Cross and Blue Shield of North Carolina
Independence Blue Cross
BlueCross BlueShield of North Dakota
Highmark, Inc.
Blue Cross of Northeastern Pennsylvania
BlueCrass and BlueShield of Tennessee
Blue Cross and Blue Shield of Vermont
Blue Cross &Blue Shield of Rhode Island
Premera Blue Cross
Blue Cross and Blue Shield of South Carolina
Blue Cross and Blue Shield of Wyoming
Kaiser Permanente
Cigna
Aetna
United
WellPoint
Humana
Capital District Physicians' Health Plan (CDPHP), Albany, New York
Capital Health Plan, Tallahassee, Florida
Care Oregon, Portland, Oregon
Emblem Health, New York, New York
Fallon Community Health Plan, Worcester, Massachusetts
Geisinger Health Plan, Danville, Pennsylvania
Group Health, Seattle, Washington
Group Health Cooperative Of South Central Wisconsin, Madison, Wisconsin
Health Partners, Minneapolis, Minnesota
Independent Health, Buffalo, New York
Kaiser Foundation Health Plan Oakland, California
Martin's Point Health Care, Portland, Maine
New West Health Services, Helena, Mt
The Permanente Federation, Oakland, California
Priority Health, Grand Rapids, Michigan
Scott & White Health Plan, Temple, Texas
Security Health Plan, Marshfield, Wisconsin
Tufts Health Plan, Waltham, Massachusetts
 Obtained via FOIA by Judicial Watch, Inc.

UCARE, Minneapolis, Minnesota

UPMC Health Plan, Pittsburgh, Pennsylvania

Q: I understand that there are tax benefits related to the extension of dependent coverage. Can you
explain these benefits?

A. Under a change in tax law included in the Affordable Care Act, the value of any employer-provided health
coverage for an employee's child is. excluded from the employee's income through the end of the taxable year
in which the child turns 26. This tax benefit applies regardless of whether the plan or the insurer is required by
law to extend health care coverage to the adult child or the plan or insurer voluntarily extends the coverage.

Q: When does this tax benefit go into effect?

A: The tax benefit is effective March 30,2010. Consequently, the exclusion applies to any coverage that is
provided to an adult child from that date through the end of the taxable year in which the child turns 26.

Q: Who benefits from this tax treatment?

A: This expanded health care tax benefit applies to various workplace and retiree health plans. It also applies
to self-employed individuals who qualify for the self-employed health insurance deduction on their federal
income tax return .

Q: May employees purchase health care coverage for their adult child on a pre-tax basis through the
employer's cafeteria plan?

A: Yes. In addition to the exclusion from income of any employer contribution towards qualifying adult child
coverage, employees may pay the employee portion of the health care coverage for an adult child on a pre-tax
basis through the employer's cafeteria plan - a plan that allows employees to choose from a menu of tax-free
benefit options and cash or taxable benefits. The IRS provided in recent guidance [(Notice 2010-38)] that the
cafeteria plan could be amended retroactively up until December 31,2010 to permit these pre-tax salary
reduction contributions.

Q: It seems like plans and insurers can terminate dependent coverage after a child turns 26, but
employers are allowed to exclude from the employee's income the value of any employer-provided
health coverage through the end of the calendar year in which the child turns age 26. This is
confusing.

A. Under the law, the requirement to make adult coverage available applies only until the date that the child
turns 26. However, if coverage extends beyond the 26 th birthday, the value of the coverage can continue to be
excluded from the employee's income for the full tax year (generally the calendar year) in which the child had
turned 26. For example, if a child turns 26 in March but is covered under the employer plan of his parent
through December 31 st (the end of most people's taxable year), the value of the health care coverage through
December 31 st is excluded from the employee's income for tax purposes. If the child stops coverage before
December 31 st, then the premiums paid by the employee up to the time the plan was stopped will be excluded
from the employee's income.

-###-
 Obtained via FOIA by Judicial Watch, Inc.

Young Adults and the Affordable Care Act:

Protecting Young Adults and Eliminating Burdens on Families and Businesses

The Affordable Care Act allows young adults to stay on their parents' health care plan until age
26. Before the President signed this landmark Act into law, many health plans and issuers could
and did in fact remove young adults from their parents' policies because of their age, leaving
many college graduates and others with no insurance. This helps to explain problems like:

Young adults have the highest rate of uninsured of any age group. About 30% of
young adults are uninsured, representing more than one in five of the uninsured. This
rate is higher than any other age group, and is three times higher than the uninsured rate
among children.

Young adults have the lowest rate of access to employer-based insurance. As young
adults transition into the job market, they often have entry-level jobs, part-time jobs, or
jobs in small businesses, and other employment that typically comes without employer-
sponsored health insurance. The uninsured rate among employed young adults is one-
third higher than older employed adults.

Young adults' health and finances are at risk. Contrary to the myth that young people
don't need health insurance, one in six young adults has a chronic illness like cancer,
diabetes or asthma. Nearly half of uninsured young adults report problems paying
medical bills.

Providing Relief for Young Adults

The Affordable Care Act requires plans and issuers that offer coverage to children on their
parents' plan to make the coverage available until the adult child reaches the age of26. Many
parents and their children who worried about losing health insurance after the children moved
away from home or graduated from college no longer need to worry.

The Departments of Health and Human Services, Labor, and Treasury have issued regulations
implementing the Affordable Care Act by expanding dependent coverage for adult children up to
age 26. Key elements include:

Coverage Extended to More Children. The goal of this new policy is to cover as many
young adults under the age of26 as possible with the least burden. Plans and issuers that
 Obtained via FOIA by Judicial Watch, Inc.

offer dependent coverage must offer coverage to enrollees' adult children until age 26,
even if the young adult no longer lives with his or her parents, is not a dependent on a
parent's tax return, or is no longer a student. There is a transition for certain existing
group plans that generally do not have to provide dependent coverage until 2014 if the
adult child has another offer of employer-based coverage aside from coverage through
the parent. The new policy providing access for young adults applies to both married and
unmarried children, although their own spouses and children do not qualify.

Effective for Plan or Policy Years Beginning On or After September 23, 2010.
Secretary Kathleen Sebelius called on leading insurance companies to begin covering
young adults voluntarily before the implementation date required by the Affordable Care
Act (which is plan or policy years beginning on or after September 23 rd). Early
implementation would avoid gaps in coverage for new college graduates and other young
adults and save on insurance company administrative costs of dis-enrolling and re-
enrolling them between May 2010 and September 23,2010. Over 65 companies have
responded to this call saying they will voluntarily continue coverage for young adults
who graduate or age off their parents' insurance before the implementation deadline.

All Eligible Young Adults Will Have A Special Enrollment Opportunity. For plan or
policy years beginning on or after September 23,2010, plans and issuers must give
children who qualify an opportunity to enroll that continues for at least 30 days regardless
of whether the plan or coverage offers an open enrollment period. This enrollment
opportunity and a written notice must be provided not later than the fIrst day of the fIrst
plan or policy year beginning on or after September 23,2010. The new policy does not
otherwise change the enrollment period or start of the plan or policy year.

Same Benefits/Same Price. Any qualifIed young adult must be offered all of the benefIt
packages available to similarly situated individuals who did not lose coverage because of
cessation of dependent status. The qualifIed individual cannot be required to pay more
for coverage than those similarly situated individuals. The new policy applies only to
health insurance plans that offer dependent coverage in the fIrst place: while most
insurers and employer-sponsored plans offer dependent coverage, there is no requirement
to do so.

Access to Insurance: What Young Adults and Parents Need to Do:

Check for Immediate Options: Private health insurance companies that cover the
majority of Americans have volunteered to provide coverage earlier than the
implementation deadline for young adults losing coverage as a result of graduating from
coIlege or aging out of dependent coverage on a family policy. This stop-gap coverage,
in many cases, is available now. Ask your employer and insurer about this option.

Watch for Open Enrollment: If early coverage is not an option with your employer or
insurance company, then young adults will qualify for an open enroIlment period to join
their parents' family plan or policy beginning on or after September 23,2010. Insurers
 Obtained via FOIA by Judicial Watch, Inc.

and employers are required to provide notice for this special open enrollment period.
Watch for it or ask about it.

Expect an Offer of Continued Enrollment: Insurers and employers that sponsor health
plans will inform young adults of continued eligibility for coverage until the age of26.
To get the coverage, young adults and their parents need not do anything but sign up and
pay for this option.

New Tax Benefits for Adult Child Coverage

The new regulation complements guidance issued by the Treasury Department on April 27,
2010, on the tax benefits provided for such coverage through the Affordable Care Act. Under a
new tax provision in the Affordable Care Act and the Treasury guidance, the value of any
employer-provided health coverage for an employee's child is excluded from the employee's
income through the end of the taxable year in which the child turns 26. This tax benefit applies
regardless of whether the plan is required by law to extend health care coverage to the adult child
or the plan voluntarily extends the coverage.

Key elements include:

Tax Benefit Continues Beyond Extended Coverage Requirement. While the

Affordable Care Act requires health care plans to cover enrollees' children up to age 26,
some employers may decide to continue coverage beyond the child's 26 th birthday. In
such a case, the Act provides that the value of the employer-provided health coverage is
excluded from the employee's income for the entire taxable year in which the child turns
26. Thus, if a child turns 26 in March but stays on the plan through December 31 st (the
end of most people's taxable year), all health benefits provided that year are excluded for
income tax purposes.

Available Immediately. These tax benefits are effective March 30,2010. The exclusion
applies to any coverage that is provided to an adult child from that date through the end
ofthe taxable year in which the child turns 26.

Broad Eligibility. This expanded health care tax benefit applies to various workplace
and retiree health plans. It also applies to self-employed individuals who qualify for the
self-employed health insurance deduction on their federal income tax return.

Both Employer and Employee Shares of Health Premium Are Excluded from
Income. In addition to the exclusion from income of any employer contribution towards
qualifying adult child coverage, employees can receive the same tax benefit if they
contribute toward the cost of coverage through a "cafeteria plan." This benefit is
available immediately, even if the cafeteria plan document has not yet been amended to
reflect the change. To reduce the burden on employers, they have until the end of2010
to amend their cafeteria plan documents to incorporate this change.
 Obtained via FOIA by Judicial Watch, Inc.

Early implementation by the companies listed below will avoid gaps in coverage for new college
graduates and other young adults and save on insurance company administrative costs of dis-
enrolling and re-enrolling them between May 2010 and the start of the plan or policy year
beginning on or after September 23,2010. Early enrollment will also enable young,
overwhelmingly healthy people who will not engender large insurance costs to stay in the
insurance pool. The following companies have agreed to implement this program before the
September 23,2010 deadline:

Blue Cross and Blue Shield of Alabama

Blue Cross Blue Shield of Delaware
Blue Cross and Blue Shield of Arizona, Inc.
Blue Cross and Blue Shield of Florida
Arkansas Blue Cross and Blue Shield
Blue Cross and Blue Shield of Hawaii
Blue Shield of California
Blue Cross ofldaho Health Service
Regence Blue Shield ofldaho
Wellmark Blue Cross and Blue Shield oflowa
Health Care Service Corporation
Blue Cross and Blue Shield of Kansas
Blue Cross Blue Shield Association
Blue Cross and Blue Shield of Louisiana
WellPoint, Inc.
CareFirst BlueCross and BlueShield
Blue Cross and Blue Shield of Massachusetts
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Michigan
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Nebraska
Blue Cross & Blue Shield of Mississippi
Horizon Blue Cross and Blue Shield of New Jersey, Inc.
HealthNow New York, Inc.
The Regence Group
Excellus Blue Cross and Blue Shield
Capital BlueCross
Blue Cross and Blue Shield of North Carolina
Independence Blue Cross
BlueCross BlueShield of North Dakota
Highmark, Inc.
Blue Cross of Northeastern Pennsylvania
BlueCross and BlueShield of Tennessee
Blue Cross and Blue Shield of Vermont
Blue Cross & Blue Shield of Rhode Island
 Obtained via FOIA by Judicial Watch, Inc.

Premera Blue Cross

Blue Cross and Blue Shield of South Carolina
Blue Cross and Blue Shield of Wyoming
Kaiser Permanente
Cigna
Aetna
United
WellPoint
Humana
Capital District Physicians' Health Plan (CDPHP), Albany, New York
Capital Health Plan, Tallahassee, Florida
Care Oregon, Portland, Oregon
Emblem Health, New York, New York
Fallon Community Health Plan, Worcester, Massachusetts
Geisinger Health Plan, Danville, Pennsylvania
Group Health, Seattle, Washington
Group Health Cooperative Of South Central Wisconsin, Madison, Wisconsin
Health Partners, Minneapo lis, Minnesota
Independent Health, Buffalo, New York
Kaiser Foundation Health Plan Oakland, California
Martin's Point Health Care, Portland, Maine
New West Health Services, Helena, Mt
The Permanente Federation, Oakland, California
Priority Health, Grand Rapids, Michigan
Scott & White Health Plan, Temple, Texas
Security Health Plan, Marshfield, Wisconsin
Tufts Health Plan, Waltham, Massachusetts
UCARE, Minneapolis, Minnesota
UPMC Health Plan, Pittsburgh, Pennsylvania

-###-
Obtained via FOIA by Judicial Watch, Inc.

Thursday,
May 13, 2010

Part II

Department of the Treasury

Internal Revenue Service
26 CFR Parts 54 and 602

Department of Labor
Employee Benefits Security
Administration
29 CFR Part 2590

Department of Health and

Human Services
45 CFR Parts 144, 146, and 147

Group Health Plans and Health Insurance

Issuers Relating to Dependent Coverage
of Children to Age 26 Under the Patient
Protection and Affordable Care Act;
Interim Final Rule and Proposed Rule
 Obtained via FOIA by Judicial Watch, Inc.
27122 Federal Register/ Vol. 75, No. 92 I Thursday, May 13, 2010/Ruies and Regulations
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Parts 54 and 602
[TO 9482]
RIN 1545-BJ46
DEPARTMENT OF LABOR
Employee Benefits Security
Administration
29 CFR Part 2590
RIN 121D-AB41
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the Secretary
[OCII0-4150-IFC]
45 CFR Parts 144, 146, and 147
RIN 0991-AB66
Interim Final Rules for Group Health
Plans and Health Insurance Issuers
Relating to Dependent Coverage of
Children to Age 26 Under the Patient
Protection and Affordable Care Act
AGENCY: Internal Revenue Service ,
Department of the Treasury; Employee
Benefits Security Administration,
Department of Labor; Department of
Health and Human Services.
ACTION: Interim final rules with request
for comments.
SUMMARY: This document contains
interim final regulations implementing
the requirements for group health plans
and health insurance issuers in the
group and individual markets under
provisions of the Patient Protection and
Affordable Care Act regarding
dependent coverage of children who
have not attained age 26.
DATES: Effective date. These interim
final regulations are effective on July 12,
2010.
Comment date. Comments are due on
or before August 11, 2010.
Applicability date. These interim final
r gulalions generally apply to group
health plans aud group health insurance
issuers for plan years beginning on or
after September 23 . 2010. These interim
Dnal regulations generally apply to
individual health insurance issuers for
policy years beginning on or after
September 23,2010.
ADDRESSES: Written comments may be
submitted to any of the addresses
specified below. Any comment that is
submitted to any Department will be
shared with the other Departments.
Please do not submit duplicates.
All comments will be made available
to the public. Waming: Do not include
any personally identifiabJe information
(such as name, address, or other contact
information) or confidential business
information that you do not want
publicly disclosed. All comments are
posted on the Internet exactly as
received, and can be retrieved by most
Internet search engines. No deletions,
modifications, or redactions will be
made to the comments received, as they
are public records. Comments may be
s ubmitted anonymous ly.
DeporLtnen{ o[Labor. Comments to
the Department of Labor, identified by
RJN 121 0- AB41. by one of the following
methods:
Federal eRulemaking Portal: http://
www.regulations.gov. Follow the
instructions for submitting comments.
E-mail: E-OHPSCA.EBSA@dol.gov.
Mail or Hand Delivery: Office of
Health Plan Standards and Compliance
Assistance, Employee Benefits Security
Administration, Room N-5653 , U.S.
Department of Labor, 200 Constitution
Avenue NW., Washington , DC 20210.
Attention: RIN 1210-AB41.
Comments received by the
Departmen.t of Labor wi II be posted
without change to I1LLp://
www.regulaUons.gov and http://
www.doJ.gov/ebsa, and available for
public inspection at the Public
Disclosw'e Room, N- 1513, Employee
Benefits Security Administration, 200
Constitution Avenue, NW., Washington.
DC 20210.
Department of Health and Human
Services. In commenting. please refer to
file code OCIIO-4150-IFC. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
four ways (please choose only one of the
ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to http://www.regulations.gov. Follow
the instructions under the "More Search
Options" tab.
2. By regular mail. You may mail
written comments to the following
address only: Office of Consumer
Information and Insurance Oversight,
Department of Health and Human
Services, Attention: OCIIO-4150-IFC,
P.O. Box 8016. Baltimore, MD 21244-
1850.
Please allow sufficient time for mailed
comments to be received before the
dose of the comment period.
3. By express or overnighl mail. You
may send wrilten comments to lhe
follOWing address only: Office of
Consum er Information and Insurance
Oversight, Department of Health and
Human Services, Attention: OCIIO-
4150-IFC, Mail Stop C4-26-05. 7500
Security Boulevard, Baltimore. MD
21244-1850.
4. By hand or courier. rf you prefer.
you may deliver (by hand or courier)
your written comments before the close
or
of the comment period to eilher the
following addresses:
a. For delivery in Washington, DC-
Office of Consumer Information and
Insurance Oversight, Department of
Health and Human Services. Room 445-
G. Hubert H. Humphrey Building. 200
Independence Avenue. SW ..
Washington. DC 20201 (Because access
to the interior of the Hubert H.
Humphrey Building is not readily
available to persons without Federal
government identification, commenters
are encouraged to leave their comments
in the ocno drop slots located in the
main lobby of the building. A stamp-in
clock is available for persons wishing to
retain a proof of filing by stamping in
and retaining an extra copy of the
comments being filed.).
b. For delivery in Baltimore, MD-
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your
comments to the Baltimore address.
please call (410) 786-7195 in advance to
schedule your arrival with one of our
staff members.
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
Submission of comments on
paperwork requirements. You may
submit comments on this document's
paperwork requirements by following
the instructions at the end of the
"Collection of Information
Requirements" section in this document.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the pubJ ic, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: http://
www.regulations.gov. Follow the search
instructions on that Web site to view
public comments.
Comments received timely will also
be available for public inspection as
lhey are received. generally beginning
approximately Lhree weeks sEtel;
public~lion of a document, at tbe
headquarters of the Centers for Medicare
& Medicaid Services, 7500 Security
 Obtained via FOIA by Judicial Watch, Inc.
Federal Register/Vol. 75, No. 9Z/Thursday, May 13, Z010/Rules and Regulations
Boulevard, Baltimore, Maryland 21244,
Monday through Friday of each week
from 8:30 a.m. to 4 p.m. EST. To
schedule an appointment to view public
comments, phone 1-800-743-3951.
Internal Revenue Service. Comments
to the IRS, identified by REG-114494-
10, by one of the following methods:
Federal eRulemaking Portal: http://
www.regulations.gov. Follow the
instructions for submitting comments.
Mail: CC:PA:LPD:PR (REG-114494-
10), room 5205, Internal Revenue
Service, P.O. Box 7604, Ben Franklin
Station, Washington, DC 20044.
Hand or courier delivery: Monday
through Friday between the hours of 8
a.m. and 4 p.m. to: CC:PA:LPD:PR
(REG-114494-10), Courier's Desk,
Internal Revenue Service, 1111
Constitution Avenue, NW., Washington
DC 20224.
All submissions to the IRS will be
open to public inspection and copying
in room 1621, 1111 Constitution
Avenue, NW., Washington, DC from 9
a.m. to 4 p.m.
FOR FURTHER INFORMATION CONTACT:
Amy Turner or Beth Baum, Employee
Benefits Security Administration,
Department of Labor, at (202) 693-8335;
Karen Levin, Internal Revenue Service,
Department of the Treasury, at (202)
622--6080; Jim Mayhew, Office of
Consumer Information and Insurance
Oversight, Department of Health and
Human Services, at (410) 786-1565.
Customer Service Information:
Individuals interested in obtaining
information from the Department of
Labor concerning employment-based
health coverage laws may call the EBSA
Toll-Free Hotline at 1-866-444-EBSA
(3272) or visit the Department of Labor's
Web site (http://www.dol.gov/ebsa).In
addition, information from HHS on
private health insurance for consumers
can be found on the Centers for
Medicare & Medicaid Services (CMS)
Web site (http://www.cms.hhs.gov/
HealthlnsReformforConsume/
01_ Overview.asp).
SUPPLEMENTARY INFORMATION:
I. Background
The Patient Protection and Affordable
Care Act (the Affordable Care Act),
Public Law 111-148, was enacted on
March 23, 2010; the Health Care and
Education Reconciliation Act (the
Reconciliation Act), Public Law 111-
152, was enacted on March 30, 2010.
The Affordable Care Act and the
Reconciliation Act reorganize, amend,
and add to the provisions of part A of
title XXVII of the Public Health Service
Act (PHS Act) relating to group health
plans and health insurance issuers in
the group and individual markets. The
term "group health p.lan" includes both
insured and self-insured group health
plans. 1 The Affordable Care Act adds
section 715 to the Employee Retirement
Income Security Act (ERISA) and
section 9815 to the Internal Revenue
Code (the Code) to make the provisions
of parl A of Litl e XXVII of the PHS Acl
applicable und r ERISA and the Code lo
grou.p health plans, and healLh
insurance issuers proViding health
insurance coverage in connection wilh
group health plans, as if those
provisions of the PHS Act were
included in ERISA and the Code. The
PHS Act sections incorporated by this
reference are sections 2701 through
2728. PHS Act sections 2701 through
2719A are substantially new, though
they incorporate some provisions of
prior law. PHS Act sections 2722
through 2728 are sections of prior law
renumbered with some, mostly minor,
changes. Section 1251 of the Affordable
Care Act, as modified by section 10103
of the Affordable Care Act and section
2301 of the Reconciliation Act, specifies
that certain plans or coverage existing as
of the date of enactment (i.e.,
grandfathered health plans) are subject
to only certain provisions.
Subtitles A and C of title I of the
Affordable Care Act amend the
requirements of title XXVII of the PHS
Act (changes to which are incorporated
into ERISA section 715). The
preemption provisions of ERISA section
731 and PHS Act section 27242
(implemented in 29 CFR 2590.731(a)
and 45 CFR 146.143(a)) apply so that the
requirements of the Affordable Care Act
are not to be "construed to supersede
any provision of State law which
establishes, implements, or continues in
effect any standard or requirement
solely relating to health insurance
issuers in connection with group or
individual health insurance coverage
except to the extent tha t such standard
or requiremenl prevents the application
of a requiremenl" of the Affordable Care
Act. Accordingly. State laws thal
impose on hea lth ins1.U'ance issuers
stricter requiremenls Lhan lhose
imposed by the Affordable Care Act will
not be superseded by Lhe Affordable
Care Act.
1 The term "group health plan" is used in title
XXVII of the PHS Act. part 7 of ERISA. and chapter
100 of the Code, and is distinct from the term
"health plan", as u sed in other provisions of title I
of the Affordable Care Act. The term "health plan"
does not include self-insured group health plans.
2 Code section 9815 incorporates the preemption
proviSions of PHS Act section 2724. Prior to the
Affordable Care Act, there were no express
preemption provis ions in chapter 100 of the Code.
27123
The Departments of Health and
Human Services, Labor, and the
Treasury (the Departmen ts) expect to
issue regulations impl emenLing Ihe
revised PHS Act sections 2701 Lhrough
2719A in several phases. The first
publication in this series was a Request
for Information relating to the medical
loss ratio provisions of PHS AcLsection
2718, published in lhe Federal Registet
on April 14, 2010 (75 FR 19297). These
Lnterim final regulations are being
published to implement PHS Act
section 2714 (requiring dependent
coverage of children to age 26). PHS Act
section 2714 gene l'ally is effective for
plan years [in the individual markel.
policy years) beginning on or after
September 23 , 2010, which is six
monlhs afler lhe March 23, 2010 dale of
enactment of the Affordable Care Act.3
The implementation of other provisions
of PHS Act sections 2701 through
2719A and section 1251 of the
Affordable Care Act will be addressed in
future regulations.
Because subtitles A and C of title I of
the Affordable Care Act contain
requirements that are applicable to both
the group and individual health
insurance markets, it would be
duplicative to insert the requirements
into both the existing 45 CFR part 146
(Requirements for the Group Health
Insurance Market) and 45 CFR part 148
(Requirements for the Individual Health
Insurance Market). Accordingly, these
interim final regulations create a new
part 147 in subchapter B of 45 CFR to
implement the provisions of the
Affordable Care Act. The provisions of
the Affordable Care Act, to the extent
that they apply to group health plans
and group health insurance coverage,
are also implemented under new
regulations added to 29 CFR part 2590
and 26 CFR part 54.
II. Overview of the Regulations
A. PHS Act Section 2714, Continued
Eligibility of Children Until Age 26 (26
CFR 54.9815-2714, 29 CFR 2590.715-
2714,45 CFR 147.120)
Section 2714 of the PHS Act, as added
by the Affordable Care Act (and
amended by the Reconciliation Act),
and these interim final regulations
provide that a plan or issuer that makes
available dependent coverage 4 of
children must make such coverage
available for children until attainment
, See section 1004 oflhe Affordable Care Act.
4 For purposes of these interim final regulations.
dependent coverage means coverage of any
individual under the terms of a group heallb plan.
or group or individual health insurance coverage.
because of the relationship to a participant (in the
individual markel. primary subscriber).