Not so fast: Pending HHS rules subject to 60-day pause
Sorry, hospitals, the price transparency rule isn't on the list.
Multiple rules posted by the Department of Health and Human Services during the final days of the Trump Administration are now subject to a 60-day pause for review. If the previous administration’s actions raise questions of “fact, law or policy,” the designated officials now leading the agencies can further delay effective dates and consult with the Office of Management and Budget about other actions, Bloomberg Law reported.
Related: Biden’s first challenge: Undoing Trump administration health care policies
“The OMB director will implement this regulatory review, and any communications regarding any matters pertaining to this review should be addressed to the OMB director,” wrote Ronald A. Klain, assistant to the president and chief of staff, in a memo. “For those rules that raise substantial questions of fact, law, or policy, agencies should notify the OMB director and take further appropriate action in consultation with the OMB director.”
The following rules related to the benefits industry are included in the review:
- Medicare prescription formularies: A request for applications in a voluntary Medicare prescription drug payment model would allow participating Part D plans to include on their approved payment lists only one drug per class instead of the current requirement of two.
- Direct insulin and Epinephrine discounts: A final rule says certain health centers must pass discounts they get on insulin and epinephrine directly to their patients.
- Best-price Medicaid contracts: Drug companies should have an easier time entering into contracts with state Medicaid agencies that refer to the “value” of a drug. Those sorts of contracts can save states money on expensive products.
- Faster drug coverage decisions: Under this proposal, Medicare patients could get their medications faster.
- Foreign drug prices: An interim final rule ties federal reimbursement for drugs administered in doctors’ offices to lower prices paid in other countries. Drugs administered by doctors, often for serious illnesses like cancer, are usually expensive.
- Health privacy and records access: Health-care providers would have fewer barriers to share patients’ health information and give patients access to their own records. Patients would be better informed about their right to their own records under the rule.
- Health programs Medicare advantage: A rate announcement by the CMS gives Medicare Advantage plans a nearly 4.1 percent revenue increase in 2022.
- Risk adjustment rule: A final rule aims to ensure that health insurers are paid when covering the sickest patients.
- Pre-Obamacare health plan rule: A joint final rule with HHS, the Internal Revenue Service and the Labor Department makes it easier for employers and insurers to continue offering health plans that were in existence before Obamacare took effect. The rule provides more flexibility to make changes to cost-sharing requirements for enrollees in group plans offered by employers.
- Health reimbursement plan rule: A final IRS rule clarifies employers’ responsibilities under the Affordable Care Act when they offer employees help to buy Obamacare plans. The rule says employees enrolled in Obamacare through a health reimbursement arrangement can’t seek premium tax credits that generally help lower-income people afford plans.
- Obamacare exchange rule: A final rule lets states largely bypass the federal Obamacare exchange, HealthCare.gov. The rule enables web brokers and insurers to directly enroll people in health plans. Critics say the rule could result in lower enrollment in Affordable Care Act plans.
- Patient profile rule: A final rule issued requires Obamacare, Medicaid and children’s health plans to bundle all patient information into a package for other doctors to use. The rule also requires that patients have access to their profile.
For rules that have been sent to the Office of the Federal Register but not yet published, the memo calls for immediate withdrawal and further review and approval. Those that have already been published will be postponed for 60 days pending review.
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