[Federal Register Volume 82, Number 111 (Monday, June 12, 2017)]
[Proposed Rules]
[Pages 26885-26887]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-12130]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Chapter IV
Office of the Secretary
45 CFR Subtitle A
[CMS-9928-NC]
RIN 0938-ZB39
Reducing Regulatory Burdens Imposed by the Patient Protection and
Affordable Care Act & Improving Healthcare Choices To Empower Patients
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Request for information.
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SUMMARY: The Department of Health and Human Services (HHS) is actively
working to reduce regulatory burdens and improve health insurance
options under Title I of the Patient Protection and Affordable Care
Act. Executive Order 13765, ``Minimizing the Economic Burden of the
Patient Protection and Affordable Care Act Pending Repeal,'' directs
the Secretary of Health and Human Services to achieve these aims. HHS
seeks comment from interested parties to inform its ongoing efforts to
create a more patient-centered health care system that adheres to the
key principles of affordability, accessibility, quality, innovation,
and empowerment.
DATES: Comments must be submitted on or before July 12, 2017.
ADDRESSES: You may submit comments in one of three ways (please choose
only one of the ways listed):
1. Electronically. You may submit electronic comments to http://www.regulations.gov. Follow the ``Submit a comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-9928-NC, P.O. Box 8016,
Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-9928-NC,
[[Page 26886]]
Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
FOR FURTHER INFORMATION CONTACT: Vanessa Jones, (202) 690-7000.
SUPPLEMENTARY INFORMATION:
Submission of Comments: All submissions received must include the
Agency name CMS-9928-NC for this notice. All comments received may be
posted without change to http://www.regulations.gov, including any
personal information provided.
I. Background
On January 20, 2017, President Trump issued Executive Order 13765,
``Minimizing the Economic Burden of the Patient Protection and
Affordable Care Act Pending Repeal,'' to minimize the unwarranted
economic and regulatory burdens of the Patient Protection and
Affordable Care Act (PPACA) (Pub. L. 111-148). To meet these
objectives, the President directed the Secretary of Health and Human
Services (the Secretary) and the heads of all other executive
departments and agencies with authorities and responsibilities under
the PPACA, to the maximum extent permitted by law, to afford the States
more flexibility and control to create a more free and open health care
market; provide relief from any provision or requirement of the PPACA
that would impose a fiscal burden on any State or a cost, fee, tax,
penalty, or regulatory burden on individuals, families, health care
providers, health insurers, patients, recipients of health care
services, purchasers of health insurance, or makers of medical devices,
products, or medications; provide greater flexibility to States and
cooperate with them in implementing health care programs; and encourage
the development of a free and open market in interstate commerce for
the offering of health care services and health insurance, with the
goal of achieving and preserving maximum options for patients and
consumers.
The Department of Health and Human Services (HHS) is the federal
government's principal agency charged with protecting the health of all
Americans and providing essential human services. HHS's
responsibilities include Medicare, Medicaid, increasing access to care
and private health coverage, support for public health preparedness and
emergency response, biomedical research, substance abuse and mental
health treatment and prevention, assurance of safe and effective drugs
and other medical products, protection of our Nation's food supply,
assistance to low income families, the Head Start program, services to
older Americans, and direct health services delivery. HHS is comprised
of staff divisions and operating divisions, many of which are
responsible for promulgating regulations pursuant to HHS's statutory
authority.
Among HHS's goals is to establish a robust and resilient framework
for each HHS division to undertake a periodic, thoughtful analysis of
its significant existing regulations issued under Title I of the PPACA,
to determine whether each rule advances or impedes HHS priorities of
stabilizing the individual and small group health insurance markets;
empowering patients and promoting consumer choice; enhancing
affordability; and returning regulatory authority to the States. We
seek public input on changes that could be made, consistent with
current law, to existing regulations under HHS's jurisdiction that
would result in a more streamlined, flexible, and less burdensome
regulatory structure, including identifying regulations that eliminate
jobs or inhibit job creation; are outdated, unnecessary, or
ineffective; impose costs that exceed benefits; or create a serious
inconsistency or otherwise interfere with regulatory reform initiatives
and policies.
Since the first weeks of the Administration, HHS has worked to
reduce burdens and improve health insurance options under the
provisions of Title I of the PPACA for which HHS has jurisdiction. On
February 17, 2017, HHS published a proposed rule in the Federal
Register entitled, ``Patient Protection and Affordable Care Act; Market
Stabilization,'' (82 FR 10980) containing regulatory changes that are
critical to stabilizing the individual and small group health insurance
markets. After receiving and considering public comment, HHS published
the Patient Protection and Affordable Care Act; Market Stabilization
Final rule on April 18, 2017 (82 FR 18346). The new rules will place
downward pressure on premiums, curb abuses, and encourage full-year
enrollment by expanding pre-enrollment verification of eligibility for
new exchange enrollees using special enrollment periods; encourage
patients to avoid coverage lapses; provide greater flexibility to
issuers related to actuarial value of plans; return to the States the
authority and means to assess issuer network adequacy; revise the
timeline for qualified health plan (QHP) certification and rate review
to give issuers flexibility to incorporate benefit changes and maximize
the number of coverage options available to patients; and more closely
align the open enrollment period for the individual market with the
employer-sponsored insurance market and Medicare, thus helping to lower
prices for Americans by reducing adverse selection. We have also taken
a number of other steps to reduce burden, improve choices, and
stabilize the insurance market:
Issued guidance announcing HHS's intent to propose new
health coverage enrollment options for small businesses enrolling
through the Federally-facilitated Small Business Health Options Program
(FF-SHOP), reducing burdens and making it easier for small employers
and their employees to purchase coverage.
Announced a new streamlined and simplified direct
enrollment process for consumers signing up for individual market
coverage with the assistance of web-brokers or issuers in states with
Exchanges that rely on HealthCare.gov for their eligibility and
enrollment functions.
Issued guidance to States explaining their freedom to seek
innovative approaches to lowering premiums and protecting consumers via
State innovation waivers under section 1332 of the PPACA, which
included new information to help states seek waivers from requirements
in Title I of the PPACA, and establish high-risk pools/state-operated
reinsurance programs.
Extended the HHS Risk Adjustment and Data Validation (HHS-
RADV) pilot by another year, providing needed flexibility for issuers
to adapt to the new HHS-RADV audit tool and protocols to ensure that
lessons learned from the first pilot year are implemented effectively,
and enabling the Centers for Medicaid & Medicare Services (CMS) to
ensure that issuers are compliant with all HHS-RADV requirements,
increasing the stability of the markets and the integrity of risk
adjustment transfers.
Adjusted the QHP certification calendar, to provide
issuers additional time to prepare and States additional time to review
2018 products and rates with greater certainty in response to recent
policy changes.
Issued guidance to issuers allowing patients to keep their
transitional individual and small group insurance plans in 2018.
These initial steps will help issuers and States work with HHS to
achieve shared goals, including stabilizing the individual and small
group health insurance markets; empowering patients and promoting
consumer choice; enhancing affordability; and affirming the traditional
authority of the States in regulating the business of health insurance.
In this Request for Information, HHS now seeks input from the public on
other changes within its
[[Page 26887]]
authority and consistent with the law to further achieve these aims.
II. Solicitation of Comments
HHS is interested in soliciting public comments about changes to
existing regulations or guidance, or other actions within HHS's
authority, that could further the following goals with respect to the
individual and small group health insurance markets:
1. Empowering patients and promoting consumer choice. What
activities would best inform consumers and help them choose a plan that
best meets their needs? Which regulations currently reduce consumer
choices of how to finance their health care and health insurance needs?
Choice includes the freedom to choose how to finance one's healthcare,
which insurer to use, and which provider to use.
2. Stabilizing the individual, small group, and non-traditional
health insurance markets. What changes would bring stability to the
risk pool, promote continuous coverage, increase the number of younger
and healthier consumers purchasing plans, reduce uncertainty and
volatility, and encourage uninsured individuals to buy coverage?
3. Enhancing affordability. What steps can HHS take to enhance the
affordability of coverage for individual consumers and small
businesses?
4. Affirming the traditional regulatory authority of the States in
regulating the business of health insurance. Which HHS regulations or
policies have impeded or unnecessarily interfered with States' primary
role in regulating the health insurance markets they know best?
This is a request for information only. Respondents are encouraged
to provide complete but concise responses to the questions outlined
above. We note that a response to every question is not required. This
request for information is issued solely for information and planning
purposes; it does not constitute a notice of proposed rulemaking or
request for proposals, applications, proposal abstracts, or quotations.
This request for information does not commit the United States
Government (``Government'') to contract for any supplies or services or
make a grant award. Further, HHS is not seeking proposals through this
request for information and will not accept unsolicited proposals.
Respondents are advised that the Government will not pay for any
information or administrative costs incurred in response to this
request for information; all costs associated with responding to this
request for information will be solely at the interested party's
expense. Not responding to this request for information does not
preclude participation in any future rulemaking or procurement, if
conducted. It is the responsibility of the potential responders to
monitor this request for information announcement for additional
information pertaining to this request. We also note that HHS will not
respond to questions about the policy issues raised in this request for
information. HHS may or may not choose to contact individual
responders. Such communications would only serve to further clarify
written responses. Contractor support personnel may be used to review
request for information responses. Responses to this notice are not
offers and cannot be accepted by the Government to form a binding
contract or issue a grant. Information obtained as a result of this
request for information may be used by the Government for program
planning on a non-attribution basis. Respondents should not include any
information that might be considered proprietary or confidential. This
request for information should not be construed as a commitment or
authorization to incur cost for which reimbursement would be required
or sought. All submissions become Government property and will not be
returned. HHS may publically post the comments received, or a summary
thereof. While responses to this request for information do not bind
HHS to any further actions related to the response, all submissions
will be made publicly available on http://www.regulations.gov.
III. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping or third-party disclosure
requirements. This request for information constitutes a general
solicitation of comments. In accordance with the implementing
regulations of the Paperwork Reduction Act (PRA) at 5 CFR 1320.3(h)(4),
information subject to the PRA does not generally include ``facts or
opinions submitted in response to general solicitations of comments
from the public, published in the Federal Register or other
publications, regardless of the form or format thereof, provided that
no person is required to supply specific information pertaining to the
commenter, other than that necessary for self-identification, as a
condition of the agency's full consideration of the comment.''
Consequently, this document need not be reviewed by the Office of
Management and Budget under the authority of the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501 et seq.).
Dated: June 6, 2017.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: June 7, 2017.
Thomas E. Price,
Secretary, Department of Health and Human Services.
[FR Doc. 2017-12130 Filed 6-8-17; 4:15 pm]
BILLING CODE 4120-01-P