[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]



Centers for Medicare & Medicaid Services

42 CFR Chapter IV

Office of the Secretary

45 CFR Subtitle A

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.


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.

    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 
    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 
    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 
    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]