HHS releases plans for further deregulation, with focus on financial risk, non-ACA plans

Providers, insurers and pharmacies can expect a major regulatory overhaul later this year. 

The Trump administration's spring 2018 unified agenda, released on Wednesday, offered a preview into various agencies' regulatory and deregulatory plans for the near future. Policy changes outlined by the Department of Health and Human Services (HHS) include reduced paperwork burdens for hospitals, greater flexibility for non-ACA-compliant plans, and additional tactics to fight the opioid epidemic, all of which have been previously addressed by the Trump administration. 

"Responsible regulatory reform promotes economic growth and innovation, leaving the American people with more freedom to pursue their work and exercise ingenuity," Neomi Rao, administrator of the Office of Information and Regulatory Affairs at the OMB, said in a statement. She added that the agenda follows President Donald Trump's executive order to eliminate two regulatory actions for each new regulation. 

Hospitals and providers

Long-term care facilities, in particular, are likely to see their pile of regulatory paperwork shrink. One future proposed rule, among the nearly 150 in HHS' regulatory list, includes the removal of "unnecessary, obsolete, or excessively burdensome" requirements that such providers need to comply with to participate in Medicare and Medicaid.

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No further details will be available until the rule is officially proposed, but the agency said the rule would "increase the ability of healthcare professionals to devote resources to improving resident care" instead of paperwork. Hospitals and providers have been calling for paperwork reduction initiatives and appear to have found a friend in the Trump administration.  

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HHS also plans to streamline the Medicare claims appeals process by fixing cross-references, unclear terms and definitions, and other errors that could be burdensome for providers and beneficiaries. 

The American Hospital Association appeared satisfied with the focus on burden reduction.

"We know that efficiencies can be found in many areas, such as streamlined quality reporting, administrative simplification, and less burdensome reporting on the use of electronic health records, among others," Joanna Hiatt Kim, vice president of payment policy, told FierceHealthcare in an email. 

Changes to accountable care organizations are also expected. Some ACOs have been asking the agency for more time in non-financial risk-based contracts, instead of the six-year limit. However, the agency appears to be moving in the opposite direction, as one proposal on the Medicare Shared Savings Program includes "facilitating the transition to performance-based risk," signaling a greater push for risk-based arrangements. 


One proposed rule would allow more flexibility in the availability of grandfathered health plans, which were in place before the Affordable Care Act (ACA) and exempt from the new requirements, in individual and small group markets. HHS is also expected to push the expansion of health savings accounts and association health plans.

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Association health plans were introduced by HHS earlier this year, but experts worried that those plans wouldn't include enough consumer protections. 


The agency is also planning additional actions to restructure requirements around prescription drugs. HHS plans to simplify retail pharmacy standards including allowing for "proper recordkeeping when less than the full amount of a prescription for controlled substances is distributed by the pharmacy."

The agency said the enhancement is critical for pharmacies due to the ongoing opioid crisis. 

The Office of Information and Regulatory Affairs plans to announce the total cost of savings from deregulatory actions this fall.