Web:www.chlpi.org●Email:[email protected]
Repeal,Reconciliation,andReview:BriefingofFast-Track
MethodsCongressionalRepublicansMayUsetoWeakenor
RepealtheACAUndertheTrumpAdministration
TheTrumpAdministrationandthenewCongresshaveanambitiousagendaforhealthcare
policyinthefirstseveralmonthsof2017.Inordertoachievetheirgoalsofquickly
repealingandreplacingtheAffordableCareAct(ACA),theymustutilizereconciliation,a
fast-trackprocessintendedtoresolvebudgetchallenges.Thiswhitepaperreviewsthe
history,procedure,andlimitationsofreconciliationanddiscussesthepotentialimpact
Republicanscanmakeonhealthcarepolicyusingreconciliation.Thiswhitepaperalso
discussesanotherproceduraltoolCongressionalRepublicansmayusetounderminethe
ACA,theCongressionalReviewAct(CRA).TheCRAgrantsCongressanabilitytoreview
androll-backregulationspromulgatedbyanoutgoingPresidentialAdministration.
I.
ReconciliationOverview1
CreatedbytheCongressionalBudgetActof1974(CBA),thepurposeofreconciliationwas
toescapelaboriousdebatesovertheimplementationofbudgetresolutionsbyexpediting
proposedchangesingovernmentoutlaystoconformtoproposedbudgets.Asaresult,
reconciliationcanbeusedonlyforproposalsrelatingto:1)taxesandrevenues,2)
spending,and3)thefederaldebtlimit.Reconciliationisfurtherlimitedbecauseitcanonly
beappliedtomandatoryorentitlementspending,notdiscretionaryspending.
A.
InvokingReconciliation
Reconciliationcanonlybeutilizedaspartofabudgetprocess,usuallyinitiatedbythe
President.AsdirectedbytheCBA,thePresidentformulatesandpresentsabudgetto
Congress,whoarefreetodisregardhisproposal.Originally,thePresidentsubmittedhis
1Forfurtherinformationonreconciliation,seeJUDYSCHNEIDER,MICHAELL.KOEMPEL&ROBERTKEITH,
CONGRESSIONALDESKBOOK:THEPRACTICALANDCOMPREHENSIVEGUIDETOCONGRESS314-41(TheCapitol.Net,Inc.,6th
ed.2012);ROBERTKEITH,CONG.RESEARCHSERV.,RL33030,THEBUDGETRECONCILIATIONPROCESS:HOUSEAND
SENATEPROCEDURES(2005).
budgetproposalbyJanuary.In1990,thisdeadlinewasmovedtoFebruary.Thischange
meansthat,inaPresidentialtransitionyear,theincomingPresidentsubmitsthebudget
proposalinsteadoftheoutgoingone.ThismeansthattheTrumpAdministration,notthe
ObamaAdministration,willbesubmittingthenextPresidentialbudget.Inrecentyears,
thistimetablehasbeenregardedasaguidelineratherthanadeadline,leavingthe
PresidentfreetosubmitabudgetproposallaterthanFebruary.2
UndertheCBA,theHouseandSenatearesupposedtoadoptabudgetresolutioneachyear.
Budgetresolutionsarenotlaws,butasetofinstructionstovariousCongressional
CommitteestoestablishanoverallbudgetplanandsetguidelinesfortheseCommitteeson
spendingandrevenue.BudgetresolutionsarefilibusterproofintheSenate,soSenate
Democratscannotpreventanewbudgetresolutionfrombeingpassedinearly2017.Once
CongresspassesabudgetresolutionwithdirectivestotheCommittees,theactualprocess
ofreconciliationbegins.
B.
ReconciliationProcedure
ThebudgetresolutionpassedeachyearbyCongressmayincludereconciliationdirectives
askingspecifiedCongressionalCommitteestorecommendlegislationchangingexistinglaw
inordertobringspending,revenues,andthedebtlimitinconformitywiththeproposed
budget.Thereconciliationdirectivesspecifytheamountsofchangestospendingand
revenues,butdonowspecifyhowtomodifygovernmentalprogramstoachievethese
numbers.IfmorethanoneCommitteeissubjecttoreconciliationdirectives,Houseand
SenateBudgetCommitteeswillpackagetherecommendationsoftheirrelevantcommittees
intoanomnibusbillforconsiderationbythefullHouseorSenate.
Atthispointoftheprocess,theHouseandSenateoperateonparalleltracks.TheHouse
CommitteeswillsubmittheirrecommendationstotheHouseBudgetCommitteeandthe
SenateCommitteeswilldothesametotheSenateBudgetCommittee.TheseBudget
Committeeswillpackageallrecommendationsintoanomnibusbillforconsiderationby
thefullHouseorSenate.ThebillscontainingtherecommendationsoftheCommitteesare
oftenreferredtoasomnibusreconciliationbills.TheHouseandSenateinitiallyconsider
theirownreconciliationbillsseparatefromeachother,andvirtuallyalwayspassdifferent
versions.
TheHouseandSenatemayamendtheirreconciliationbills,butusuallytheseamendments
mustbecostneutral.IntheSenate,debatesonreconciliationbillsarelimitedtotwenty
hours.Therefore,thesebillsarefilibusterproofandSenateDemocratswillnotbeableto
preventareconciliationbillfrombeingvoteduponuntilthe2018midtermelectionsatthe
earliest.IntheSenate,onlyasimplemajority(fiftyonevotes)isneededtopassa
2Forabudgetprocesstimeline,seeAppendixA.
2
reconciliationbill.TheHouseusuallyadoptsspecialrulessettingforthspecificprocedures,
suchasmaximumtimefordebates,forconsideringitsreconciliationbills.
OnceboththeHouseandSenatehavepassedtheirreconciliationbills,ajointconference
committeeattemptstoharmonizebothbills.Inordertominimizethisstep,theSenatewill
typicallyconsideroneortwobillsinitiallybutthenmodifytheHousereconciliationbillin
ordertoproceedtoaconference.Ifanagreementisreachedbythejointconference,both
chambersvoteonthecompromiseversion.Thejointreconciliationbillisthensenttothe
President,whomayvetothebill.CongresscanoverrideaPresidentialvetowithatwothirdsvoteineachChamber.IfthePresidentvetoesthemeasureandCongresscannot
override,theprocessisoverandrequiresanewbudgetresolutiontorestart.
C.
LimitsonReconciliation
1.
TimingofReconciliation
Congressgetsonly“onebiteattheapple”eachyeartoaddressspending,revenues,andthe
federaldebtlimitthroughreconciliation.ThisisbecausetheSenatecanconsidereach
reconciliationappropriatetopiconlyonceperbudgetresolution,meaningthatitcanpassa
maximumofthreeconciliationbillsperbudgetresolution/year.3Forexample,iftheSenate
passedareconciliationbillthatcoveredbothspendingandrevenues,butwas
overwhelmingdevotedtospending,itwouldstillbebarredfrompassingarevenuefocused
reconciliationbillthatyearbecauseithadalreadyvisitedthattopic.
TherearesuggestionsthatCongressmayattempttosubvertthisrulebyadoptingtwo
budgetresolutionsduringthefirstseveralmonthsoftheTrumpAdministration.Lastyear
Congressfailedtopassabudgetforfiscalyear2017,creatinganopportunityforCongress
totaketheunprecedentedmeasureofadoptingtwobudgetresolutionsin2017.Thetwo
budgetresolutionswouldyieldtworeconciliationbills-oneforfiscal2017,theotherfor
fiscal2018.
AllowingfortworeconciliationopportunitieswouldgiveCongresstheopportunitytomove
quicklyonrepealingtheACAwithoutforeclosingtheopportunitytousereconciliationata
laterpointtoadvanceotherportionsoftheiragenda.Thefiscalyear2017reconciliation
billwilllikelyrepealtheprovisionsoftheACAthatarereconciliationappropriate.The
fiscalyear2018reconciliationbillwouldlikelyfocusontaxreforms.TomPrice,Trump’s
futureSecretaryoftheDepartmentofHealthandHumanServices,hasstatedthatmajor
3TheSenatecanchoosetoaddressspending,revenues,andthefederaldebtlimitinthesamereconciliation
billorinseparatereconciliationbills.Soitcouldpassonebilladdressingallthreeissues,threebillseach
addressingoneissueindividuals,ortwobills—oneaddressingtwoissuesandanotheroneaddressingthe
remainingissue.
3
changestothecurrentMedicarestructuremaybepartofthefiscalyear2018budget
process.4
2.
TheByrdRule
TheByrdRuleisanimportantlimitationonreconciliationintheSenate.Namedafterits
sponsor,lateSenatorRobertByrd(D-WV),theruleallowssenatorstoblockanyprovisions
oramendmentstotheSenatereconciliationbillthatareextraneoustothereconciliation
process.Thisincludesanythingthatdoesnotdirectlyaffectspending,revenues,andthe
debtlimit.ThepurposeoftheByrdRuleistopreventSenateCommitteesfromadopting
provisionsunrelatedtotheirbudgetresolutiondirectives,includingprovisionsthatwould
ordinarilystruggletogetpassed.TheByrdRuleisnotautomatic,meaningthatasenator
mustobjecttoanoffendingprovisiontogetitstricken.Becausesenatorsmayinvokethe
ByrdRuleduringconsiderationofthejointreconciliationbill,itcanbeusedtoblockthe
Housefromaddingextraneousprovisionstothefinalversionofthereconciliationbill.
ItisoftendifficulttodetermineifamatterisextraneousundertheByrdRule.The“ruleof
thumb”isthatameasureisextraneousifitdoesnotchangespendingorrevenues,orifthe
changestospendingandrevenuesaremerelyincidentaltothepolicycomponentsofthe
provision.5TheSenateParliamentarian,whoisappointedbythemajoritypartyinthe
Senate,advisestheSenate’spresidingofficerregardingpointsoforderincludingtheByrd
Rule.WhenCongressattemptedtorepealtheACAusingreconciliationin2015,the
ParliamentariandeterminedthataprovisionrepealingtheIndependentPaymentAdvisory
BoardviolatedtheByrdRuleasaprimarilypolicy-basedprovisionwithincidental
budgetaryeffects6anditwasremovedfromthatreconciliationbill.TheSenatePresiding
Officer—whocanbetheVicePresidentbutisoftenasenatorfromthemajorityparty—can
choosetooverruletheSenateParliamentarian.ItisunclearwhothePresidingOfficerwill
beduringtheupcomingreconciliationprocessandwhetherheorshewillbeinclinedto
overruletheParliamentarian.
D.
ImpactsontheACAandAccesstoCare
Republicansusedthereconciliationprocesslastyearinanattempttorepealmanykey
provisionsoftheACA.PresidentObamavetoedthatreconciliationbillandRepublicansdid
4JoshMarshall,TrumpHHSPickSaidMedicarePhaseoutWouldPassNextSummer,TALKINGPOINTSMEMO(Nov.
29,2016,1:44AM),https://talkingpointsmemo.com/livewire/trump-hhs-pick-said-medicare-phaseoutwould-pass-next-summer)
5Aprovisionisalsoextraneouswhere(1)itproducesaspendingincreaseorrevenuedecreasewhenthe
instructedcommitteeisnotincompliancewithitsinstructions;(2)itisoutsidethejurisdictionofthe
committeethatsubmittedit;(3)itwouldincreasethedeficitforafiscalyearbeyondthosecoveredbythe
reconciliationmeasure;or(4)itrecommendschangesinSocialSecurity.Section313oftheCongressional
BudgetActof1974;2U.S.C.§644.
6MelissaQuinn,SenateParliamentarian:HousePartialObamacareRepealDead-on-ArrivalinSenate,THEDAILY
SIGNAL(Oct.20,2015),http://dailysignal.com/2015/10/20/senate-parliamentarian-house-partialobamacare-repeal-dead-on-arrival-in-senate/
4
nothavesufficientnumberstooverridehisveto.Thereconciliationbillwouldhave
eliminatedMedicaidexpansion,premiumandcost-sharingsubsidiesby2018.Thebill
wouldhaveeliminatedthepenaltiesassociatedwiththeindividualandemployer
mandates.Thereconciliationbillwouldhavedestabilizedtheinsurancemarketbecauseit
wouldhavekeptsomekeyconsumerprotections,suchasguaranteedissueandcommunity
healthratings,whileeliminatingtherequirementtoobtainhealthinsurance.Thiswould
haveledtoindividualsrefrainingfrompurchasinghealthinsuranceuntiltheyweresick,
whichwouldhavesentpremiumsskyrocketingtounaffordableheights.
TheforthcomingACArepealattemptisexpectedtolooksimilartolastyear’sreconciliation
bill.ItwilllikelyphaseoutMedicaidexpansionandthesubsidiesandremovepenalties
relatingtotheindividualandemployermandates.Unlikethepreviousreconciliation
attempt,however,itmayincludecomponentsofCongressionalRepublicans’ACA
“replacement”plan.These“replace”changesthatmaybeincludedintheupcoming
reconciliationbillinclude:restructuringMedicaidviablockgrantsorpercapitacaps;
replacingthesubsidieswithlessgeneroustaxcreditsoreventaxdeductions;encouraging
healthsavingsaccountsthroughtax-freecontributions;establishingstateinnovation
grantsandhigh-riskpoolfunding;allowingproviderstorefusetoprovideabortionsand
allowinginsurerstorefusetocontractwithproviderswhoprovideabortions.The
reconciliationbillmayalsoincludeMedicarereforms,includingallowingMedicareto
negotiatedrugprices;adjustingreimbursementcapstoMedicareAdvantage;repealing
CMMIandtheIndependentPaymentAdvisoryBoard;readjustingreimbursementto
hospitalsandDSHfunding;andincreasingtheagerequirementsforMedicare.Someof
theseproposalsmaybequestionableundertheByrdRule,butitisexpectedthat
RepublicanswillbelesslikelytolistentotheParliamentarianduringthisreconciliation
process.7
TheByrdRuleislikelytoprotectcertaincomponentsoftheACA,including:thebanonpreexistingconditionsexclusions;healthstatusunderwritingrestrictions;capsonannualand
lifetimespendinglimits;actuarialvaluerequirements;andmandatedbenefitssuchasthe
EssentialHealthBenefits.TheByrdRuledoesnotcompletelyprotectthesecomponents,
however.IfCongressusesreconciliationtoremovethesubsidiesandtheindividual
mandate,thesecomponentsarelikelytobecomeunworkableasdiscussedabove.
TheByrdRuleisalsolikelytoblockcertaincomponentsoftheRepublicanhealthcare
policyagenda.ThefollowingRepublicanproposalsareunlikelytobepassaByrdRule
challenge:allowinginsurerstosellacrossstatelines;requiringpricetransparencyfromall
healthcareproviders,includingthosewhodonotcontractwithMedicaidorMedicare;
7BrianBlaseandPaulWinfree,HowtoRepealObamacare:AroadmapfortheGOP,POLITICO(November11,
2016,7:31AM)http://www.politico.com/agenda/story/2016/11/repeal-obamacare-roadmap-republicans000230
5
reformingprescriptiondrugpricingandallowingforre-importationofpharmaceuticals;
reformingtheFDA;reformingmedicalmalpractice;andreformingmedicallicensure.
Congresswouldhavetopasstheseproposalsusingnormalprocedures,whichmeansthat
SenateDemocratswouldbeabletofilibusterobjectionableproposalsandthatRepublicans
wouldhavetofindsixtyvotesforanyproposalsthatdidmakeittovoting.
II.
CongressionalReviewActOverview8
CongressalsohastoolstooverridesomecomponentsoftheACAestablishedbyagency
rulemakingasopposedtolegislation.TheCongressionalReviewAct9(CRA)requiresall
federalagenciestosubmittoCongressforreviewacopyoftheirfinalregulationsalong
withreportsjustifyingthereasonsforitspromulgation.TheCRAalsoestablishes
proceduresforCongresstousetorepealagencyregulationsitdisagreeswith.Theprocess
establishedbytheCRAiscumbersomeandhasbeenusedonce,in2001,sinceitsinception
in1996.Thereisreason,however,tothinkthatthecircumstancesarerightforittobe
wieldedaggressivelyandsuccessfullybytheupcomingCongress,withthesupportof
PresidentTrump,toundoatleastsomeofPresidentObama’slegacy.
A.
CongressionalReviewProcedure
TheCRAcanbeusedforreviewofabroadrangeofagencyaction.Thelegislativehistory
andinterpretationoftheCRA’sdefinitionofwhatconstitutesreviewableagencyaction
embracesnearlyeverystatementanagencymaymake,includinginterpretive,procedural,
andsubstantiverules,guidelines,andpolicyproclamations.WhileCongressmayusethe
CRAtoreviewawiderangeofagencyaction,itismostlikelythattheywillusetheCRAto
reviewonlymajorrules.Thesearedefinedashavinganannualimpactontheeconomyof
$100millionormore,willincreasecostsandpricesforcertainconstituencies,orwillhave
someotheradverseeffectontheeconomy.TheOfficeofInformationandRegulatory
AffairsintheWhiteHouseOfficeofManagementBudgetdetermineswhetheraparticular
ruleisdeemedmajor.ManyoftheregulationsimplementingtheACAdohaveasignificant
impactontheeconomy.Agoodindicationofwhetheraruleismajorforthepurposesof
theCRAiswhetherithasatleastasixtydayperiodbeforeimplementation.
UndertheCRA,Congresshasuptosixtylegislativedaystoreviewandoverruleamajor
rulepromulgatedbyafederalagency.Withinthatperiod,Congresscanintroduceajoint
resolutionofdisapproval.Theresolutionissubmittedinitiallytotheappropriate
CongressionalCommittee,butthirtySenatorsmaypetitiontobringtheresolutiontothe
8ForfurtherinformationontheCongressionalReviewAct,seeMORTONROSENBERG,CONG.RESEARCHSERV.,
RL30116,CONGRESSIONALREVIEWOFAGENCYRULEMAKING:ANUPDATEANDASSESSMENTOFTHECONGRESSIONAL
REVIEWACTAFTERADECADE(2008).
95U.S.C.§801-808.
6
fullSenateiftheCommitteetakeslongerthantwentydaystoreview.IftheSenateagrees
toreviewajointresolutionofdisapproval,debateislimitedtonomorethantenhours,no
amendmentstotheresolutionormotionstoproceedtootherordersofbusinessare
permitted,andtheresolutionmaypassbysimplemajority,orfifty-onevotes.Thejoint
resolutionofdisapprovalmustbesignedbythePresident,orovercomeaPresidentialveto
bytwo-thirdsmajorityvoteinboththeHouseandtheSenate.Whenajointresolutionis
passed,itretroactivelynullifiestheruleandprohibitsanagencyfrompromulgating
substantiallysimilarruleswithoutCongressionalapproval.
Asinmanygovernmentalprocedures,thesixtydayreviewperiodismorecomplicated
thanitinitiallyseems.TheCRAgivesCongresssixtylegislativedaystoconsidera
regulation,meaningdaysthateitherhouseofCongressisadjournedformorethanthree
daysdonotcounttowardsthisdeadline.Thereisacarryoverperiodforrulesthatwere
promulgatedlessthansixtylegislativedaysbeforeeitherhouseofCongressadjourned.
Theseheldoverrulesaretreatedasiftheywerepublishedonthe15thsessiondayofeach
houseofthenextsession,dramaticallyextendingtheperiodofreview.
B.
LimitsonCongressionalReview
Becauseitisonlyrarelyused,thereisalotofuncertaintyaroundproperCRAprocedures.
ItisnotclearwhetherCongresscan“bundle”togethermorethanoneobjectionable
regulationintoasinglejointresolutionofdisapproval,whichwouldexpeditetheremoval
ofmultipleregulations.ItisalsonotclearifCongresscanfindonlyonepartofalarger
regulationobjectionable,orifitmuststrikedowntheentireregulationitsjointresolution
ofdisapproval.BecausetherearemultipleDemocraticregulationsinthecrosshairsof
CongressionalRepublicans,somelawmakersarepushingtoclarifytheexpeditingprocess.
RepresentativeDarrellIssa(R-CA)proposedameasurecalledthe“MidnightRulesRelief
Actof2016”toallowCongresstoinvalidatemultiplerulesinasinglevote,10easingthe
logisticalburdenofrollingbacksomanyregulationsindividually.Whilethisproposal
passedintheHouse,Obamaishighlyunlikelytosignthemeasure.Issawilllikelypropose
themeasureagainoncetheTrumpAdministrationbeginsanditismorelikelytosucceed
then.
TheCRAhasonlybeenusedtooverturnamajorruleoncesinceitwasimplementedin
1996.AtthetailendoftheClintonAdministration,theOccupationalSafetyandHealth
Administration(OSHA)promulgatedacontroversialregulationdesignedtocurb
ergonomicinjuriesintheworkplace.DuringthenewsessionofCongressfollowingthe
inaugurationofPresidentBush,ajointresolutionofdisapprovalwaspassed.Mostother
10YukaHayashi,RepublicanLawmakersEyeFreezeonObamaRegulations,THEWALLSTREETJOURNAL(Nov.18,
2016,2:15PM),http://www.wsj.com/articles/republican-lawmakers-eye-freeze-on-obama-regulations1479489099
7
attemptstousetheCRAhavebeenblockedbytheneedforPresidentialapproval,becausea
Presidentwhoapprovedaregulationwouldbeunlikelytosignlegislationoverturningit.
C.
ImpactontheACAandAccesstoCare
WhilePresidentObamaisinoffice,anyjointresolutionofdisapprovalisunlikelyto
succeedbecausePresidentObamawouldvetosucharesolutionandRepublicansdonot
haveenoughseatstooverrideaPresidentialveto.Theregulationspromulgatedbythe
ObamaAdministrationbecomesmuchmorevulnerabletoajointresolutionofdisapproval
oncePresidentTrumptakesofficebecauseheislikelytosignanyresolutionundoingthe
workofhispredecessor.Unfortunately,asignificantnumberofregulationspromulgated
bytheObamaAdministration,includingsomekeyhealthcarerelatedones,mayfallunder
thepurviewoftheCRAduringthenextCongressionalsession.11Currently,theproposed
listdoesnotincludetheregulationspromulgatingtheAnti-Discriminationprotectionsof
Section1557oftheACA,butthiscouldchange.
Theresetperiodforallmajorrulescanbedeterminedbycountingbackfromtheprojected
adjournmentby60daysoflegislativedaysineachhouseofCongressusingsecond-session
proposedmeetingschedules,andthentakingtheearlierofthetwodates.Usingthis
method,theCongressionalResearchServiceestimatesthatrulessubmittedafterMay30,
2016,willbesubjecttotherenewedreviewperiodsin2017undertheTrump
Administration.Thesecond-sessionproposedmeetingschedulesareopentochangesand
itisanticipatedthatRepublicanleadershipmaypushtoendthesecond-sessionasearlyas
possible.ThiswouldmoveevenmoreregulationspromulgatedbytheObama
AdministrationintothereviewperiodallowedbytheCRAtothenextCongress.
Somelegalexpertsarepredictingthat,becauseoftheAdministrationchange-overfroma
DemocratictoRepublicanPresidentsimilarto2001,theCRAwilloncemorebe
successfullyusedtoroll-backcontroversialregulations.Agoodgaugeoftheintenttouse
theCRAtoaggressivelystrikedownObamaAdministrationregulationswillbehowmuch
earlierthanscheduledRepublicanleadershipchoosestoclosethecurrentCongressional
session,inordertohaveasmanyregulationsfallundertheCRAreviewofthenext
Congress.
Forquestionsorinquiries,pleasecontactCarmelShachar,ClinicalInstructorattheCenterfor
HealthLawandPolicyInnovation,[email protected],orPhilWaters,Clinical
FellowattheCenterforHealthLawandPolicyInnovation,[email protected].
11ForalistofhealthcarerelatedregulationsthatmayfallunderCRAreviewinthenextCongress,see
AppendixB.
8
AppendixA
BudgetProcessTimeline*
OnorBefore:
ActiontobeCompleted:
FirstMondayinFebruary
Presidentsubmitsbudget
February15
CBOsubmitsreportstoBudgetCommittees
April1
Committeessubmitviewsandestimatesto
BudgetCommittees(owndatefrequently
set)
April15
SenateBudgetCommitteereports
concurrentresolutiononthebudget
May15
Congresscompletesactiononthe
concurrentresolutiononthebudget(not
signedbyPOTUS)
June10
Annualappropriationbillsmaybe
consideredinHouse
June15
Congresscompletesactiononreconciliation
legislation(ifresolutionincludes
“reconciliationdirectives”)
June30
Housecompletesactiononannual
appropriationsbills
October1
Fiscalyearbegins
*ThistablerepresentsthetimelineintheCongressionalBudgetActof1974.Recently,
Congresshasprolongedthebudgetprocessandhasconsidered,reported,andaimedto
completeactiononappropriationbillsinthespringandsummermonths.
9
AppendixB
ThefollowingaremajorrulesthatmaybesubjectreviewundertheCongressionalReview
ActbythenextCongress.Aruleisdefinedasamajorruleifitwilllikelyhaveanannual
effectontheeconomyof$100millionormore,increasecostsorpricesforconsumers,
industriesorstateandlocalgovernments,orhavesignificantnegativeeffectsonthe
economy.Thisisnotanexhaustivelist,focusingonlyonhealthcarerelatedregulations.It
assumesthattheearliestdayofthereviewperiodwasMay30,2016.
TitleofRuleinFederalRegister
ONCHealthITCertificationProgram:
EnhancedOversightandAccountability
MedicareAndMedicaidPrograms;Reform
OfRequirementsForLong-TermCare
Facilities
ChildCareAndDevelopmentFund(CCDF)
Program
EstablishingPaidSickLeaveForFederal
Contractors
EmergencyPreparednessRequirementsFor
MedicareAndMedicaidParticipating
ProvidersAndSuppliers
SafetyAndEffectivenessOfConsumer
Antiseptics;TopicalAntimicrobialDrug
ProductsForOver-The-Counter-HumanUse
MedicareProgram;HospitalInpatient
ProspectivePaymentSystemsForAcute
CareHospitalsAndTheLong-TermCare
HospitalProspectivePaymentSystem&
PolicyChanges&FiscalYear2017Rates;
QualityReportingRequirementsFor
SpecificProviders;GraduateMedical
Education;HospitalNotificationProcedures
ApplicableToBeneficiariesReceiving
ObservationServices;TechnicalChanges
RelatingToCostsToOrganizations&
MedicareCostReports;FinalizationOf
InterimFinalRulesWithCommentPeriod
OnLTCHPPSPaymentsForSevereWounds,
ModificationsOfLimitationsOn
RedesignationByTheMedicareGeographic
ClassificationReviewBoard,&Extensions
OfPaymentsToMDHSAndLow-Volume
Hospitals
MedicareProgram;ProspectivePayment
Agency
DepartmentofHealthandHumanServices,
OfficeoftheSecretary
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
AdministrationForChildrenAndFamilies
DepartmentOfLabor,OfficeOfThe
Secretary
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices:
MedicareAndMedicaidPrograms
DepartmentOfHealthAndHumanServices,
FoodAndDrugAdministration
DepartmentOfHealth&HumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
10
SystemAndConsolidatedBillingForSkilled
NursingFacilitiesForFY2017,SNFValueBasedPurchasingProgram,SNFQuality
ReportingProgram,AndSNFPayment
ModelsResearch
MedicareProgram;InpatientRehabilitation
FacilityProspectivePaymentSystemFor
FederalFiscalYear2017
MedicareProgram;FF2017HospiceWage
IndexAndPaymentRateUpdateAnd
HospiceQualityReportingRequirements
MedicareProgram;FY2017Inpatient
PsychiatricFacilitiesProspectivePayment
System--RateUpdate
MedicationAssistedTreatmentForOpioid
UseDisorders
MedicareProgram;MedicareClinical
DiagnosticLaboratoryTestsPayment
System
MedicareProgram;MedicareShared
SavingsProgram;AccountableCare
Organizations-
-RevisedBenchmarkRebasing
Methodology,FacilitatingTransitionTo
Performance-Based
Risk,AndAdministrativeFinalityOf
FinancialCalculations
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
DepartmentOfHealthAndHumanServices,
CentersForMedicare&MedicaidServices
Forafulllistofmajorregulationsatissue,see:
https://www.insidehighered.com/sites/default/server_files/files/Major%20Rules%20Subject%20to%20CRA%20Under
%20Carryover%2011-17-2016%20(1).pdf
11