Report Shows Implementation of Health Reform Law Not Even Half Complete

The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) was enacted in March 2010 and will become fully effective in January 2014. So how far along is the government in implementing the law? By one measure–the number of new regulations issued–federal agencies have done a lot to implement the health care reform legislation, but there is a lot more to come.

The Congressional Research Service (CRS), which provides policy and legal analysis to members of Congress, noted in a recent report that the Obama administration as of December 2012 has completed work on 20 final rules relating to PPACA, will issue 18 new final rules in 2013, and 22 further regulatory actions in 2014 or later. The CRS analysis is based on the portion of Unified Agenda related to the Department of Health and Human Services. The Unified Agenda is a compendium of all regulatory action planned by all federal agencies, and is usually published twice each year.

The Unified Agenda lists upcoming activities in three separate categories: “active” actions, including rules in the prerule stage (i.e., advance notices of proposed rulemaking that are expected to be issued in the next 12 months); proposed rule stage (i.e., notices of proposed rulemaking that are expected to be
issued in the next 12 months) and final rule stage; “completed” actions (i.e., final rules or rules that have been withdrawn since the last edition of the Unified Agenda); and “long-term” actions (i.e., items under development that agencies do not expect to take action on in the next 12 months).

Final Rules

Of the 18 Final rules expected to be released in the next 12 months, nine will be issued by agencies within the Department of Health and Human Services, three by the Department of Treasury, and the rest by other agencies. The Unified Agenda listed five Final rules that were considered to have at least an annual effect on the economy of $100 million. These fives rules include two HHS/FDA rules on “Food Labeling: Nutrition Labeling for Food Sold in Vending Machines” (0910-AG56 ) and “Food Labeling: Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments”(0910-AG57 ); an HHS/CMS rule on “Home and Community-Based State Plan Services Program and Provider Payment Reassignments” (0938-AO53 );  an HHS/CMS rule on “Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health” (0938-AQ36 ); and an HHS/CMS rule on “Covered Outpatient Drugs” (0938-AQ41 ).

The two FDA rules and the CMS rule on covered outpatient drugs are expected to have a particular impact on small businesses, small governments, and small not-for-profit organizations.

Proposed Rules 

Among the Proposed rules recently issued (or that will be issued shortly) that are expected to have at least a $100 million annual effect on the economy are the following: an HHS/CMS rule on “Medicaid, Exchanges, and Children’s Health Insurance Programs” (0938-AR04 ), published on January 22, 2013 ; an HHS/CMS rule on “Medicare Advantage (MA) and Prescription Drug Benefit Programs,” which was expected to be published sometime during December 2012, but had not been published as of February 1, 2013; an HHS/CMS rule on “Health Insurance Market: Rate Review,” which the agency published on November 26, 2012; an HHS/CMS rule on “Administrative Simplification: Compliance with Health Plan Certification” (0938-AQ85 ) which the agency expects to publish in March 2013; an Office of Personnel Management rule on “Multi-State Exchanges,” which the agency published on December 5, 2012; and a rule on “Preventive Services,” which was published jointly by several agencies, including HHS/CMS,  on March 21, 2012, and then updated on February 6, 2013.

Long-Term Actions

The most recent version of the Unified Agenda lists 22 long-term actions related to implementation of the health reform law. For 15 of those actions, no date is set for when a rule might be issued. Of the seven remaining long-term actions, four are expected in December 2013, two are expected in 2014, and one is expected in 2015. The four to be released later this year all will come from the Department of Treasury and all relate to the administration of group health insurance plans.