{"description":"Documents matching 'challenge smart four difficulty levels compete compliance'","count":434,"total_pages":22,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=challenge+smart+four+difficulty+levels+compete+compliance&format=json&page=2","results":[{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges","type":"Proposed Rule","abstract":"These proposals are intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the interoperability of systems used across the health care industry. We are proposing new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs), including issuers that offer small group market QHPs on the Federally-facilitated Small Business Health Options Program (FF- SHOP) Exchanges (hereinafter referred to as \"small group market QHP issuers on the FF-SHOPs\") (collectively \"impacted payers\"), to make available electronic prior authorization for drugs. We are also proposing to extend many existing interoperability requirements for the prior authorization of non-drug items and services to include prior authorizations for drugs to further reduce patient and provider burden. We are also proposing to require impacted payers to report their application programming interfaces (API) endpoints and related information for the Patient Access, Provider Directory, Provider Access, Payer-to-Payer, and Prior Authorization APIs to CMS. To help assess the impact of our policies, we are proposing to collect API usage metrics. In addition, we are proposing to apply the existing interoperability requirements to small group market QHP issuers on the FF-SHOPs as impacted payers. To improve impacted payers' ability to exchange health information while continuing CMS's drive toward interoperability, we are proposing to require certain Health Level Seven (HL7[supreg]) Fast Healthcare Interoperability Resources (FHIR[supreg]) implementation guides (IGs) that are currently recommended. In addition, HHS is proposing to adopt the HL7 FHIR base standard and certain associated specifications and IGs as the Health Insurance Portability and Accountability Act of 1996 (hereinafter referred to as \"HIPAA\") (Pub. L. 104-191, enacted Aug. 21, 1996) standards for dental, professional, and institutional \"referral certification and authorization\" transactions and \"eligibility for a health plan\" transactions associated with prior authorization. We are proposing to add a definition for \"failure to report,\" which would allow CMS to impose a civil monetary penalty (CMP) on applicable manufacturers or applicable group purchasing organizations (GPOs) if those entities fail to grant CMS timely access to documents for the purposes of an audit. Finally, ONC is using this rulemaking to propose to adopt updated versions of certain health information technology (health IT) standards and specifications for HHS use, such as CMS's interoperability requirements, to support a more robust health IT infrastructure.","document_number":"2026-07205","html_url":"https://www.federalregister.gov/documents/2026/04/14/2026-07205/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-standards","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-04-14/pdf/2026-07205.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-07205.pdf?1775852111","publication_date":"2026-04-14","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"reporting <span class=\"match\">levels</span>, that is, the organizational <span class=\"match\">levels</span> at which the payer aggregates and submits the required data, as finalized for the Patient Access API usage metrics. MA organizations would thus report at the contract <span class=\"match\">level</span>, state Medicaid and CHIP FFS programs at the state <span class=\"match\">level</span>, and QHP issuers on the FFEs at the issuer <span class=\"match\">level</span>. We also propose that Medicaid managed care plans and CHIP managed care entities would report metrics at the plan and program <span class=\"match\">level</span> for the reasons discussed previously. By way of examples, reporting at the issuer <span class=\"match\">level</span> means"},{"title":"Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies","type":"Rule","abstract":"This final rule sets forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this final rule finalizes permanent and temporary behavior adjustments and recalibrates the case- mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. This final rule also finalizes changes to the face-to-face encounter policy and changes to the Home Health Quality Reporting Program (HH QRP) and the expanded Health Value-Based Purchasing (HHVBP) Model requirements. In addition, it updates the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). Lastly it finalizes: a technical change to the HH conditions of participation; updates to DMEPOS supplier conditions of payment; updates to provider and supplier enrollment requirements; and changes to DMEPOS accreditation requirements.","document_number":"2025-21767","html_url":"https://www.federalregister.gov/documents/2025/12/02/2025-21767/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-hh-pps-rate","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-12-02/pdf/2025-21767.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-21767.pdf?1764364516","publication_date":"2025-12-02","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"for reconsideration, we may reverse our initial finding of non-<span class=\"match\">compliance</span> if: (1) the HHA provides proof of <span class=\"match\">compliance</span> with all requirements during the reporting period; or (2) the HHA provides adequate proof of a valid or justifiable excuse for non-<span class=\"match\">compliance</span> if the HHA was not able to comply with requirements during the reporting period (77 FR 67096). We also stated that we will uphold an initial finding of non-<span class=\"match\">compliance</span> if the HHA cannot show any justification for non-<span class=\"match\">compliance</span> (77 FR 67096). \n As previously discussed, we codified our reconsideration"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS-RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; permissible plan-level adjustment to the index rate to account for cost-sharing reductions (CSRs); reconsideration standards for certification denials; changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a policy to publicly share aggregated, summary- level Quality Improvement Strategy (QIS) information on an annual basis; and revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2025-00640","html_url":"https://www.federalregister.gov/documents/2025/01/15/2025-00640/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-15/pdf/2025-00640.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-00640.pdf?1736802922","publication_date":"2025-01-15","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"calendar year for which a standard health plan provides coverage for BHP enrollees. \n See \n 42 CFR 600.5.\n \n \n \n \n 12 \n  “Metal tiers” refer to the different actuarial value plan <span class=\"match\">levels</span> offered on the Exchanges. Bronze-<span class=\"match\">level</span> plans generally must provide 60 percent actuarial value; silver-<span class=\"match\">level</span> 70 percent actuarial value; gold-<span class=\"match\">level</span> 80 percent actuarial value; and platinum-<span class=\"match\">level</span> 90 percent actuarial value. See 45 CFR 156.140.\n \n \n \n In the December 20, 2022 \n Federal Register \n (87 FR 77722) (hereafter referred to as the 2023 final BHP Payment Notice)"},{"title":"United States of America et al. v. RealPage, Inc. et al.; Proposed Final Judgment and Competitive Impact Statement","type":"Notice","abstract":null,"document_number":"2025-21966","html_url":"https://www.federalregister.gov/documents/2025/12/05/2025-21966/united-states-of-america-et-al-v-realpage-inc-et-al-proposed-final-judgment-and-competitive-impact","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-12-05/pdf/2025-21966.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-21966.pdf?1764855909","publication_date":"2025-12-05","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"Antitrust Division","name":"Antitrust Division","id":23,"url":"https://www.federalregister.gov/agencies/antitrust-division","json_url":"https://www.federalregister.gov/api/v1/agencies/23","parent_id":268,"slug":"antitrust-division"}],"excerpts":"amassed a massive reservoir of competitively sensitive data from <span class=\"match\">competing</span> landlords and used that data to sell AIRM and YieldStar. RealPage has ensured that rivals cannot <span class=\"match\">compete</span> on the merits unless they enter into similar agreements with landlords, offer to share competitively sensitive information among rival landlords, and engage in actions to increase <span class=\"match\">compliance</span>. As a result of its exclusionary conduct, RealPage has been able to obstruct rival software providers from <span class=\"match\">competing</span> via revenue management products that do not harm the competitive"},{"title":"United States of America et al. v. RealPage, Inc. et al. Proposed Final Judgment and Competitive Impact Statement","type":"Notice","abstract":null,"document_number":"2025-17086","html_url":"https://www.federalregister.gov/documents/2025/09/05/2025-17086/united-states-of-america-et-al-v-realpage-inc-et-al-proposed-final-judgment-and-competitive-impact","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-09-05/pdf/2025-17086.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-17086.pdf?1756989920","publication_date":"2025-09-05","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"Antitrust Division","name":"Antitrust Division","id":23,"url":"https://www.federalregister.gov/agencies/antitrust-division","json_url":"https://www.federalregister.gov/api/v1/agencies/23","parent_id":268,"slug":"antitrust-division"}],"excerpts":"amassed a massive reservoir of competitively sensitive data from <span class=\"match\">competing</span> landlords and used that data to sell AIRM and YieldStar. RealPage has ensured that rivals cannot <span class=\"match\">compete</span> on the merits unless they enter into similar agreements with landlords, offer to share competitively sensitive information among rival landlords, and engage in actions to increase <span class=\"match\">compliance</span>. As a result of its exclusionary conduct, RealPage has been able to obstruct rival software providers from <span class=\"match\">competing</span> via revenue management products that do not harm the competitive"},{"title":"United States of America et al. v. RealPage, Inc. et al. Proposed Final Judgment and Competitive Impact Statement","type":"Notice","abstract":null,"document_number":"2026-01009","html_url":"https://www.federalregister.gov/documents/2026/01/21/2026-01009/united-states-of-america-et-al-v-realpage-inc-et-al-proposed-final-judgment-and-competitive-impact","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-01-21/pdf/2026-01009.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-01009.pdf?1768916709","publication_date":"2026-01-21","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"Antitrust Division","name":"Antitrust Division","id":23,"url":"https://www.federalregister.gov/agencies/antitrust-division","json_url":"https://www.federalregister.gov/api/v1/agencies/23","parent_id":268,"slug":"antitrust-division"}],"excerpts":"amassed a massive reservoir of competitively sensitive data from <span class=\"match\">competing</span> landlords and used that data to sell AIRM and YieldStar. RealPage has ensured that rivals cannot <span class=\"match\">compete</span> on the merits unless they enter into similar agreements with landlords, offer to share competitively sensitive information among rival landlords, and engage in actions to increase <span class=\"match\">compliance</span>. As a result of its exclusionary conduct, RealPage has been able to obstruct rival software providers from <span class=\"match\">competing</span> via revenue management products that do not harm the competitive"},{"title":"Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities","type":"Rule","abstract":"This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2025 based on our continuing experience with these systems. We describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. Also, this final rule updates the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, and Hospital Inpatient Quality Reporting Program. We also summarize information received in response to a Request for Information on potential modifications to the Safety of Care measure group in the Overall Hospital Quality Star Rating methodology. In this final rule, we are also finalizing our proposal to narrow the description of \"custody\" in the Medicare payment exclusion rule and to revise the special enrollment period criteria for formerly incarcerated individuals. We are also finalizing our Medicaid and Children's Health Insurance Program (CHIP) continuous eligibility provisions. We are also finalizing the proposal to reduce the review timeframe for standard prior authorization requests for certain covered outpatient department services paid under the OPPS from 10-business days to 7-calendar days. Further, this rule finalizes updates to the Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) in an effort to advance the health and safety of pregnant, birthing, and postpartum women. This rule also finalizes our proposed policy to separately pay Indian Health Service (IHS) and Tribal hospitals for high-cost drugs furnished in hospital outpatient departments through an add-on payment in addition to the all-inclusive rate (AIR) under the authorities used to calculate the AIR starting January 1, 2025. Finally, we are finalizing exceptions to the Medicaid clinic services four walls requirement for IHS and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas.","document_number":"2024-25521","html_url":"https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-11-27/pdf/2024-25521.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-25521.pdf?1730492130","publication_date":"2024-11-27","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"patient (<span class=\"match\">Level</span> 1)); CPT code 99282 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 2)); CPT code 99283 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 3)); CPT code 99284 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 4)); CPT code 99285 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 5)) or HCPCS code G0380 (Type B emergency department visit (<span class=\"match\">Level</span> 1)); HCPCS code G0381 (Type B emergency department visit (<span class=\"match\">Level</span> 2));"},{"title":"Amendments and Nonconformance Penalties for Model Year 2027 and Later Heavy-Duty Highway Engines and Amendments to Inducement Provisions for SCR-Equipped Diesel Engines","type":"Proposed Rule","abstract":"The U.S. Environmental Protection Agency (EPA) is proposing regulatory amendments to certain compliance provisions and test procedures related to model year (MY) 2027 and later heavy-duty highway engines. These amendments would include changes to the regulatory useful life periods and the emission-related warranty periods. The EPA also proposes to add clarity to certain regulatory compliance provisions and correct errors in the regulations to support the MYs 2027 and later program for heavy-duty highway engines and vehicles. This includes certain amendments related to provisions adopted in January 2023 as well as other provisions adopted in earlier rules. The EPA also proposes to make nonconformance penalties (NCPs) available to manufacturers of medium heavy-duty engines (Medium HDE) and heavy heavy-duty engines (Heavy HDE) beginning in MY 2027. In addition, the EPA proposes to amend the requirements for selective catalytic reduction (SCR) system inducement provisions for newly manufactured diesel-fueled highway engines and vehicles (i.e., light- and medium- duty vehicles and heavy-duty engines) and nonroad engines and equipment. The EPA is also considering new inducement guidance for in- use highway and nonroad diesel engines, vehicles, and equipment.","document_number":"2026-14112","html_url":"https://www.federalregister.gov/documents/2026/07/14/2026-14112/amendments-and-nonconformance-penalties-for-model-year-2027-and-later-heavy-duty-highway-engines-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-07-14/pdf/2026-14112.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-14112.pdf?1783946711","publication_date":"2026-07-14","agencies":[{"raw_name":"ENVIRONMENTAL PROTECTION AGENCY","name":"Environmental Protection Agency","id":145,"url":"https://www.federalregister.gov/agencies/environmental-protection-agency","json_url":"https://www.federalregister.gov/api/v1/agencies/145","parent_id":null,"slug":"environmental-protection-agency"}],"excerpts":"numerically greater than the value determined from PCA testing. The <span class=\"match\">compliance</span> <span class=\"match\">level</span> is used to calculate the NCP, but it also serves as the emission standard for any <span class=\"match\">compliance</span> testing. As a result, selecting a higher <span class=\"match\">compliance</span> <span class=\"match\">level</span> would result in a greater NCP but would also give the manufacturer a bigger <span class=\"match\">compliance</span> margin for managing their <span class=\"match\">compliance</span> risk. In no case would the <span class=\"match\">compliance</span> <span class=\"match\">level</span> exceed the UL.\n \n \n • \n Section 1071.40(a): \n Calculating the <span class=\"match\">compliance</span> <span class=\"match\">level</span> from PCA testing must account for infrequent regeneration adjustment"},{"title":"Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies","type":"Proposed Rule","abstract":"This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule proposes permanent and temporary behavior adjustments and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. Lastly, this proposed rule proposes policy changes to the face-to-face encounter policy. It also proposes changes to the Home Health Quality Reporting Program (HH QRP) and the expanded Health Value-Based Purchasing (HHVBP) Model requirements. In addition, it would update the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). Lastly it proposes: a technical change to the HH conditions of participation; updates to DMEPOS supplier conditions of payment; updates to provider and supplier enrollment requirements; and changes to DMEPOS accreditation requirements.","document_number":"2025-12347","html_url":"https://www.federalregister.gov/documents/2025/07/02/2025-12347/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-hh-pps-rate","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-07-02/pdf/2025-12347.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-12347.pdf?1751314517","publication_date":"2025-07-02","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"for reconsideration, we may reverse our initial finding of non-<span class=\"match\">compliance</span> if: (1) the HHA provides proof of <span class=\"match\">compliance</span> with all requirements during the reporting period; or (2) the HHA provides adequate proof of a valid or justifiable excuse for non-<span class=\"match\">compliance</span> if the HHA was not able to comply with requirements during the reporting period (77 FR 67096). We also stated that we will uphold an initial finding of non-<span class=\"match\">compliance</span> if the HHA cannot show any justification for non-<span class=\"match\">compliance</span> (77 FR 67096). \n \n As previously discussed, we codified our reconsideration"},{"title":"National Primary Drinking Water Regulations for Lead and Copper: Improvements (LCRI)","type":"Rule","abstract":"In December 2023, the U.S. Environmental Protection Agency (EPA) requested comment on the proposed the Lead and Copper Rule Improvements (LCRI), which informed the revisions to the National Primary Drinking Water Regulation (NPDWR) for lead and copper. After consideration of public comment on the LCRI, and consistent with the provisions set forth under the Safe Drinking Water Act (SDWA), the EPA is finalizing revisions to the NPDWR for lead and copper. In this rule, the agency is finalizing requirements for drinking water systems to replace lead and certain galvanized service lines. The final rule also removes the lead trigger level, reduces the lead action level to 0.010 mg/L, and strengthens tap sampling procedures to improve public health protection and simplify implementation relative to the 2021 Lead and Copper Rule Revisions (LCRR). Further, this final rule strengthens corrosion control treatment, public education and consumer awareness, requirements for small systems, and sampling in schools and child care facilities. The final rule will significantly reduce the adverse human health impacts of exposure to toxic lead in drinking water.","document_number":"2024-23549","html_url":"https://www.federalregister.gov/documents/2024/10/30/2024-23549/national-primary-drinking-water-regulations-for-lead-and-copper-improvements-lcri","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-30/pdf/2024-23549.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-23549.pdf?1729264518","publication_date":"2024-10-30","agencies":[{"raw_name":"ENVIRONMENTAL PROTECTION AGENCY","name":"Environmental Protection Agency","id":145,"url":"https://www.federalregister.gov/agencies/environmental-protection-agency","json_url":"https://www.federalregister.gov/api/v1/agencies/145","parent_id":null,"slug":"environmental-protection-agency"}],"excerpts":" \n \n \n Action <span class=\"match\">Level</span> and Trigger <span class=\"match\">Level</span> \n \n \n \n \n • P90 <span class=\"match\">level</span> above lead action <span class=\"match\">level</span> of 0.015 mg/L or copper action <span class=\"match\">level</span> of 1.3 mg/L requires additional actions.\n • Lead action <span class=\"match\">level</span> exceedance requires 7 percent LSLR (includes partial replacements), CCT recommendation and possible study and installation, and PE within 60 days after the end of the monitoring period. \n \n \n • P90 <span class=\"match\">level</span> above lead action <span class=\"match\">level</span> of 0.015 mg/L or copper action <span class=\"match\">level</span> of 1.3 mg/L requires more actions than the previous rule.\n • Defines lead trigger <span class=\"match\">level</span> as P90 &gt; 0.010"},{"title":"GENIUS Act Requirements and Standards for FDIC-Supervised Permitted Payment Stablecoin Issuers and Insured Depository Institutions","type":"Proposed Rule","abstract":"The Federal Deposit Insurance Corporation (FDIC) is soliciting comment on a proposal that would implement certain requirements pursuant to the Guiding and Establishing National Innovation for U.S. Stablecoins Act (GENIUS Act) applicable to FDIC-supervised permitted payment stablecoin issuers and insured depository institutions, clarify deposit insurance coverage for deposits held as reserve assets for payment stablecoins, and clarify the treatment of tokenized deposits.","document_number":"2026-06974","html_url":"https://www.federalregister.gov/documents/2026/04/10/2026-06974/genius-act-requirements-and-standards-for-fdic-supervised-permitted-payment-stablecoin-issuers-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-04-10/pdf/2026-06974.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-06974.pdf?1775738716","publication_date":"2026-04-10","agencies":[{"raw_name":"FEDERAL DEPOSIT INSURANCE CORPORATION","name":"Federal Deposit Insurance Corporation","id":164,"url":"https://www.federalregister.gov/agencies/federal-deposit-insurance-corporation","json_url":"https://www.federalregister.gov/api/v1/agencies/164","parent_id":null,"slug":"federal-deposit-insurance-corporation"}],"excerpts":"appropriate operational, <span class=\"match\">compliance</span>, and information technology risk management principles-based requirements and standards, including Bank Secrecy Act and sanctions <span class=\"match\">compliance</span> standards, that are tailored to the business model and risk profile of PPSIs and consistent with applicable law. Accordingly, proposed § 350.6 would implement this provision and address: (i) general operational and managerial standards; (ii) information technology and security; and (iii) the anti-money laundering and economic sanctions <span class=\"match\">compliance</span> programs certification requirement"},{"title":"Cybersecurity Maturity Model Certification (CMMC) Program","type":"Rule","abstract":"With this final rule, DoD establishes the Cybersecurity Maturity Model Certification (CMMC) Program in order to verify contractors have implemented required security measures necessary to safeguard Federal Contract Information (FCI) and Controlled Unclassified Information (CUI). The mechanisms discussed in this rule will allow the Department to confirm a defense contractor or subcontractor has implemented the security requirements for a specified CMMC level and is maintaining that status (meaning level and assessment type) across the contract period of performance. This rule will be updated as needed, using the appropriate rulemaking process, to address evolving cybersecurity standards, requirements, threats, and other relevant changes.","document_number":"2024-22905","html_url":"https://www.federalregister.gov/documents/2024/10/15/2024-22905/cybersecurity-maturity-model-certification-cmmc-program","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-15/pdf/2024-22905.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-22905.pdf?1728650732","publication_date":"2024-10-15","agencies":[{"raw_name":"DEPARTMENT OF DEFENSE","name":"Defense Department","id":103,"url":"https://www.federalregister.gov/agencies/defense-department","json_url":"https://www.federalregister.gov/api/v1/agencies/103","parent_id":null,"slug":"defense-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"2—Minimum Flow-Down Requirements \n \n Prime contractor requirement \n \n Minimum subcontractor requirement\n If the subcontractor will process, store, or transmit \n \n FCI \n CUI \n \n \n <span class=\"match\">Level</span> 1 (Self) \n <span class=\"match\">Level</span> 1 (Self) \n N/A. \n \n \n <span class=\"match\">Level</span> 2 (Self) \n <span class=\"match\">Level</span> 1 (Self) \n <span class=\"match\">Level</span> 2 (Self). \n \n \n <span class=\"match\">Level</span> 2 (C3PAO) \n <span class=\"match\">Level</span> 1 (Self) \n <span class=\"match\">Level</span> 2 (C3PAO). \n \n \n <span class=\"match\">Level</span> 3 (DIBCAC) \n <span class=\"match\">Level</span> 1 (Self) \n <span class=\"match\">Level</span> 2 (C3PAO). \n \n \n \n Summary of Provisions Contained in This Rule \n Section 170.1 Purpose \n Section 170.1 addresses the purpose of this rule. It describes the CMMC Program and establishes"},{"title":"United States of America et al. v. RealPage, Inc. et al.; Proposed Final Judgment and Competitive Impact Statement","type":"Notice","abstract":null,"document_number":"2025-01886","html_url":"https://www.federalregister.gov/documents/2025/01/30/2025-01886/united-states-of-america-et-al-v-realpage-inc-et-al-proposed-final-judgment-and-competitive-impact","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-30/pdf/2025-01886.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-01886.pdf?1738158308","publication_date":"2025-01-30","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"Antitrust Division","name":"Antitrust Division","id":23,"url":"https://www.federalregister.gov/agencies/antitrust-division","json_url":"https://www.federalregister.gov/api/v1/agencies/23","parent_id":268,"slug":"antitrust-division"}],"excerpts":"Paragraphs V.B and VI.A. The <span class=\"match\">Compliance</span> Monitor will have other powers as the Court deems appropriate. The <span class=\"match\">Compliance</span> Monitor will have no responsibility for operation of the Defendant's business. No attorney client relationship will be formed between Defendant and the <span class=\"match\">Compliance</span> Monitor. \n C. The <span class=\"match\">Compliance</span> Monitor will have the authority to take such steps as, in the <span class=\"match\">Compliance</span> Monitor's discretion and the United States' view, may be necessary to accomplish the <span class=\"match\">Compliance</span> Monitor's responsibilities. The <span class=\"match\">Compliance</span> Monitor may seek information"},{"title":"The Trade-Through Rule and Locked and Crossed Markets Provisions of Regulation NMS","type":"Proposed Rule","abstract":"The Securities and Exchange Commission (\"Commission\" or \"SEC\") is proposing amendments to Regulation NMS (\"Regulation NMS\") under the Securities Exchange Act of 1934 (\"Exchange Act\"). The proposed amendments would rescind the trade-through rule for NMS stocks, the provision regarding locking and crossing quotations for NMS stocks, and certain defined terms. The proposed amendments would also make conforming changes to other related provisions.","document_number":"2026-12163","html_url":"https://www.federalregister.gov/documents/2026/06/17/2026-12163/the-trade-through-rule-and-locked-and-crossed-markets-provisions-of-regulation-nms","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-17/pdf/2026-12163.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-12163.pdf?1781613912","publication_date":"2026-06-17","agencies":[{"raw_name":"SECURITIES AND EXCHANGE COMMISSION","name":"Securities and Exchange Commission","id":466,"url":"https://www.federalregister.gov/agencies/securities-and-exchange-commission","json_url":"https://www.federalregister.gov/api/v1/agencies/466","parent_id":null,"slug":"securities-and-exchange-commission"}],"excerpts":"use a third-party service to surveil for their <span class=\"match\">compliance</span> with Commission rules, including Rule 611, and related FINRA rules, including Rule 5310. These firms usually send their order and trade records to a third-party that specializes in <span class=\"match\">compliance</span> monitoring or transaction cost analysis (“TCA”) and may offer the examination of trade-through <span class=\"match\">compliance</span> as part of a package of services. The third party then matches the trade and order records with historical market data and examines for <span class=\"match\">compliance</span> with and violations of trading rules, including"},{"title":"HIPAA Security Rule To Strengthen the Cybersecurity of Electronic Protected Health Information","type":"Proposed Rule","abstract":"The Department of Health and Human Services (HHS or \"Department\") is issuing this notice of proposed rulemaking (NPRM) to solicit comment on its proposal to modify the Security Standards for the Protection of Electronic Protected Health Information (\"Security Rule\") under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). The proposed modifications would revise existing standards to better protect the confidentiality, integrity, and availability of electronic protected health information (ePHI). The proposals in this NPRM would increase the cybersecurity for ePHI by revising the Security Rule to address: changes in the environment in which health care is provided; significant increases in breaches and cyberattacks; common deficiencies the Office for Civil Rights has observed in investigations into Security Rule compliance by covered entities and their business associates (collectively, \"regulated entities\"); other cybersecurity guidelines, best practices, methodologies, procedures, and processes; and court decisions that affect enforcement of the Security Rule.","document_number":"2024-30983","html_url":"https://www.federalregister.gov/documents/2025/01/06/2024-30983/hipaa-security-rule-to-strengthen-the-cybersecurity-of-electronic-protected-health-information","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-06/pdf/2024-30983.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-30983.pdf?1735334119","publication_date":"2025-01-06","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"a final rule would be 60 days after publication.\n 21 \n \n Regulated entities would have until the “<span class=\"match\">compliance</span> date” to establish and implement policies, procedures, and practices to achieve <span class=\"match\">compliance</span> with any new or modified standards. \n \n Regulated entities would be permitted to comply earlier than the <span class=\"match\">compliance</span> date, but the Department would not take action against them for noncompliance with the proposed changes that occurs before the <span class=\"match\">compliance</span> date. Except as otherwise provided, 45 CFR 160.105 provides that regulated entities must comply with"},{"title":"2018 Quadrennial Regulatory Review-Review of the Commission's Broadcast Ownership Rules","type":"Rule","abstract":"In this document, the Federal Communications Commission (Commission) retains the broadcast ownership rules with minor modifications in compliance with the Telecommunications Act of 1996 which requires the Commission to review its broadcast ownership rules quadrennially to determine whether they are necessary in the public interest as a result of competition. Specifically, the Commission retains the Dual Network Rule, modifies the Local Radio Ownership Rule to make permanent the interim contour-overlap methodology long used to determine ownership limits in areas outside the boundaries of defined Nielsen Audio Metro markets and in Puerto Rico, and modifies the Local Television Ownership Rule to reflect changes that have occurred in the television marketplace and current industry practices.","document_number":"2024-02577","html_url":"https://www.federalregister.gov/documents/2024/02/15/2024-02577/2018-quadrennial-regulatory-review-review-of-the-commissions-broadcast-ownership-rules","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-15/pdf/2024-02577.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-02577.pdf?1707918315","publication_date":"2024-02-15","agencies":[{"raw_name":"FEDERAL COMMUNICATIONS COMMISSION","name":"Federal Communications Commission","id":161,"url":"https://www.federalregister.gov/agencies/federal-communications-commission","json_url":"https://www.federalregister.gov/api/v1/agencies/161","parent_id":null,"slug":"federal-communications-commission"}],"excerpts":"was historically premised on the notion that <span class=\"match\">four</span> full power stations in a market corresponded with <span class=\"match\">four</span> Big <span class=\"match\">Four</span> network affiliates. However, as discussed below, there are now numerous examples where entities have moved programming from what had been top-<span class=\"match\">four</span> rated stations (including Big <span class=\"match\">Four</span> network affiliates) to low power stations or multicast streams, such that what had been top-<span class=\"match\">four</span> rated station programming now may be aggregated on fewer than <span class=\"match\">four</span> full power stations (or among fewer than <span class=\"match\">four</span> separate owners) in a market. Accordingly, even"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Rule","abstract":"This final rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); requirements related to defrayal for the cost of any State-required benefits in addition to the EHB; cost- sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive plan years; QHP issuer quality improvement strategies (QISs); and revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States. This final rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-10050","html_url":"https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-20/pdf/2026-10050.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10050.pdf?1779135308","publication_date":"2026-05-20","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"which would be included with <span class=\"match\">SMART</span> submissions. We stated that HHS would review all <span class=\"match\">SMART</span> submissions and would issue formal letters to State Exchanges summarizing observations on areas of noncompliance and identifying any required corrective actions. We stated that This <span class=\"match\">SMART</span>-based <span class=\"match\">compliance</span> monitoring process would serve as a critical safeguard against program integrity risks by providing HHS with regular, audited documentation of State Exchange operations and would be relied on under the SBE-EDE model.\n \n Beyond the <span class=\"match\">SMART</span> process, we stated in the"},{"title":"Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability","type":"Proposed Rule","abstract":"This proposed rule seeks to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information through proposals for: standards adoption; adoption of certification criteria to advance public health data exchange; expanded uses of certified application programming interfaces, such as for electronic prior authorization, patient access, care management, and care coordination; and information sharing under the information blocking regulations. It proposes to establish a new baseline version of the United States Core Data for Interoperability. The proposed rule would update the ONC Health IT Certification Program to enhance interoperability and optimize certification processes to reduce burden and costs. The proposed rule would also implement certain provisions related to the Trusted Exchange Framework and Common Agreement (TEFCA), which would support the reliability, privacy, security, and trust within TEFCA.","document_number":"2024-14975","html_url":"https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-08-05/pdf/2024-14975.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-14975.pdf?1721825115","publication_date":"2024-08-05","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"data elements that the USCDI v4 comprises. \n ii. <span class=\"match\">SMART</span> App Launch 2.2 \n As discussed in section III.B.2, we propose to adopt the HL7® FHIR® <span class=\"match\">SMART</span> Application Launch Framework Implementation Guide release 2.2.0 (<span class=\"match\">SMART</span> v2.2 Guide) in § 170.215(c)(3). We propose that the adoption of the <span class=\"match\">SMART</span> v2 Guide in § 170.215(c)(2) expires on January 1, 2028. We propose that a Health IT Module certified to criteria referencing the implementation specifications in § 170.215(c) may use the <span class=\"match\">SMART</span> v1, <span class=\"match\">SMART</span> v2, or <span class=\"match\">SMART</span> v2.2 guides for the time period up to and including"},{"title":"Regulation NMS: Minimum Pricing Increments, Access Fees, and Transparency of Better Priced Orders","type":"Rule","abstract":"The Securities and Exchange Commission (\"Commission\" or \"SEC\") is adopting amendments to certain rules of Regulation National Market System (\"Regulation NMS\") under the Securities Exchange Act of 1934, as amended (\"Exchange Act\") to amend the minimum pricing increments for the quoting of certain NMS stocks, reduce the access fee caps, and enhance the transparency of better priced orders.","document_number":"2024-21867","html_url":"https://www.federalregister.gov/documents/2024/10/08/2024-21867/regulation-nms-minimum-pricing-increments-access-fees-and-transparency-of-better-priced-orders","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-08/pdf/2024-21867.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-21867.pdf?1728305119","publication_date":"2024-10-08","agencies":[{"raw_name":"SECURITIES AND EXCHANGE COMMISSION","name":"Securities and Exchange Commission","id":466,"url":"https://www.federalregister.gov/agencies/securities-and-exchange-commission","json_url":"https://www.federalregister.gov/api/v1/agencies/466","parent_id":null,"slug":"securities-and-exchange-commission"}],"excerpts":"n.18.\n \n \n \n \n 953 \n  In addition, with respect to the <span class=\"match\">compliance</span> dates, several commenters requested the \n \n Commission consider the interaction between the proposed rules and other recent Commission rules. In determining <span class=\"match\">compliance</span> dates, the Commission considers the benefits of the rules as well as the costs of delayed <span class=\"match\">compliance</span> dates and the potential overlapping <span class=\"match\">compliance</span> dates. For reasons discussed throughout the release, to the extent that there are costs from overlapping <span class=\"match\">compliance</span> dates, we expect the benefits of the rules to justify"},{"title":"Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities","type":"Proposed Rule","abstract":"This proposed rule would revise the Medicare hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2025 based on our continuing experience with these systems. In this proposed rule, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. Also, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting Program, Rural Emergency Hospital Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, and Hospital Inpatient Quality Reporting Program. This proposed rule would request information on options being considered for future changes to the Overall Hospital Quality Star Rating methodology. The proposed rule would narrow the description of \"custody\" for purposes of Medicare's no legal obligation to pay payment exclusion. The proposed rule would revise the eligibility requirements in the special enrollment period (SEP) for formerly incarcerated individuals to tie the eligibility for this SEP to the determination made by the Social Security Administration that they are no longer incarcerated for releases that occur on and after January 1, 2025. This rule also proposes to codify the requirement in the Consolidated Appropriations Act, 2023 (CAA, 2023) to provide 12 months of continuous eligibility to children under the age of 19 in Medicaid and CHIP, with limited exceptions. Further, this proposed rule would provide updates to the Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs) in an effort to advance the health and safety of pregnant, birthing, and postpartum patients. This rule proposes to separately pay IHS and tribal hospitals for high-cost drugs furnished in hospital outpatient departments through an add-on payment in addition to the AIR under the authorities used to calculate the AIR starting January 1, 2025. This rule also requests further information related to a Tribal Technical Advisory Group request to apply the Indian Health Service encounter rate to all outpatient tribal clinics. Finally, the proposed rule would provide exceptions to the Medicaid clinic services benefit four walls requirement for Indian Health Service and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas.","document_number":"2024-15087","html_url":"https://www.federalregister.gov/documents/2024/07/22/2024-15087/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-07-22/pdf/2024-15087.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-15087.pdf?1720615525","publication_date":"2024-07-22","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"patient (<span class=\"match\">Level</span> 1)); CPT code 99282 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 2)); CPT code 99283 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 3)); CPT code 99284 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 4)); CPT code 99285 (Emergency department visit for the evaluation and management of a patient (<span class=\"match\">Level</span> 5)) or HCPCS code G0380 (Type B emergency department visit (<span class=\"match\">Level</span> 1)); HCPCS code G0381 (Type B emergency department visit (<span class=\"match\">Level</span> 2));"}]}