{"description":"Documents matching 'health plan transactions associated prior'","count":5841,"total_pages":50,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=health+plan+transactions+associated+prior&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":"currently recommended. In addition, HHS is proposing to adopt the HL7 FHIR base standard and certain <span class=\"match\">associated</span> specifications and IGs as the <span class=\"match\">Health</span> 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” <span class=\"match\">transactions</span> and “eligibility for a <span class=\"match\">health</span> <span class=\"match\">plan</span>” <span class=\"match\">transactions</span> <span class=\"match\">associated</span> with <span class=\"match\">prior</span> authorization. We are proposing to add a definition for “failure to report,” which would allow CMS"},{"title":"Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures","type":"Rule","abstract":"This final rule implements requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010--collectively, the Affordable Care Act. Specifically, this final rule adopts standards for health care claims attachments transactions, which will support health care claims transactions, and a standard for electronic signatures to be used in conjunction with health care claims attachments transactions.","document_number":"2026-05676","html_url":"https://www.federalregister.gov/documents/2026/03/24/2026-05676/administrative-simplification-adoption-of-standards-for-health-care-claims-attachments-transactions","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-03-24/pdf/2026-05676.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-05676.pdf?1774037709","publication_date":"2026-03-24","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":"both <span class=\"match\">health</span> <span class=\"match\">plans</span> and <span class=\"match\">health</span> care providers. \n Section 1173(a) of the Act provides that the Secretary must adopt standards for financial and administrative <span class=\"match\">transactions</span>, and data elements for those <span class=\"match\">transactions</span>, to enable <span class=\"match\">health</span> information to be exchanged electronically. The original HIPAA provisions require the Secretary to adopt standards for the following <span class=\"match\">transactions</span>: (1) <span class=\"match\">health</span> claims or equivalent encounter information; (2) <span class=\"match\">health</span> claims attachments; (3) enrollment and disenrollment in a <span class=\"match\">health</span> <span class=\"match\">plan</span>; (4) eligibility for a <span class=\"match\">health</span> <span class=\"match\">plan</span>; (5)"},{"title":"Statement of Policy on Bank Merger Transactions","type":"Rule","abstract":"The FDIC is taking final action to rescind the Statement of Policy on Bank Merger Transactions published in 2024 (2024 Statement of Policy) and reinstate its Statement of Policy on Bank Merger Transactions that was in effect prior to the 2024 Statement of Policy (Bank Merger Statement of Policy). The reinstated Bank Merger Statement of Policy will remain in effect pending the FDIC's review of all aspects of the regulatory framework governing the FDIC's review of merger transactions in connection with a future proposal to comprehensively revise its merger policy.","document_number":"2025-12493","html_url":"https://www.federalregister.gov/documents/2025/07/03/2025-12493/statement-of-policy-on-bank-merger-transactions","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-07-03/pdf/2025-12493.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-12493.pdf?1751460318","publication_date":"2025-07-03","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":"is taking final action to rescind the Statement of Policy on Bank Merger <span class=\"match\">Transactions</span> published in 2024 (2024 Statement of Policy) and reinstate its Statement of Policy on Bank Merger <span class=\"match\">Transactions</span> that was in effect <span class=\"match\">prior</span> to the 2024 Statement of Policy (Bank Merger Statement of Policy). The reinstated Bank Merger Statement of Policy will remain in effect pending the FDIC's review of all aspects of the regulatory framework governing the FDIC's review of merger <span class=\"match\">transactions</span> in connection with a future proposal to comprehensively revise its merger"},{"title":"Proposed Exemption for Certain Prohibited Transactions Involving Hawai'i Pacific Health and Its Subsidiary, Straub Clinic & Hospital Located in Honolulu, Hawaii","type":"Notice","abstract":"The Department of Labor (the Department) is considering granting an exemption that would permit the Hawai[revaps]i Pacific Health Retirement Plan (the Plan) to sell a parcel of improved real property (the Property) to Straub Clinic & Hospital (Straub) for at least the greater of $16,247,000 or 10% over the Appraised Value of the Property as of the date of the sale (the Sale). As discussed in the Summary of Facts and Representations section below, absent an exemption, the Sale would be prohibited by the Employee Retirement Income Security Act of 1974 (ERISA) and/or the Internal Revenue Code of 1986 (the Code).","document_number":"2025-21195","html_url":"https://www.federalregister.gov/documents/2025/11/26/2025-21195/proposed-exemption-for-certain-prohibited-transactions-involving-hawaii-pacific-health-and-its","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-11-26/pdf/2025-21195.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-21195.pdf?1764078329","publication_date":"2025-11-26","agencies":[{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"}],"excerpts":"discretion. \n See \n 29 CFR 2570.49.\n \n \n The Applicant and the <span class=\"match\">Plan</span> \n \n 1. Hawai'i Pacific <span class=\"match\">Health</span> is a tax-exempt, charitable organization that \n \n operates a <span class=\"match\">health</span> system in Hawaii. Hawai'i Pacific <span class=\"match\">Health</span> sponsors the <span class=\"match\">Plan</span>, which is a defined benefit <span class=\"match\">plan</span> with 8,513 participants and $451,900,283 in net assets as of December 31, 2023. The <span class=\"match\">Plan's</span> named fiduciary and <span class=\"match\">plan</span> administrator is the Hawai'i Pacific <span class=\"match\">Health</span> Retirement <span class=\"match\">Plan</span> Finance Committee (Committee).\n \n 2. Hawai'i Pacific <span class=\"match\">Health</span> wholly controls Straub. Straub owns and operates a medical center"},{"title":"Micro-Captive Listed Transactions and Micro-Captive Transactions of Interest","type":"Rule","abstract":"This document contains final regulations that identify transactions that are the same as, or substantially similar to, certain micro-captive transactions as listed transactions, a type of reportable transaction, and certain other micro-captive transactions as transactions of interest, another type of reportable transaction. Material advisors and certain participants in these listed transactions and transactions of interest are required to file disclosures with the IRS and are subject to penalties for failure to disclose. The final regulations affect participants in these transactions as well as material advisors.","document_number":"2025-00393","html_url":"https://www.federalregister.gov/documents/2025/01/14/2025-00393/micro-captive-listed-transactions-and-micro-captive-transactions-of-interest","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-14/pdf/2025-00393.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-00393.pdf?1736543718","publication_date":"2025-01-14","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"Internal Revenue Service","name":"Internal Revenue Service","id":254,"url":"https://www.federalregister.gov/agencies/internal-revenue-service","json_url":"https://www.federalregister.gov/api/v1/agencies/254","parent_id":497,"slug":"internal-revenue-service"}],"excerpts":"identify <span class=\"match\">transactions</span> that are the same as, or substantially similar to, certain micro-captive <span class=\"match\">transactions</span> as listed <span class=\"match\">transactions</span>, a type of reportable transaction, and certain other micro-captive <span class=\"match\">transactions</span> as <span class=\"match\">transactions</span> of interest, another type of reportable transaction. Material advisors and certain participants in these listed <span class=\"match\">transactions</span> and <span class=\"match\">transactions</span> of interest are required to file disclosures with the IRS and are subject to penalties for failure to disclose. The final regulations affect participants in these <span class=\"match\">transactions</span> as well"},{"title":"Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard","type":"Rule","abstract":"This final rule adopts updated versions of the retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These updated versions are modifications to the currently adopted standards for the following retail pharmacy transactions: health care claims or equivalent encounter information; eligibility for a health plan; referral certification and authorization; and coordination of benefits. This final rule also adopts a modification to the standard for the Medicaid pharmacy subrogation transaction.","document_number":"2024-29138","html_url":"https://www.federalregister.gov/documents/2024/12/13/2024-29138/administrative-simplification-modifications-of-health-insurance-portability-and-accountability-act","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-12-13/pdf/2024-29138.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-29138.pdf?1734011124","publication_date":"2024-12-13","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":"enrollment and disenrollment in a <span class=\"match\">health</span> <span class=\"match\">plan</span>; eligibility for a <span class=\"match\">health</span> <span class=\"match\">plan</span>; <span class=\"match\">health</span> care payment and remittance advice; <span class=\"match\">health</span> <span class=\"match\">plan</span> premium payments; first report of injury; <span class=\"match\">health</span> claim status; and referral certification and authorization. The Affordable Care Act additionally required the Secretary to adopt standards for electronic funds transfers <span class=\"match\">transactions</span>. Section 1173(a)(1)(B) of the Act requires the Secretary to adopt standards for any other financial and administrative <span class=\"match\">transactions</span> the Secretary determines appropriate. Section 1173(a)(4) of the"},{"title":"Federal Employees Health Benefits Program: Verification Requirements for Family Member Coverage","type":"Rule","abstract":"The FEHB Protection Act of 2025 (FPA) requires OPM to issue regulations and implement a process to verify: The veracity of any qualifying life event (QLE) through which a health benefits plan enrollee seeks to add a member of family to their enrollment and that when an enrollee adds a family member to the health benefits plan, including during any open season, the individual is a qualified member of family. This final rule also clarifies responsibilities for initial family member eligibility determinations for the Postal Service Health Benefits (PSHB) Program.","document_number":"2026-11022","html_url":"https://www.federalregister.gov/documents/2026/06/02/2026-11022/federal-employees-health-benefits-program-verification-requirements-for-family-member-coverage","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-02/pdf/2026-11022.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11022.pdf?1780085714","publication_date":"2026-06-02","agencies":[{"raw_name":"OFFICE OF PERSONNEL MANAGEMENT","name":"Personnel Management Office","id":406,"url":"https://www.federalregister.gov/agencies/personnel-management-office","json_url":"https://www.federalregister.gov/api/v1/agencies/406","parent_id":null,"slug":"personnel-management-office"}],"excerpts":"implement a process to verify: The veracity of any qualifying life event (QLE) through which a <span class=\"match\">health</span> benefits <span class=\"match\">plan</span> enrollee seeks to add a member of family to their enrollment and that when an enrollee adds a family member to the <span class=\"match\">health</span> benefits <span class=\"match\">plan</span>, including during any open season, the individual is a qualified member of family. This final rule also clarifies responsibilities for initial family member eligibility determinations for the Postal Service <span class=\"match\">Health</span> Benefits (PSHB) Program. \n \n \n DATES: \n \n Effective Date: \n This rule is effective on July"},{"title":"Notice of Issuance of the Department of the Army Program Comment for Army Warfighting Readiness and Associated Infrastructure","type":"Notice","abstract":"The Advisory Council on Historic Preservation has issued a program comment for the U.S. Department of the Army that sets forth how the Army may comply with Section 106 of the National Historic Preservation Act on Army installations for its warfighting readiness activities and associated infrastructure, including: training, testing, equipping, and industrial activities and management actions on associated infrastructure.","document_number":"2026-08674","html_url":"https://www.federalregister.gov/documents/2026/05/05/2026-08674/notice-of-issuance-of-the-department-of-the-army-program-comment-for-army-warfighting-readiness-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-05/pdf/2026-08674.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-08674.pdf?1777898746","publication_date":"2026-05-05","agencies":[{"raw_name":"ADVISORY COUNCIL ON HISTORIC PRESERVATION","name":"Advisory Council on Historic Preservation","id":225,"url":"https://www.federalregister.gov/agencies/advisory-council-on-historic-preservation","json_url":"https://www.federalregister.gov/api/v1/agencies/225","parent_id":null,"slug":"advisory-council-on-historic-preservation"}],"excerpts":"NHLs. The Army FPO will consider written comments from the ACHP and NPS and may require installations and commands to revise NHL treatment <span class=\"match\">plans</span> in consideration of the views provided by the ACHP and NPS. <span class=\"match\">Prior</span> to taking any action that adversely affects an NHL, the command and installation will receive the FPO's written endorsement of the NHL treatment <span class=\"match\">plan</span>. The Army FPO will make the approved treatment <span class=\"match\">plan</span> available to the ACHP and NPS for informational purposes. \n 4.2.4. Management of Tier 2 Properties—Properties of Traditional Religious and"},{"title":"Exemption for Certain Prohibited Transactions Involving Meta Platforms, Inc. (Meta) Located in Menlo Park, CA","type":"Notice","abstract":"This document provides notice of an individual exemption from certain prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974 (ERISA). The exemption permits Prudential Life Insurance Company of America (Prudential) to reinsure the Meta Platforms Inc. Health and Welfare Benefit Plan (Plan)'s group term life insurance benefits, accidental death and dismemberment benefits, survivor income benefits, supplemental employee term coverage, dependent term life insurance (spouse or domestic partner), dependent term life insurance (children) (the Reinsured Benefits), by entering into a reinsurance contract with Ekahi Insurance Company, LLC (Ekahi), an insurance company that is owned by Meta Platforms, Inc. (Meta or the Applicant). This arrangement is hereinafter referred to as the \"Reinsurance Arrangement.\"","document_number":"2025-12641","html_url":"https://www.federalregister.gov/documents/2025/07/08/2025-12641/exemption-for-certain-prohibited-transactions-involving-meta-platforms-inc-meta-located-in-menlo","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-07-08/pdf/2025-12641.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-12641.pdf?1751892313","publication_date":"2025-07-08","agencies":[{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"}],"excerpts":"Exemption at 89 FR 92162 (November 21, 2024).\n \n \n The Sponsor \n 1. Meta Platforms, Inc. (Meta) is a multinational technology company headquartered in Menlo Park, California. Meta sponsors the <span class=\"match\">Plan</span>. \n The <span class=\"match\">Plan</span> \n 2. Meta Platforms Inc. <span class=\"match\">Health</span> and Welfare Benefit <span class=\"match\">Plan</span> (<span class=\"match\">Plan</span>) provides the following <span class=\"match\">health</span> and welfare benefits to its employees and their beneficiaries: <span class=\"match\">health</span>, dental, vision, temporary disability insurance for accidents and sickness, prepaid legal services, long-term disability, death benefits, basic employee term life coverage, basic AD&amp;D"},{"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":"13406), we issued the <span class=\"match\">health</span> insurance market rules, including provisions related to the single risk pool. We codified that, for catastrophic <span class=\"match\">plans</span>, issuers may make a <span class=\"match\">plan</span>-specific adjustment to the market-wide index rate based on the expected impact of the specific eligibility categories for those <span class=\"match\">plans</span>. This <span class=\"match\">plan</span>-specific adjustment would be uniform across all of an issuer's catastrophic <span class=\"match\">plans</span> (that is, risk across all catastrophic <span class=\"match\">plans</span> must be pooled).\n \n In that rule, we also codified that a <span class=\"match\">health</span> <span class=\"match\">plan</span> is a catastrophic <span class=\"match\">plan</span> if it: (1) meets all"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed 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 proposed 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); cost-sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive years; QHP issuer quality improvement strategies (QISs); revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States; and seeks comment on potential adjustments to other Federal standards, including the Federal medical loss ratio (MLR) standard in the individual market. This proposed rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-02769","html_url":"https://www.federalregister.gov/documents/2026/02/11/2026-02769/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-2026-02-11/pdf/2026-02769.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-02769.pdf?1770671709","publication_date":"2026-02-11","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":"State-specific <span class=\"match\">plans</span>, we apply the CSR adjustment factors that correspond to each <span class=\"match\">plan's</span> AV. See, \n e.g., \n the 2025 Payment Notice, 89 FR at 26252-26253. However, a different approach is taken for States whose State-specific <span class=\"match\">plans</span> take the form of Medicaid expansion <span class=\"match\">plans</span> offered on the Exchange (for example, Arkansas), because these Medicaid-expansion <span class=\"match\">plans</span> are identical in all their parameters, including AV and degree of <span class=\"match\">plan</span> liability, to other <span class=\"match\">plans</span> offered on the Exchange in those States and are differentiated from their comparable <span class=\"match\">plans</span> only in"},{"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":"49 \n  \n Id. \n \n \n 2. <span class=\"match\">Health</span> Information Technology for Economic and Clinical <span class=\"match\">Health</span> (HITECH) Act \n \n On February 17, 2009, Congress enacted the <span class=\"match\">Health</span> Information Technology for Economic and Clinical <span class=\"match\">Health</span> Act of 2009 (HITECH Act), part of the American Recovery and Reinvestment Act of 2009 (ARRA),\n 50 \n \n promoting the nationwide adoption and standardization of <span class=\"match\">health</span> information technology (<span class=\"match\">health</span> IT) to support the electronic sharing of clinical data. The HITECH Act created financial incentives for <span class=\"match\">health</span> IT use among <span class=\"match\">health</span> care practitioners"},{"title":"Request for Information; Health Technology Ecosystem","type":"Notice","abstract":"Effective and responsible adoption of technology can empower patients to make better decisions for their health and well-being. This request for information (RFI) seeks input from the public regarding the market of digital health products for Medicare beneficiaries as well as the state of data interoperability and broader health technology infrastructure. Responses to this RFI may be used to inform CMS and ASTP/ONC efforts to lead infrastructure progress to cultivate this market, increasing beneficiary access to effective digital capabilities needed to make informed health decisions, and increasing data availability for all stakeholders contributing to health outcomes.","document_number":"2025-08701","html_url":"https://www.federalregister.gov/documents/2025/05/16/2025-08701/request-for-information-health-technology-ecosystem","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-05-16/pdf/2025-08701.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-08701.pdf?1747149309","publication_date":"2025-05-16","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":"adoption of <span class=\"match\">health</span> management and care navigation applications, reduce barriers to data access and exchange, realize the potential of recent innovations in healthcare that promote better <span class=\"match\">health</span> outcomes, and accelerate progress towards a patient-centric learning <span class=\"match\">health</span> system. \n CMS and ASTP/ONC seek feedback from stakeholders, including but not limited to: patients and caregivers, providers, payers, <span class=\"match\">health</span> IT companies, <span class=\"match\">health</span> information exchanges, <span class=\"match\">health</span> information networks, clearinghouses, researchers, and developers of digital <span class=\"match\">health</span> products"},{"title":"Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions To Unleash Prosperity","type":"Proposed Rule","abstract":"This proposed rule focuses on deregulatory actions identified in HHS regulations regarding Health information technology standards, implementation specifications, and certification criteria and certification programs for health information technology, and information blocking. This proposed rule seeks to reduce burden, offer flexibility to both developers and providers, and support innovation through the removal and revisions of certain certification criteria and regulatory provisions. This proposed rule also seeks to address reported misuse and abuse of information blocking definitions and exceptions.","document_number":"2025-23896","html_url":"https://www.federalregister.gov/documents/2025/12/29/2025-23896/health-data-technology-and-interoperability-astponc-deregulatory-actions-to-unleash-prosperity","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-12-29/pdf/2025-23896.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-23896.pdf?1766438109","publication_date":"2025-12-29","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":"highest possible quality of life for each citizen. ASTP/ONC is issuing this proposed rule in an effort to streamline and reduce administrative burdens on <span class=\"match\">health</span> care providers, <span class=\"match\">health</span> information technology (IT) developers, and the <span class=\"match\">health</span> IT community overall. This proposed rule would also improve patient and <span class=\"match\">health</span> care provider access to electronic <span class=\"match\">health</span> information (EHI) and promote <span class=\"match\">health</span> IT and <span class=\"match\">health</span> care market competition with proposals to revise the information blocking regulations.\n \n \n \n 1 \n  \n https://www.federalregister.gov/documents/202"},{"title":"Exemption for Associated General Contractors of America, San Diego Chapter, Inc. Apprenticeship and Training Fund, Located in San Diego, CA","type":"Notice","abstract":"This document gives notice of an individual exemption from certain prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974, as amended (ERISA or the Act). The exemption permits the Associated General Contractors of America, San Diego Chapter, Inc. (the Chapter) to lease certain improved real property (the Property) located in San Diego, California to the Associated General Contractors of America, San Diego Chapter, Inc. Apprenticeship and Training Fund (the Plan or the Applicant).","document_number":"2024-31599","html_url":"https://www.federalregister.gov/documents/2025/01/06/2024-31599/exemption-for-associated-general-contractors-of-america-san-diego-chapter-inc-apprenticeship-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-06/pdf/2024-31599.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-31599.pdf?1735911919","publication_date":"2025-01-06","agencies":[{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"}],"excerpts":"the Proposed Exemption, the <span class=\"match\">Plan</span> provides apprenticeship training for construction trade employees within five Southern California counties. The <span class=\"match\">Plan</span> is funded by participating employers (contributing approximately 90% of the <span class=\"match\">Plan's</span> annual funding) and the State of California (contributing approximately 10% of the <span class=\"match\">Plan's</span> annual funding). Apprentices do not contribute to the <span class=\"match\">Plan</span>. The <span class=\"match\">Plan's</span> most recent audited financial statements reflect that the <span class=\"match\">Plan's</span> total assets were $13,681,005 as of March 31, 2024. \n 2. The <span class=\"match\">Plan's</span> Board of Trustees (the Board)"},{"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":"services with a focus on the experience of individuals, <span class=\"match\">health</span> IT developers, and <span class=\"match\">health</span> care providers.\n 9 \n \n The proposed rule supports the Department of <span class=\"match\">Health</span> and Human Services' agency-wide approach to electronic <span class=\"match\">prior</span> authorization that meets the Department's interoperability and burden reduction goals, such as reducing documentation requirements <span class=\"match\">associated</span> with completing <span class=\"match\">prior</span> authorization requests for payers.\n 10 \n \n Proposed certification criteria would make available certified <span class=\"match\">health</span> IT that can enable payers contracting with the Federal"},{"title":"Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization","type":"Rule","abstract":"This final rule revises the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals; makes changes relating to Medicare graduate medical education (GME) for teaching hospitals; updates the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); updates and makes changes to requirements for certain quality programs; and makes other policy- related changes. We are also finalizing the provisions of the interim final action with comment period regarding the changes to the FY 2025 IPPS rates due to the court decision in Bridgeport Hosp. v. Becerra. Lastly, it finalizes certain updates to the ONC Health Information Technology (IT) Certification Program.","document_number":"2025-14681","html_url":"https://www.federalregister.gov/documents/2025/08/04/2025-14681/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-ipps-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-08-04/pdf/2025-14681.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-14681.pdf?1753992911","publication_date":"2025-08-04","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":"date range used for episode attribution; (12) removing <span class=\"match\">health</span> equity <span class=\"match\">plans</span> and <span class=\"match\">health</span> related social needs data reporting; (13) broadening the Skilled Nursing Facility (SNF) 3-day rule waiver; (14) modifying the referral to primary care services requirement; and (15) removing the Decarbonization and Resilience Initiative (DRI). \n k. ONC <span class=\"match\">Health</span> IT Certification Program Updates \n \n In the <span class=\"match\">Health</span> Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public <span class=\"match\">Health</span> Interoperability proposed rule (HTI-2 Proposed Rule) (89"},{"title":"National Plan and Provider Enumeration System (NPPES) Data Changes","type":"Notice","abstract":"This notice provides information on changes to a data element collected by the National Plan and Provider Enumeration System (NPPES) when a provider applies for a National Provider Identifier (NPI), which changes are made pursuant to provisions of the January 20, 2025, Executive Order, 14168 (90 FR 8615). This notice also provides an explanation of the nature and rationale for the changes, and their effect on public-facing data available in NPPES downloadable files and the query-only database on the internet.","document_number":"2025-14478","html_url":"https://www.federalregister.gov/documents/2025/07/31/2025-14478/national-plan-and-provider-enumeration-system-nppes-data-changes","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-07-31/pdf/2025-14478.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-14478.pdf?1753879512","publication_date":"2025-07-31","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":"Secretary to adopt a unique standard <span class=\"match\">health</span> identifier for individuals, employers, <span class=\"match\">health</span> <span class=\"match\">plans</span>, and <span class=\"match\">health</span> care providers for use in the <span class=\"match\">health</span> care system and to specify the purposes for which the identifiers may be used. A proposed rule titled “National Standard <span class=\"match\">Health</span> Care Provider Identifier” (hereinafter referred to as the national provider identifier (NPI) proposed rule) appeared in the May 7, 1998, \n Federal Register \n (63 FR 25320), and proposed a standard unique <span class=\"match\">health</span> identifier, or NPI, for <span class=\"match\">health</span> care providers (providers) and requirements"},{"title":"Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA), National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard; Updates to Compliance and Other Related Dates","type":"Rule","abstract":"This document updates compliance and other dates presented in the final rule that appeared in the December 13, 2024 Federal Register titled \"Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard\" to conform with the subsequent final rule that appeared in the February 11, 2025 Federal Register.","document_number":"2025-15958","html_url":"https://www.federalregister.gov/documents/2025/08/21/2025-15958/administrative-simplification-modifications-of-health-insurance-portability-and-accountability-act","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-08-21/pdf/2025-15958.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-15958.pdf?1755693975","publication_date":"2025-08-21","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":"1996 (HIPAA). These updated versions are modifications to previously adopted standards for the following retail pharmacy <span class=\"match\">transactions</span>: <span class=\"match\">health</span> care claims or equivalent encounter information; eligibility for a <span class=\"match\">health</span> <span class=\"match\">plan</span>; referral certification and authorization; and coordination of benefits. This final rule also adopted a modification to the standard for the Medicaid pharmacy subrogation transaction. Subsequently, we determined this final rule contained a technical error regarding the 8-month transition period before full compliance with retail pharmacy"},{"title":"Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure","type":"Proposed Rule","abstract":"The Department is proposing a regulation that would require providers of pharmacy benefit management services and affiliated providers of brokerage and consulting services to disclose information about their compensation to fiduciaries of self-insured group health plans subject to the Employee Retirement Income Security Act (ERISA). These disclosures are needed so that fiduciaries can assess the reasonableness of the contracts or arrangements with these service providers, including the reasonableness of the service providers' compensation. These disclosure requirements would apply for purposes of ERISA's statutory prohibited transaction exemption for services arrangements. This proposal implements section 12 of President Trump's Executive Order 14273, Lowering Drug Prices by Once Again Putting Americans First, which instructs the Department to propose regulations to improve employer health plan transparency into the direct and indirect compensation received by pharmacy benefit managers. If finalized, this regulation would affect sponsors and other fiduciaries of self-insured group health plans and certain service providers to such plans.","document_number":"2026-01907","html_url":"https://www.federalregister.gov/documents/2026/01/30/2026-01907/improving-transparency-into-pharmacy-benefit-manager-fee-disclosure","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-01-30/pdf/2026-01907.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-01907.pdf?1769721310","publication_date":"2026-01-30","agencies":[{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"}],"excerpts":"Responsible <span class=\"match\">plan</span> fiduciaries of self-insured group <span class=\"match\">health</span> <span class=\"match\">plans</span> must determine that service provider relationships involving the self-insured group <span class=\"match\">health</span> <span class=\"match\">plan</span> meet certain conditions to avoid constituting a prohibited transaction under ERISA. Specifically, unless an exemption applies, the furnishing of goods, services, or facilities between a self-insured group <span class=\"match\">health</span> <span class=\"match\">plan</span> and a party in interest to the <span class=\"match\">plan</span> is a prohibited transaction under ERISA section 406(a)(1)(C). A person providing services to the self-insured group <span class=\"match\">health</span> <span class=\"match\">plan</span> is defined"}]}