{"description":"Documents matching 'hipaa patient protection affordable care'","count":803,"total_pages":41,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=hipaa+patient+protection+affordable+care&format=json&page=2","results":[{"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":"Health Insurance Portability and Accountability Act of 1996 (<span class=\"match\">HIPAA</span>), and the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act, as amended by the Health <span class=\"match\">Care</span> and Education Reconciliation Act of 2010, enacted on March 30, 2010—collectively, the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act. Specifically, this final rule adopts standards for health <span class=\"match\">care</span> claims attachments transactions, which will support health <span class=\"match\">care</span> claims transactions, and a standard for electronic signatures to be used in conjunction with health <span class=\"match\">care</span> claims attachments transactions. \n \n \n DATES: \n \n \n Effective"},{"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":"Education Reconciliation Act of 2010 (Pub. L. 111-152), which amended and revised several provisions of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act, was enacted on March 30, 2010. In this rulemaking, the two statutes are referred to collectively as the “<span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act” or “<span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act.”\n \n \n \n \n 2 \n  \n See \n sections 1301, 1302, 1311, 1312, 1313, 1321, 1331, and 1343 of the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act and section 2792 of the PHS Act.\n \n \n \n \n 3 \n  The WFTC legislation (Pub. L. 119-21) was enacted on July 4, 2025.\n"},{"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":"Education Reconciliation Act of 2010 (Pub. L. 111-152), which amended and revised several provisions of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act, was enacted on March 30, 2010. In this rulemaking, the two statutes are referred to collectively as the “<span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act” or “<span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act.”\n \n \n \n \n 2 \n  \n See \n sections 1301, 1302, 1311, 1312, 1313, 1321, 1331, and 1343 of the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act and section 2792 of the PHS Act.\n \n \n \n \n 3 \n  The WFTC legislation (Pub. L. 119-21) was enacted on July 4, 2025.\n"},{"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":"Severability \n A. Purpose and Background \n \n The “Medicare and Medicaid Programs; <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act; Interoperability and <span class=\"match\">Patient</span> Access for MA Organizations and Medicaid Managed <span class=\"match\">Care</span> Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed <span class=\"match\">Care</span> Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, and Health <span class=\"match\">Care</span> Providers” final rule (85 FR 25510) (hereinafter referred to as the “2020 CMS Interoperability and <span class=\"match\">Patient</span> Access final rule”) appeared in the \n Federal Register \n on May 1, 2020. That"},{"title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability","type":"Rule","abstract":"This final rule revises standards relating to denial of coverage for failure to pay past-due premium; excludes Deferred Action for Childhood Arrivals recipients from the definition of \"lawfully present;\" establishes the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and cost-sharing reductions, annual eligibility redeterminations, de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB.","document_number":"2025-11606","html_url":"https://www.federalregister.gov/documents/2025/06/25/2025-11606/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-06-25/pdf/2025-11606.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-11606.pdf?1750709712","publication_date":"2025-06-25","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"}],"excerpts":"American worker. Health <span class=\"match\">care</span> represents a substantial portion of a family's budget and a tremendous cost to Federal taxpayers. To provide emergent relief from rising improper enrollments and health <span class=\"match\">care</span> costs, we are finalizing several regulatory actions aimed at strengthening the integrity of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (ACA) eligibility and enrollment systems to reduce waste, fraud, and abuse that we proposed in the 2025 <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act; Marketplace Integrity and <span class=\"match\">Affordability</span> proposed rule (90 FR 12942)"},{"title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability","type":"Proposed Rule","abstract":"This proposed rule would revise standards relating to past-due premium payments; exclude Deferred Action for Childhood Arrivals recipients from the definition of \"lawfully present\"; the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; failure to file and reconcile; income eligibility verifications for premium tax credits and cost-sharing reductions; annual eligibility redetermination; the automatic reenrollment hierarchy; the annual open enrollment period; special enrollment periods; de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements and for income-based cost-sharing reduction plan variations; and the premium adjustment percentage methodology; and prohibit issuers of coverage subject to EHB requirements from providing coverage for sex-trait modification as an EHB.","document_number":"2025-04083","html_url":"https://www.federalregister.gov/documents/2025/03/19/2025-04083/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-03-19/pdf/2025-04083.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-04083.pdf?1741810509","publication_date":"2025-03-19","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"}],"excerpts":"2010. The Healthcare and Education Reconciliation Act of 2010 (Pub. L. 111-152, 124 Stat. 1049), which amended and revised several provisions of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act, was enacted on March 30, 2010. In this rulemaking, the two statutes are referred to collectively as the “<span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act,” “<span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act,” or “ACA”.\n \n \n The ACA's individual market rules require issuers to guarantee coverage to all applicants regardless of pre-existing conditions and restrict issuers from setting premiums based"},{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally- Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program; Correcting Amendment","type":"Rule","abstract":"This document corrects technical errors in the final rule that appeared in the February 8, 2024 Federal Register titled \"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program\".","document_number":"2024-24801","html_url":"https://www.federalregister.gov/documents/2024/10/25/2024-24801/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-advancing-interoperability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-25/pdf/2024-24801.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-24801.pdf?1729773924","publication_date":"2024-10-25","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":"corrects technical errors in the final rule that appeared in the February 8, 2024 \n Federal Register \n titled “Medicare and Medicaid Programs; <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed <span class=\"match\">Care</span> Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed <span class=\"match\">Care</span> Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible"},{"title":"HIPAA Privacy Rule To Support Reproductive Health Care Privacy","type":"Rule","abstract":"The Department of Health and Human Services (HHS or \"Department\") is issuing this final rule to modify the Standards for Privacy of Individually Identifiable Health Information (\"Privacy 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 Department is issuing this final rule after careful consideration of all public comments received in response to the notice of proposed rulemaking (NPRM) for the HIPAA Privacy Rule to Support Reproductive Health Care Privacy (\"2023 Privacy Rule NPRM\") and public comments received on proposals to revise provisions of the HIPAA Privacy Rule in the NPRM for the Confidentiality of Substance Use Disorder (SUD) Patient Records (\"2022 Part 2 NPRM\").","document_number":"2024-08503","html_url":"https://www.federalregister.gov/documents/2024/04/26/2024-08503/hipaa-privacy-rule-to-support-reproductive-health-care-privacy","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-26/pdf/2024-08503.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-08503.pdf?1713816919","publication_date":"2024-04-26","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":"health <span class=\"match\">care</span> providers.\n 120 \n \n The Department has long recognized that health <span class=\"match\">care</span> professionals who lose the trust of their <span class=\"match\">patients</span> cannot deliver high-quality <span class=\"match\">care</span>.\n 121 \n \n Similarly, if a health <span class=\"match\">care</span> provider does not trust that the PHI they include in an individual's medical records will be kept private, the health <span class=\"match\">care</span> provider may leave gaps or include inaccuracies when preparing medical records, creating a risk that ongoing or future health <span class=\"match\">care</span> would be compromised. In contrast, heightened confidentiality and privacy <span class=\"match\">protections</span> enable"},{"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":"such harms are far greater in the health <span class=\"match\">care</span> sector because of their potential to adversely affect an individual's health or quality of life, or even to cost an individual their life.\n 136 \n \n As stated by the Health <span class=\"match\">Care</span> Industry Cybersecurity Task Force in its 2017 report on the state of cybersecurity in health <span class=\"match\">care</span>: “The health <span class=\"match\">care</span> system cannot deliver effective and safe <span class=\"match\">care</span> without deeper digital connectivity. If the health <span class=\"match\">care</span> system is connected, but insecure, this connectivity could betray <span class=\"match\">patient</span> safety, subjecting them to unnecessary"},{"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":"the NCVHS noted that other types of changes will benefit <span class=\"match\">patients</span> by enhancing pharmacy and payer <span class=\"match\">patient</span> <span class=\"match\">care</span> workflows through the replacement of many clinical free text fields with discrete codified fields. This will enable automation that can trigger real-time workflows that could aid in goals such as combatting the opioid crisis or communicating relevant therapy-related information for at-risk <span class=\"match\">patients</span>. Improvements will support better <span class=\"match\">patient</span> <span class=\"match\">care</span> and safety through more accurate <span class=\"match\">patient</span> identification and enhanced availability and routing of"},{"title":"Excepted Fertility Benefits","type":"Proposed Rule","abstract":"This document contains proposed rules that would amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act to establish certain fertility benefits as a new category of limited excepted benefits. Excepted benefits are generally exempt from the market requirements that were added to those laws by the Health Insurance Portability and Accountability Act, the Patient Protection and Affordable Care Act, the No Surprises Act, and certain other Federal laws specifically related to group health plans and group and individual health insurance coverage.","document_number":"2026-09479","html_url":"https://www.federalregister.gov/documents/2026/05/13/2026-09479/excepted-fertility-benefits","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-13/pdf/2026-09479.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-09479.pdf?1778589913","publication_date":"2026-05-13","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"},{"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"},{"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"}],"excerpts":"Mothers' Health <span class=\"match\">Protection</span> Act; \n 3 \n \n the Women's Health and Cancer Rights Act; \n 4 \n \n the Genetic Information Nondiscrimination Act of 2008; \n 5 \n \n the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA); \n 6 \n \n the Children's Health Insurance Program Reauthorization Act of 2009; \n 7 \n \n Michelle's Law; \n 8 \n \n the <span class=\"match\">Patient</span> \n \n <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act,\n 9 \n \n as amended by the Health <span class=\"match\">Care</span> and Education Reconciliation Act of 2010 (collectively known as the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act or ACA); \n 10"},{"title":"Health Data, Technology, and Interoperability: Protecting Care Access","type":"Rule","abstract":"This final rule has finalized certain proposals from the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability Proposed Rule (HTI-2 Proposed Rule) and in doing so supports the access, exchange, and use of electronic health information. Specifically, this final rule amends the information blocking regulations to revise two existing information blocking exceptions and establish an additional reasonable and necessary activity that does not constitute information blocking referred to as the Protecting Care Access Exception.","document_number":"2024-29683","html_url":"https://www.federalregister.gov/documents/2024/12/17/2024-29683/health-data-technology-and-interoperability-protecting-care-access","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-12-17/pdf/2024-29683.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-29683.pdf?1734356733","publication_date":"2024-12-17","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":"63622 and 63803) and finalized in this final rule. \n We reiterate here for emphasis the reminder we included in the HTI-2 Proposed Rule (89 FR 63622) that <span class=\"match\">HIPAA</span> covered entities and business associates must comply with the <span class=\"match\">HIPAA</span> Privacy Rule, including privacy <span class=\"match\">protections</span> in the “<span class=\"match\">HIPAA</span> Privacy Rule to Support Reproductive Health <span class=\"match\">Care</span> Privacy” final rule (89 FR 32976, April 26, 2024) (2024 <span class=\"match\">HIPAA</span> Privacy Rule) and any other applicable Federal laws that govern the use of EHI. For example, an actor's practice likely to interfere with an individual's"},{"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":"quality, <span class=\"match\">affordable</span> coverage to consumers while minimizing administrative burden and ensuring program integrity. The changes in this final rule are intended to help advance health equity, mitigate health disparities, and alleviate discrimination.\n \n \n \n 1 \n  The <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (Pub. L. 111-148, 124 Stat. 119) was enacted on March 23, 2010. The Healthcare and Education Reconciliation Act of 2010 (Pub. L. 111-152, 124 Stat. 1049), which amended and revised several provisions of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act"},{"title":"Privacy Act of 1974; System of Records","type":"Notice","abstract":"In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS) is partially modifying an existing system of records maintained by the Office for Civil Rights (OCR), \"Program Information Management System (PIMS),\" System No. 09- 90-0052. The modifications include changing the system of records name to \"HHS Civil Rights and Health Information Privacy Program Records\" and affect only certain sections of the System of Records Notice (SORN), so HHS is not republishing the SORN in full. The system of records contains records about individual members of the public who submit or are named or otherwise involved in civil rights, conscience and religious freedom, and health information privacy-related complaints received by and compliance reviews conducted by OCR, and individuals who submit reports to OCR about breaches of unsecured protected health information (PHI) experienced by covered entities and business associates subject to the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, Breach Notification, and Enforcement Rules. OCR is modifying it to include information that programs subject to 42 CFR part 2 (\"Part 2\") (and, as applicable, a qualified service organization on a Part 2 program's behalf) report to the Secretary with respect to a breach of unsecured substance use disorder (SUD) patient records maintained by a Part 2 program (\"Part 2 records\") and complaints and compliance reviews involving potential violations of Part 2.","document_number":"2026-03003","html_url":"https://www.federalregister.gov/documents/2026/02/17/2026-03003/privacy-act-of-1974-system-of-records","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-02-17/pdf/2026-03003.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-03003.pdf?1770930912","publication_date":"2026-02-17","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"}],"excerpts":"Protection and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (42 U.S.C. 18113, 18116, 18023, and 18081, respectively); 42 U.S.C. 1395w-22(j)(3)(B), 1396u-2(b)(3)(B), 1395cc(f), 1396a(w)(3), and 14406(2) (Medicare and Medicaid conscience provisions); 42 U.S.C. 1320a-1(h), 1320c-11, 1395i-5, 1395x(e), 1395x(y)(1), 1396a(a), and 1397j-1(b) (conscience provisions related to Religious Nonmedical Health <span class=\"match\">Care</span> Institutions); 42 U.S.C. 1396f (conscience provisions related to compulsory health <span class=\"match\">care</span> services under Medicaid); 42 U.S.C. 5106i(a), 280g-1(d), 1396s(c)(2)(B)(ii), 290bb-36(f)"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed 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 proposed rule also includes proposed 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; proposed reconsideration standards for certification denials; proposed changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a proposal to publicly share aggregated, summary-level Quality Improvement Strategy (QIS) information on an annual basis; and proposed revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2024-23103","html_url":"https://www.federalregister.gov/documents/2024/10/10/2024-23103/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-2024-10-10/pdf/2024-23103.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-23103.pdf?1728072923","publication_date":"2024-10-10","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":"providing quality, <span class=\"match\">affordable</span> coverage to consumers while minimizing administrative burden and ensuring program integrity. The changes proposed in this rule are also intended to help advance health equity, mitigate health disparities, and alleviate discrimination.\n \n \n \n 1 \n  The <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (Pub. L. 111-148) was enacted on March 23, 2010. The Healthcare and Education Reconciliation Act of 2010 (Pub. L. 111-152), which amended and revised several provisions of the <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act, was enacted"},{"title":"Confidentiality of Substance Use Disorder (SUD) Patient Records","type":"Rule","abstract":"The United States Department of Health and Human Services (HHS or \"Department\") is issuing this final rule to modify its regulations to implement section 3221 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The Department is issuing this final rule after careful consideration of all public comments received in response to the notice of proposed rulemaking (NPRM) for the Confidentiality of Substance Use Disorder (SUD) Patient Records. This final rule also makes certain other modifications to increase alignment with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to improve workability and decrease burden on programs, covered entities, and business associates.","document_number":"2024-02544","html_url":"https://www.federalregister.gov/documents/2024/02/16/2024-02544/confidentiality-of-substance-use-disorder-sud-patient-records","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-16/pdf/2024-02544.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-02544.pdf?1707408916","publication_date":"2024-02-16","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":"Office of the Secretary"}],"excerpts":"with a third party that is not a health <span class=\"match\">care</span> provider for continuity of <span class=\"match\">care</span> purposes? For example, can a health <span class=\"match\">care</span> provider refer a <span class=\"match\">patient</span> experiencing homelessness to a social services agency, such as a housing provider, when doing so may reveal that the basis for eligibility is related to mental health?” (Jan. 9, 2023), \n https://www.hhs.gov/<span class=\"match\">hipaa</span>/for-professionals/faq/3008/does-<span class=\"match\">hipaa</span>-permit-health-<span class=\"match\">care</span>-providers-share-phi-individual-mental-illness-third-party-not-health-<span class=\"match\">care</span>-provider-continuity-<span class=\"match\">care</span>-purposes/index.html. \n \n \n \n The Department"},{"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) 2027 Rates; Requirements for Quality Programs; and Other Policy Changes","type":"Proposed Rule","abstract":"This proposed rule would revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital- related costs of acute care hospitals; make changes relating to Medicare graduate medical education (GME) for teaching hospitals; update 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); update and make changes to requirements for certain quality programs; and make other policy-related changes.","document_number":"2026-07203","html_url":"https://www.federalregister.gov/documents/2026/04/14/2026-07203/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-ipps-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-04-14/pdf/2026-07203.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-07203.pdf?1775852113","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"}],"excerpts":"particular circumstances brought to our attention, we consider whether the resource consumption and clinical characteristics of the <span class=\"match\">patients</span> with a given set of conditions are significantly different than the remaining <span class=\"match\">patients</span> represented in the MS-DRG. We evaluate <span class=\"match\">patient</span> <span class=\"match\">care</span> costs using average costs and lengths of stay and rely on clinical factors to determine whether <span class=\"match\">patients</span> are clinically distinct or similar to other <span class=\"match\">patients</span> represented in the MS-DRG. In evaluating resource costs, we consider both the absolute and percentage differences in average"},{"title":"Enhancing Coverage of Preventive Services Under the Affordable Care Act","type":"Proposed Rule","abstract":"This document sets forth proposed rules that would amend the regulations regarding coverage of certain preventive services under the Public Health Service Act. Specifically, this document proposes rules that would provide that medical management techniques used by non- grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage with respect to such preventive services would not be considered reasonable unless the plan or issuer provides an easily accessible, transparent, and sufficiently expedient exceptions process that would allow an individual to receive coverage without cost sharing for the preventive service that is medically necessary with respect to the individual, as determined by the individual's attending provider, even if such service is not generally covered under the plan or coverage. These proposed rules also contain separate requirements that would apply to coverage of contraceptive items that are preventive services under the Public Health Service Act. Specifically, these proposed rules would require plans and issuers to cover certain recommended over-the-counter contraceptive items without requiring a prescription and without imposing cost-sharing requirements. In addition, the proposed rules would require plans and issuers to cover certain recommended contraceptive items that are drugs and drug-led combination products without imposing cost-sharing requirements, unless a therapeutic equivalent of the drug or drug-led combination product is covered without cost sharing. Finally, this document proposes to require a disclosure pertaining to coverage and cost-sharing requirements for over-the-counter contraceptive items in plans' and issuers' Transparency in Coverage internet-based self-service tools or, if requested by the individual, on paper. These proposed rules would not modify Federal conscience protections related to contraceptive coverage for employers, plans and issuers.","document_number":"2024-24675","html_url":"https://www.federalregister.gov/documents/2024/10/28/2024-24675/enhancing-coverage-of-preventive-services-under-the-affordable-care-act","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-28/pdf/2024-24675.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-24675.pdf?1729714518","publication_date":"2024-10-28","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"},{"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"},{"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"}],"excerpts":"gov/cciio \n ), and information on health <span class=\"match\">care</span> reform can be found at \n www.HealthCare.gov. \n \n \n \n \n SUPPLEMENTARY INFORMATION: \n I. Background \n A. Coverage of Preventive Services Under the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act and Implementing Regulations \n \n The <span class=\"match\">Patient</span> <span class=\"match\">Protection</span> and <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (Pub. L. 111-148) was enacted on March 23, 2010. The Health <span class=\"match\">Care</span> and Education Reconciliation Act of 2010 (Pub. L. 111-152) was enacted on March \n \n 30, 2010. These statutes are collectively known as the <span class=\"match\">Affordable</span> <span class=\"match\">Care</span> Act (ACA). The ACA reorganized, amended,"},{"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":"exchange, and use of EHI would help enable <span class=\"match\">patient</span>-centric <span class=\"match\">care</span>, which is expected to improve equity in health outcomes. This proposed rule further recognizes <span class=\"match\">patient</span> feedback and preferences in their <span class=\"match\">care</span> and how <span class=\"match\">patients</span> and their representatives may want to monitor and share EHI with relevant health <span class=\"match\">care</span> providers and entities. The health IT certification provisions of the proposed rule aim to reduce the burden associated with prior authorization processes, which can ensure that <span class=\"match\">patients</span> receive the <span class=\"match\">care</span> they need in a timely manner, lower administrative"},{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program","type":"Rule","abstract":"This final rule will improve the electronic exchange of health care data and streamline processes related to prior authorization through 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). This final rule will also add new measures for eligible hospitals and critical access hospitals (CAHs) to report under the Medicare Promoting Interoperability Program and for MIPS eligible clinicians to report under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS). These policies, taken together, will reduce overall payer and provider burden and improve patient access to health information while continuing CMS's drive toward interoperability in the health care market.","document_number":"2024-00895","html_url":"https://www.federalregister.gov/documents/2024/02/08/2024-00895/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-advancing-interoperability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-08/pdf/2024-00895.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-00895.pdf?1705612517","publication_date":"2024-02-08","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":" <span class=\"match\">Patients</span> tend to receive <span class=\"match\">care</span> from multiple providers, leading to fragmented <span class=\"match\">patient</span> health records where various pieces of an individual's record are locked in disparate, siloed data systems. With <span class=\"match\">patient</span> data scattered across these disconnected systems, it can be challenging for providers to get a clear picture of the <span class=\"match\">patient's</span> <span class=\"match\">care</span> history, and <span class=\"match\">patients</span> may forget or be unable to provide critical information to their provider. This lack of comprehensive <span class=\"match\">patient</span> data can impede <span class=\"match\">care</span> coordination efforts and access to appropriate <span class=\"match\">care</span>. \n 2. Enhancing"}]}