{"description":"Documents matching 'hipaa violations appropriate county state'","count":471,"total_pages":24,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=hipaa+violations+appropriate+county+state&format=json&page=2","results":[{"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":"regulated entity must assess whether encryption is a reasonable and <span class=\"match\">appropriate</span> safeguard in its environment, when analyzed with reference to its likely contribution to protecting ePHI, and implement encryption if reasonable and <span class=\"match\">appropriate</span>.\n 24 \n \n If encryption is not reasonable and <span class=\"match\">appropriate</span>, a regulated entity must document why it would not be reasonable and <span class=\"match\">appropriate</span> for it to implement the safeguard and must implement an equivalent alternative measure if reasonable and <span class=\"match\">appropriate</span>.\n 25 \n \n As discussed in greater detail below, encryption is built"},{"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":"final rule was finalized and today, the existing <span class=\"match\">HIPAA</span> standard for prior authorization transactions is the X12N 278 transaction standard. We finalized the exemption process with the understanding that a <span class=\"match\">HIPAA</span>-compliant X12N 278 transaction standard would be an acceptable alternative to meet that requirement. However, if HHS's <span class=\"match\">HIPAA</span> proposals in section II.H. are finalized, that standard would no longer be <span class=\"match\">HIPAA</span>-compliant as of the finalized compliance date.\n \n \n Because the purpose of the <span class=\"match\">HIPAA</span> Administrative Simplification provisions is to ensure"},{"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":"entities,' may be subject to CMPs and criminal penalties for <span class=\"match\">violations</span> of the <span class=\"match\">HIPAA</span> regulations. HHS enforces the CMPs under section 1176 of the Act, and [DOJ] enforces the criminal penalties under section 1177 of the Act.” \n 97 \n \n As part of the HITECH Act, <span class=\"match\">state</span> attorneys general may bring civil suits for <span class=\"match\">violations</span> of the <span class=\"match\">HIPAA</span> Privacy and Security Rules on behalf of <span class=\"match\">state</span> residents.\n 98 \n \n Under this final rule, alleged <span class=\"match\">violators</span> of part 2 are subject to the same penalties as <span class=\"match\">HIPAA</span> covered entities through sections 1176 and 1177 of the Social"},{"title":"HHS Request for Comment on Chronic Disease of Addiction","type":"Notice","abstract":"Thanks to President Trump's leadership, since 2017, the country has made significant progress in addressing mental health and substance use. However, President Trump and HHS Secretary Kennedy realize that the Department and country have more work to do. To facilitate this effort, HHS invites public comment in response to this RFI on the research, development, programs, and policies that have been most successful in improving availability of and access to effective prevention, treatment, and recovery interventions for addiction, mental illness, and co-occurring substance use and mental disorders. The purpose of this RFI is to identify research, programs, and policies that have been successful and recommend novel policy ideas and gaps in research that could be addressed and implemented to further the Great American Recovery using existing funding.","document_number":"2026-11602","html_url":"https://www.federalregister.gov/documents/2026/06/10/2026-11602/hhs-request-for-comment-on-chronic-disease-of-addiction","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-10/pdf/2026-11602.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11602.pdf?1780931706","publication_date":"2026-06-10","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"}],"excerpts":"SAMHSA's <span class=\"match\">State</span> Opioid Response (SOR) grants and the Mental Health and Substance Use Block Grants.\n 3 \n \n \n \n \n 3 \n  \n https://www.samhsa.gov/sites/default/files/dear-colleague-letter-faith-based-organizations.pdf. \n \n \n 3. Development of Non-Opioid Options \n \n The Food and Drug Administration (FDA) issued guidance in September 2025 to help expand non-opioid options \n \n for chronic pain and to curb misuse.\n 4 \n \n It addresses development of non-opioid analgesics with specific attention to establishing indications, trial design, <span class=\"match\">appropriate</span> patient"},{"title":"Privacy Act of 1974; System of Records","type":"Notice","abstract":"In accordance with the Privacy Act of 1974 (as amended), the Department of the Army is modifying and reissuing a current system of records titled, \"Army Family Advocacy Program Files,\" A0608-18 DASG. The system of records name is changing from \"Army Family Advocacy Program Files\" to \"Army Family Advocacy Program Records.\" This system of records was originally established to maintain records that identify, monitor, track and provide treatment to alleged offenders, eligible victims and their families of substantiated spouse/child abuse, and neglect. The system is being updated to expand coverage to intimate partners of service members and the intimate partner's children as it pertains to allegations of domestic abuse and child abuse/neglect. Additionally, Army is updating the routine use section to add the DoD standard routine uses (routine uses A through J). The Army is also modifying various other sections within the system of records notice (SORN) to improve clarity or update information that has changed.","document_number":"2025-14120","html_url":"https://www.federalregister.gov/documents/2025/07/28/2025-14120/privacy-act-of-1974-system-of-records","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-07-28/pdf/2025-14120.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-14120.pdf?1753447509","publication_date":"2025-07-28","agencies":[{"raw_name":"DEPARTMENT OF DEFENSE","name":"Defense Department","id":103,"url":"https://www.federalregister.gov/agencies/defense-department","json_url":"https://www.federalregister.gov/api/v1/agencies/103","parent_id":null,"slug":"defense-department"},{"raw_name":"Department of the Army","name":"Army Department","id":32,"url":"https://www.federalregister.gov/agencies/army-department","json_url":"https://www.federalregister.gov/api/v1/agencies/32","parent_id":103,"slug":"army-department"}],"excerpts":"the <span class=\"match\">appropriate</span> Federal, <span class=\"match\">State</span>, local, territorial, tribal, foreign, or international law enforcement authority or other <span class=\"match\">appropriate</span> entity where a record, either alone or in conjunction with other information, indicates a <span class=\"match\">violation</span> or potential <span class=\"match\">violation</span> of law, whether criminal, civil, or regulatory in nature. \n C. To any component of the Department of Justice for the purpose of representing the DoD, or its components, officers, employees, or members in pending or potential litigation to which the record is pertinent. \n D. In an <span class=\"match\">appropriate</span> proceeding"},{"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":"that a <span class=\"match\">State</span> seeking to operate a <span class=\"match\">State</span> Exchange must first operate an SBE-FP for at least one plan year. \n \n We are finalizing our proposal to amend § 155.106(a)(2) to rescind the requirement that as part of a <span class=\"match\">State's</span> activities for its establishment of a <span class=\"match\">State</span> Exchange, the <span class=\"match\">State</span> must provide supporting documentation demonstrating progress toward meeting or implementing <span class=\"match\">State</span> Exchange Blueprint requirements, given preexisting processes per the <span class=\"match\">State</span> Blueprint Application \n 13 \n \n for CMS to collect supporting documentation from a <span class=\"match\">State</span> as part"},{"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":"that a <span class=\"match\">State</span> seeking to operate a <span class=\"match\">State</span> Exchange must first operate an SBE-FP for at least one plan year. \n \n We propose to amend § 155.106(a)(2) to rescind the requirement that as part of a <span class=\"match\">State's</span> activities for its establishment of a <span class=\"match\">State</span> Exchange, the <span class=\"match\">State</span> must provide supporting documentation demonstrating progress toward meeting or implementing <span class=\"match\">State</span> Exchange Blueprint requirements, given preexisting processes per the <span class=\"match\">State</span> Blueprint Application \n 13 \n \n for CMS to collect supporting documentation from a <span class=\"match\">State</span> as part of a <span class=\"match\">State</span> Exchange"},{"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":"through which the payer receives the request. \n \n Comment: \n A commenter noted challenges that <span class=\"match\">state</span> Medicaid agencies would face to include prior authorization data in the Patient Access API. The commenter <span class=\"match\">stated</span> that there are differences between how states process prior authorizations today, with some <span class=\"match\">state</span> Medicaid agencies relying on manual processes.\n \n \n Response: \n <span class=\"match\">State</span> expenditures on designing, developing, installing, enhancing, or operating <span class=\"match\">state</span> Medicaid systems that can conduct electronic prior authorization may be eligible for enhanced"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS-RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; permissible plan-level adjustment to the index rate to account for cost-sharing reductions (CSRs); reconsideration standards for certification denials; changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a policy to publicly share aggregated, summary- level Quality Improvement Strategy (QIS) information on an annual basis; and revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2025-00640","html_url":"https://www.federalregister.gov/documents/2025/01/15/2025-00640/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-15/pdf/2025-00640.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-00640.pdf?1736802922","publication_date":"2025-01-15","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"calendar days after a <span class=\"match\">State</span> Exchange receives a data inaccuracy from an issuer operating in an <span class=\"match\">State</span> Exchange that includes a description of an inaccuracy that meets the requirements at § 156.1210(a) through (c) and all the information that the <span class=\"match\">State</span> Exchange requires or requests to properly assess the inaccuracy, <span class=\"match\">State</span> Exchanges must review and resolve the <span class=\"match\">State</span> Exchange issuer's enrollment data inaccuracies and submit to HHS a description of the resolution of any inaccuracies described by the <span class=\"match\">State</span> Exchange issuer that the <span class=\"match\">State</span> Exchange confirms"},{"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":"data that HHS uses as the basis of APTC payments to <span class=\"match\">State</span> Exchange issuers in the automated Policy-Based Payment (PBP) system, <span class=\"match\">State</span> Exchanges must update their enrollment data before HHS makes any PBP APTC payment adjustments to a <span class=\"match\">State</span> Exchange issuer. Therefore, the <span class=\"match\">State</span> Exchange issuer must work with its <span class=\"match\">State</span> Exchange to ensure resolution of any inaccuracy impacting APTC payment. If a <span class=\"match\">State</span> Exchange issuer is directed by its <span class=\"match\">State</span> Exchange to submit inaccuracies directly to HHS, the <span class=\"match\">State</span> Exchange issuer should follow those submission instructions"},{"title":"Medicaid Program; Community Engagement Requirement for Certain Individuals","type":"Rule","abstract":"This interim final rule with comment period (IFC) interprets and implements the community engagement requirement in Medicaid under section 1902(xx) of the Social Security Act. States are required to implement the new requirement no later than January 1, 2027. This IFC specifies the requirements and expectations for States, including the Medicaid applicants and beneficiaries who must demonstrate community engagement as a condition of their eligibility, the types of qualifying activities that satisfy the community engagement requirement, the criteria to meet an exception from the requirement (that is, be deemed compliant), and the criteria to meet a specified exclusion from the requirement. It also specifies requirements for verification of qualifying activities, outreach to affected populations, steps States must take if they determine individuals are noncompliant, and additional operational considerations for States. Finally, this IFC specifies implementation timing and establishes new State reporting requirements.","document_number":"2026-11094","html_url":"https://www.federalregister.gov/documents/2026/06/03/2026-11094/medicaid-program-community-engagement-requirement-for-certain-individuals","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11094.pdf?1780346707","publication_date":"2026-06-03","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":"was in foster care under the responsibility of any <span class=\"match\">State</span> upon attaining age 18 (or such higher age as the <span class=\"match\">State</span> has elected in its title IV-E plan); and (4) was enrolled in Medicaid in any <span class=\"match\">State</span> while in such foster care. For example, suppose an individual ages out of foster care (while enrolled in Medicaid) at age 21 in <span class=\"match\">State</span> A in 2024 and subsequently moves to <span class=\"match\">State</span> B. Because this individual turned age 18 in 2021, the SUPPORT Act rules for the FFCC group do not apply to the individual. <span class=\"match\">State</span> B covers the adult group but does not have a section"},{"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":"Rule (89 FR 8758).\n 211 \n \n HHS <span class=\"match\">stated</span> that this action was in response to feedback received on multiple notices of proposed rulemaking and extensive stakeholder outreach and is intended to promote efficiency in the prior authorization \n \n process. Specifically, HHS <span class=\"match\">stated</span> that <span class=\"match\">HIPAA</span> Administrative Simplification enforcement action will not be taken against <span class=\"match\">HIPAA</span> covered entities that choose not to use the X12 278 standard as part of an electronic FHIR prior authorization process. HHS will continue to evaluate the <span class=\"match\">HIPAA</span> prior authorization transaction"},{"title":"Nondiscrimination in Health Programs and Activities","type":"Rule","abstract":"The Department of Health and Human Services (HHS or the Department) is issuing this final rule regarding section 1557 of the Affordable Care Act (ACA) (section 1557). Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Section 1557(c) of the ACA authorizes the Secretary of the Department to promulgate regulations to implement the nondiscrimination requirements of section 1557. The Department is also revising its interpretation regarding whether Medicare Part B constitutes Federal financial assistance for purposes of civil rights enforcement. Additionally, the Department is revising provisions prohibiting discrimination on the basis of sex in regulations issued by the Centers for Medicare & Medicaid Services (CMS) governing Medicaid and the Children's Health Insurance Program (CHIP); Programs of All-Inclusive Care for the Elderly (PACE); health insurance issuers and their officials, employees, agents, and representatives; States and the Exchanges carrying out Exchange requirements; agents, brokers, or web-brokers that assist with or facilitate enrollment of qualified individuals, qualified employers, or qualified employees; issuers providing essential health benefits (EHB); and qualified health plan issuers.","document_number":"2024-08711","html_url":"https://www.federalregister.gov/documents/2024/05/06/2024-08711/nondiscrimination-in-health-programs-and-activities","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-05-06/pdf/2024-08711.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-08711.pdf?1714162519","publication_date":"2024-05-06","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":"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":"consideration applicable <span class=\"match\">State</span> law governing licensure of interpreters if any are available in the <span class=\"match\">State</span> where the covered entity provides services. These commenters noted that the process of who can serve as a qualified interpreter differs from <span class=\"match\">State</span> to <span class=\"match\">State</span>, and OCR should adopt language that reflects the minimum standards of <span class=\"match\">State</span> laws governing qualifications of sign language interpreters, if any.\n \n \n Response: \n OCR understands and appreciates commenters raised concerns. Covered entities may use adherence to <span class=\"match\">State</span> law governing licensure as"},{"title":"Requirements Related to the Mental Health Parity and Addiction Equity Act","type":"Rule","abstract":"This document sets forth final rules amending regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and adding new regulations implementing the nonquantitative treatment limitation (NQTL) comparative analyses requirements under MHPAEA, as amended by the Consolidated Appropriations Act, 2021 (CAA, 2021). Specifically, these final rules amend the existing NQTL standard to prohibit group health plans and health insurance issuers offering group or individual health insurance coverage from using NQTLs that place greater restrictions on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. As part of these changes, these final rules require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on relevant outcomes related to access to mental health and substance use disorder benefits and medical/surgical benefits and to take reasonable action, as necessary, to address material differences in access to mental health or substance use disorder benefits as compared to medical/surgical benefits. These final rules also amend existing examples and add new examples on the application of the rules for NQTLs to clarify and illustrate the requirements of MHPAEA. Additionally, these final rules set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Department of the Treasury (Treasury), the Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, the Departments), as well as to an applicable State authority, and to participants, beneficiaries, and enrollees. Finally, HHS finalizes regulatory amendments to implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA, as adopted in the Consolidated Appropriations Act, 2023 (CAA, 2023).","document_number":"2024-20612","html_url":"https://www.federalregister.gov/documents/2024/09/23/2024-20612/requirements-related-to-the-mental-health-parity-and-addiction-equity-act","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-09-23/pdf/2024-20612.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-20612.pdf?1726258517","publication_date":"2024-09-23","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":"minimize contradictions with <span class=\"match\">State</span> guidelines that now limit MHPAEA protections. The commenter also remarked that self-insured plans frequently include language from <span class=\"match\">State</span>-level mandated benefit requirements prevalent in the plan's geographic area that may not be MHPAEA-compliant. \n \n Several commenters supported the removal of any reference to <span class=\"match\">State</span> guidelines to prevent situations in which contradictions between Federal and <span class=\"match\">State</span> guidelines would result in a loss of protections under MHPAEA. One commenter wrote that <span class=\"match\">State</span> law definitions often predate"},{"title":"Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving Federal Financial Assistance","type":"Rule","abstract":"The U.S. Department of Education (Department) amends the regulations implementing Title IX of the Education Amendments of 1972 (Title IX). The purpose of these amendments is to better align the Title IX regulatory requirements with Title IX's nondiscrimination mandate. These amendments clarify the scope and application of Title IX and the obligations of recipients of Federal financial assistance from the Department, including elementary schools, secondary schools, postsecondary institutions, and other recipients (referred to below as \"recipients\" or \"schools\") to provide an educational environment free from discrimination on the basis of sex, including through responding to incidents of sex discrimination. These final regulations will enable all recipients to meet their obligations to comply with Title IX while providing them with appropriate discretion and flexibility to account for variations in school size, student populations, and administrative structures.","document_number":"2024-07915","html_url":"https://www.federalregister.gov/documents/2024/04/29/2024-07915/nondiscrimination-on-the-basis-of-sex-in-education-programs-or-activities-receiving-federal","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-29/pdf/2024-07915.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07915.pdf?1713530716","publication_date":"2024-04-29","agencies":[{"raw_name":"DEPARTMENT OF EDUCATION","name":"Education Department","id":126,"url":"https://www.federalregister.gov/agencies/education-department","json_url":"https://www.federalregister.gov/api/v1/agencies/126","parent_id":null,"slug":"education-department"}],"excerpts":"Title IX can be <span class=\"match\">violated</span> not only by commission of an act but also by a failure to act. No change is needed, though, because the phrase “conduct that could constitute sex discrimination” includes both a recipient's actions and its inaction in derogation of its Title IX obligations. \n See, e.g., \n 87 FR 41423 (<span class=\"match\">stating</span> that “[t]he proposed regulations also recognize that remedies may be <span class=\"match\">appropriate</span> when the recipient's own action or inaction in response to an allegation of sex discrimination resulted in a distinct Title IX <span class=\"match\">violation</span>”).\n \n \n Changes:"},{"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":"rare disease. \n The requestor <span class=\"match\">stated</span> that CMS denied the request to create a new MS-DRG for FY 2023, <span class=\"match\">stating</span> that it would continue to explore <span class=\"match\">appropriate</span> mechanisms to address low volume MS-DRGs indicated for rare diseases; however, after receiving responses to the Request for Information (RFI), the requestor <span class=\"match\">stated</span> that there have not been any changes proposed to the IPPS. The requestor <span class=\"match\">stated</span> its belief that assigning cases for this gene therapy and the rare disease indicated to a new MS-DRG is both <span class=\"match\">appropriate</span> and warranted. According to the"},{"title":"Expansion of Buprenorphine Treatment via Telemedicine Encounter","type":"Rule","abstract":"The Drug Enforcement Administration and the Department of Health and Human Services are amending their regulations to expand the circumstances under which practitioners registered by the Drug Enforcement Administration are authorized to prescribe schedule III-V controlled substances approved by the Food and Drug Administration for the treatment of opioid use disorder via a telemedicine encounter, including an audio-only telemedicine encounter. Under these new regulations, after a practitioner reviews the patient's prescription drug monitoring program data for the state in which the patient is located during the telemedicine encounter, the practitioner may prescribe an initial six-month supply of such medications (split amongst several prescriptions totaling six calendar months) through audio-only means. Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act, or after an in-person medical evaluation is conducted. This regulation also requires the pharmacist to verify the identity of the patient prior to filling a prescription. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 generally requires an in- person medical evaluation prior to issuance of a controlled substance prescription. However, this regulation falls under one of the exceptions found within the Ryan Haight Act. Additionally, this regulation does not affect practitioner-patient relationships in cases where an in-person medical evaluation has previously occurred. The purpose of this regulation is to prevent lapses of care by continuing some of the telemedicine flexibilities that currently exist for those patients seeking treatment for opioid use disorder.","document_number":"2025-01049","html_url":"https://www.federalregister.gov/documents/2025/01/17/2025-01049/expansion-of-buprenorphine-treatment-via-telemedicine-encounter","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-17/pdf/2025-01049.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-01049.pdf?1736948756","publication_date":"2025-01-17","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"Drug Enforcement Administration","name":"Drug Enforcement Administration","id":116,"url":"https://www.federalregister.gov/agencies/drug-enforcement-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/116","parent_id":268,"slug":"drug-enforcement-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":"21 U.S.C. 823(g). Three commenters <span class=\"match\">stated</span> that a practitioner should only need one DEA registration and be legally authorized to practice telemedicine in the <span class=\"match\">state</span> in which the patient is located. Six commenters <span class=\"match\">stated</span> that the practitioner should only need to be DEA-registered and fully licensed in the <span class=\"match\">state</span> in which the patient is located. Two commenters <span class=\"match\">stated</span> that a practitioner should be able to prescribe controlled substances via telemedicine as long as they are licensed to practice medicine in the <span class=\"match\">state</span> the patient is located and that, furthermore"},{"title":"Transparency in Coverage","type":"Proposed Rule","abstract":"These proposed rules set forth proposed requirements that would amend the regulations under the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code regarding price transparency reporting requirements for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage. Specifically, these proposed rules would improve the standardization, accuracy, and accessibility of public pricing disclosures in line with the goals of the Executive Order 14221. With respect to the in-network rate and out-of-network allowed amount machine-readable files, these proposed rules would achieve these goals by adding new contextual files and additional data elements like product type, network name, and enrollment counts; changing the reporting level for aggregation of data; removing in-network rates for unlikely provider-to-service mappings; increasing the reporting period and lowering the claims threshold for out-of-network historical data; and reducing the reporting cadence. These proposed rules would also improve the findability of all of the publicly disclosed machine- readable files required under the Transparency in Coverage rules, including the prescription drug file, by requiring a text file and footer with website URLs and contact information for the files. These proposed rules would also require pricing information that is made available through an online consumer tool and paper (upon request), to also be made available by phone, and establish that the satisfaction of such requirement also satisfies the requirements of section 114 of the No Surprises Act (including for grandfathered group health plans and health insurance issuers offering grandfathered group and individual health insurance coverage that are not otherwise subject to these proposed rules).","document_number":"2025-23693","html_url":"https://www.federalregister.gov/documents/2025/12/23/2025-23693/transparency-in-coverage","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-12-23/pdf/2025-23693.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-23693.pdf?1766178909","publication_date":"2025-12-23","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":"\n Therefore, these proposed rules may require plans and issuers to disclose more detailed pricing information than some <span class=\"match\">State</span> laws currently mandate.\n \n \n \n 255 \n  National Conference of <span class=\"match\">State</span> Legislatures, \n Health Costs, Coverage and Delivery <span class=\"match\">State</span> Legislation Data Base, https://www.ncsl.org/health/health-costs-coverage-and-delivery-<span class=\"match\">state</span>-legislation \n (last updated Sep 26, 2025).\n \n \n \n \n 256 \n  Melanie Evans, \n One <span class=\"match\">State's</span> Effort to Publicize Hospital Prices Brings Mixed Results, \n Wall Street Journal (June 26, 2019), \n https://www.wsj.com/"},{"title":"Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program","type":"Rule","abstract":"This major final rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to the Medicare Diabetes Prevention Program expanded model; updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; updates to policies for Rural Health Clinics and Federally Qualified Health Centers; update to the Ambulance Fee Schedule regulations; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; updates to the Medicare Promoting Interoperability Program.","document_number":"2025-19787","html_url":"https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-11-05/pdf/2025-19787.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-19787.pdf?1761945018","publication_date":"2025-11-05","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":"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":"000 for the purchase of the remote OCT device and <span class=\"match\">stated</span> that the current rate of $47.77 provided by some MACs was inaccurate. Commenters <span class=\"match\">stated</span> that $40,000 is a reasonable cost for the innovative technology which incorporates high-resolution imaging, AI analysis, and secure data systems. Another commenter <span class=\"match\">stated</span> they submitted an invoice for an OCT system that costs $44,500. Commenters <span class=\"match\">stated</span> that for this technology to be widely available, CMS should recognize its value through an <span class=\"match\">appropriate</span> national price for the technical component 0605T."},{"title":"Privacy Act of 1974; System of Records","type":"Notice","abstract":"Pursuant to the Privacy Act of 1974, as amended, the Department of the Interior (DOI) is issuing a public notice of its intent to create the Bureau of Indian Affairs (BIA) Privacy Act system of records, INTERIOR/BIA-35, Behavioral Health and Wellness Program. This system helps the Behavioral Health and Wellness Program (BHWP) provide immediate behavioral health crisis support, clinical counseling services, crisis care coordination, and communication with the client and appropriate points of contact for referrals and continued service delivery or emergency care. This newly established system will be included in DOI's inventory of systems of records.","document_number":"2023-14877","html_url":"https://www.federalregister.gov/documents/2023/07/13/2023-14877/privacy-act-of-1974-system-of-records","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-07-13/pdf/2023-14877.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-14877.pdf?1689165927","publication_date":"2023-07-13","agencies":[{"raw_name":"DEPARTMENT OF THE INTERIOR","name":"Interior Department","id":253,"url":"https://www.federalregister.gov/agencies/interior-department","json_url":"https://www.federalregister.gov/api/v1/agencies/253","parent_id":null,"slug":"interior-department"},{"raw_name":"Bureau of Indian Affairs","name":"Indian Affairs Bureau","id":234,"url":"https://www.federalregister.gov/agencies/indian-affairs-bureau","json_url":"https://www.federalregister.gov/api/v1/agencies/234","parent_id":253,"slug":"indian-affairs-bureau"}],"excerpts":"death or client related incident. This information may be shared with <span class=\"match\">appropriate</span> local, tribal, city, <span class=\"match\">county</span>, <span class=\"match\">state</span>, or Federal law enforcement officials and first responders for immediate emergency response engagement, medical centers for emergency medical care, and social services or other agencies in the event of abuse or neglect. This information may be shared with <span class=\"match\">appropriate</span> BIE and BHWP officials and administrators as needed, as well as tribal officials for <span class=\"match\">appropriate</span> critical incident or sentinel event reporting. \n RECORD SOURCE CATEGORIES:"}]}