{"description":"Documents matching 'improve patients condition care them'","count":2960,"total_pages":50,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=improve+patients+condition+care+them&format=json&page=2","results":[{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges","type":"Proposed Rule","abstract":"These proposals are intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the interoperability of systems used across the health care industry. We are proposing new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs), including issuers that offer small group market QHPs on the Federally-facilitated Small Business Health Options Program (FF- SHOP) Exchanges (hereinafter referred to as \"small group market QHP issuers on the FF-SHOPs\") (collectively \"impacted payers\"), to make available electronic prior authorization for drugs. We are also proposing to extend many existing interoperability requirements for the prior authorization of non-drug items and services to include prior authorizations for drugs to further reduce patient and provider burden. We are also proposing to require impacted payers to report their application programming interfaces (API) endpoints and related information for the Patient Access, Provider Directory, Provider Access, Payer-to-Payer, and Prior Authorization APIs to CMS. To help assess the impact of our policies, we are proposing to collect API usage metrics. In addition, we are proposing to apply the existing interoperability requirements to small group market QHP issuers on the FF-SHOPs as impacted payers. To improve impacted payers' ability to exchange health information while continuing CMS's drive toward interoperability, we are proposing to require certain Health Level Seven (HL7[supreg]) Fast Healthcare Interoperability Resources (FHIR[supreg]) implementation guides (IGs) that are currently recommended. In addition, HHS is proposing to adopt the HL7 FHIR base standard and certain associated specifications and IGs as the Health Insurance Portability and Accountability Act of 1996 (hereinafter referred to as \"HIPAA\") (Pub. L. 104-191, enacted Aug. 21, 1996) standards for dental, professional, and institutional \"referral certification and authorization\" transactions and \"eligibility for a health plan\" transactions associated with prior authorization. We are proposing to add a definition for \"failure to report,\" which would allow CMS to impose a civil monetary penalty (CMP) on applicable manufacturers or applicable group purchasing organizations (GPOs) if those entities fail to grant CMS timely access to documents for the purposes of an audit. Finally, ONC is using this rulemaking to propose to adopt updated versions of certain health information technology (health IT) standards and specifications for HHS use, such as CMS's interoperability requirements, to support a more robust health IT infrastructure.","document_number":"2026-07205","html_url":"https://www.federalregister.gov/documents/2026/04/14/2026-07205/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-standards","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-04-14/pdf/2026-07205.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-07205.pdf?1775852111","publication_date":"2026-04-14","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"notifications for value-based <span class=\"match\">care</span> and <span class=\"match\">care</span> coordination, health <span class=\"match\">care</span> resiliency and securing health <span class=\"match\">care</span> operations in a modern health <span class=\"match\">care</span> ecosystem, <span class=\"match\">improving</span> the implementation of payer API technology through testing and \n \n certification, using technology to manage step therapy, and prior authorization requirements for laboratory tests and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items.\n \n Electronic event notifications are valuable tools for coordinating <span class=\"match\">care</span> in the modern health <span class=\"match\">care</span> environment, and we are seeking"},{"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":"regulatory burden on interested parties, and <span class=\"match\">improve</span> affordability.\n \n \n \n 1 \n  The <span class=\"match\">Patient</span> Protection and Affordable <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> Protection and Affordable <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> Protection and Affordable <span class=\"match\">Care</span> Act” or “Affordable <span class=\"match\">Care</span> Act.”\n \n \n \n \n 2 \n  \n See \n sections 1301"},{"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":"regulatory burden on interested parties, and <span class=\"match\">improve</span> affordability.\n \n \n \n 1 \n  The <span class=\"match\">Patient</span> Protection and Affordable <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> Protection and Affordable <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> Protection and Affordable <span class=\"match\">Care</span> Act” or “Affordable <span class=\"match\">Care</span> Act.”\n \n \n \n \n 2 \n  \n See \n sections 1301"},{"title":"Continuity of Care via Telemedicine for Veterans Affairs Patients","type":"Rule","abstract":"This final rule authorizes Department of Veterans Affairs (VA) practitioners acting within the scope of their VA employment to prescribe controlled substances via telemedicine to a VA patient with whom they have not conducted an in-person medical evaluation. VA practitioners are permitted to prescribe controlled substances to VA patients if another VA practitioner has, at any time, previously conducted an in-person medical evaluation of the VA patient, subject to certain conditions.","document_number":"2025-01044","html_url":"https://www.federalregister.gov/documents/2025/01/17/2025-01044/continuity-of-care-via-telemedicine-for-veterans-affairs-patients","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-17/pdf/2025-01044.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-01044.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":"“coordinated <span class=\"match\">care</span> that addresses all aspects of <span class=\"match\">patient</span> health, focuses on a <span class=\"match\">patient's</span> individual needs, and involves a multidisciplinary team of health <span class=\"match\">care</span> professionals.” \n https://www.va.gov/health/aboutvha.asp#:~:text=The%20Veterans%20Health%20Administration%20(VHA,Veterans%20enrolled%20in%20the%20VA. \n \n \n \n \n 41 \n  Readiness for the <span class=\"match\">Patient</span>-Centered Medical Home: Structural Capabilities of Massachusetts Primary <span class=\"match\">Care</span> Practices—PMC (\n nih.gov \n ) \n \n https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629002/\n \n Id.;\n \n and Concerns of Primary <span class=\"match\">Care</span> Clinicians"},{"title":"Announcement of Requirements and Registration for “EHIgnite Challenge”","type":"Notice","abstract":"The EHIgnite Challenge addresses data usability challenges in single patient electronic health information (EHI) exports. This challenge seeks to incentivize the development of tools, platforms, and workflows that transform single patient EHI exports into usable, readable, and actionable information that supports clinical care, patient engagement, and informed decision-making.","document_number":"2026-10068","html_url":"https://www.federalregister.gov/documents/2026/05/20/2026-10068/announcement-of-requirements-and-registration-for-ehignite-challenge","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-20/pdf/2026-10068.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10068.pdf?1779117307","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"}],"excerpts":"particular scenario. For example, if a <span class=\"match\">patient</span> is being transferred to a rehab or acute <span class=\"match\">care</span> facility after a complex surgery, what information does the place of <span class=\"match\">care</span> and <span class=\"match\">care</span> team need to know to provide the best possible <span class=\"match\">care</span> to this <span class=\"match\">patient</span>? If an individual is moving out of state, what information does their new primary <span class=\"match\">care</span> provider need before their first visit? \n Submissions must additionally address at least one of the following five scenarios: \n \n 1. \n Interactive <span class=\"match\">Patient</span> Tools: \n Enable <span class=\"match\">patients</span> to ask questions about their health data"},{"title":"Health Care Professionals Practicing Via Telehealth","type":"Rule","abstract":"The Department of Veterans Affairs (VA) adopts as final, with changes, a proposed rule to amend its medical regulations that govern VA's health care professionals who practice health care via telehealth. This final rule implements the authorities of the VA MISSION Act of 2018 and the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021. This final rule enables VA to maximize health care resource utilization and provide safe and convenient national health care to veterans using telehealth. It also strengthens VA's role in supporting national and State responses to war, terrorism, national emergencies and natural disasters.","document_number":"2025-19324","html_url":"https://www.federalregister.gov/documents/2025/10/02/2025-19324/health-care-professionals-practicing-via-telehealth","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-10-02/pdf/2025-19324.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-19324.pdf?1759322726","publication_date":"2025-10-02","agencies":[{"raw_name":"DEPARTMENT OF VETERANS AFFAIRS","name":"Veterans Affairs Department","id":520,"url":"https://www.federalregister.gov/agencies/veterans-affairs-department","json_url":"https://www.federalregister.gov/api/v1/agencies/520","parent_id":null,"slug":"veterans-affairs-department"}],"excerpts":" VA's achievements include: \n • A 68% reduction in <span class=\"match\">patients</span> receiving opioids (874,897 to 282,346 <span class=\"match\">patients</span>); \n \n • A 90% reduction in <span class=\"match\">patients</span> receiving opioids and benzodiazepines together (162,444 to 15,446 <span class=\"match\">patients</span>);\n \n \n • An 82% reduction in <span class=\"match\">patients</span> with high dosage opioid therapy (greater than or equal to 90 Morphine Equivalent Daily Dose) (76,466 to 13,453 <span class=\"match\">patients</span>); \n • A 73% reduction in <span class=\"match\">patients</span> on long-term opioid therapy (569,027 to 155,945 <span class=\"match\">patients</span>); \n • A 53% increase in <span class=\"match\">patients</span> on long term opioid therapies with urine drug screen"},{"title":"Request for Information: Accelerating the Adoption and Use of Artificial Intelligence as Part of Clinical Care","type":"Notice","abstract":"The HHS Office of the Deputy Secretary in collaboration with ASTP/ONC has published this Request for Information (RFI) to seek broad public comment on what HHS can do to accelerate the adoption and use of AI as part of clinical care.","document_number":"2025-23641","html_url":"https://www.federalregister.gov/documents/2025/12/23/2025-23641/request-for-information-accelerating-the-adoption-and-use-of-artificial-intelligence-as-part-of","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-12-23/pdf/2025-23641.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-23641.pdf?1766151927","publication_date":"2025-12-23","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":"in clinical <span class=\"match\">care</span>?\n \n 6. Where have AI tools deployed in clinical <span class=\"match\">care</span> met or exceeded performance and cost expectations and where have they fallen short? What kinds of novel AI tools would have the greatest potential to <span class=\"match\">improve</span> health <span class=\"match\">care</span> outcomes, give new insights on quality, and help reduce costs? \n 7. Which role(s), decision maker(s), or governing bodies within health <span class=\"match\">care</span> organizations have the most influence on the adoption of AI for clinical <span class=\"match\">care</span>? What are the primary administrative hurdles to the adoption of AI in clinical <span class=\"match\">care</span>? \n 8. Where"},{"title":"Implementation of the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018: Dispensing and Administering Controlled Substances for Medication-Assisted Treatment","type":"Rule","abstract":"The \"Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (the SUPPORT Act),\" which became law on October 24, 2018, amended the Controlled Substances Act to expand the conditions a practitioner must meet to provide medication-assisted treatment for opioid use disorder and expand the options available for a physician to be considered a qualifying physician. The SUPPORT Act also allowed a pharmacy to deliver prescribed controlled substances to a practitioner's registered location for the purpose of maintenance or detoxification treatment to be administered under certain conditions by a practitioner. The Drug Enforcement Administration promulgated an interim final rule with request for comments in November 2020 to amend its regulations to make them consistent with the SUPPORT Act and implement its requirements. On December 29, 2022, the Restoring Hope for Mental Health and Well-Being Act of 2022 removed many of the statutory provisions of the SUPPORT Act. This final rule adopts the provisions of the interim final rule that are still applicable as final, with minor changes. In addition, this final rule implements the related provisions of the Restoring Hope for Mental Health and Well-Being Act of 2022.","document_number":"2026-11526","html_url":"https://www.federalregister.gov/documents/2026/06/09/2026-11526/implementation-of-the-substance-use-disorder-prevention-that-promotes-opioid-recovery-and-treatment","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-09/pdf/2026-11526.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11526.pdf?1780922715","publication_date":"2026-06-09","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"}],"excerpts":"substance to a <span class=\"match\">patient</span> from when the practitioner receives the controlled substance from pharmacy) to 45 days, as now set forth in 21 U.S.C. 829a. \n Increasing the number of days to administer treatments from 14 days to 45 days will increase flexibility in scheduling, increase the number of <span class=\"match\">patients</span> receiving needed medication and <span class=\"match\">improve</span> <span class=\"match\">patient</span> <span class=\"match\">care</span> outcomes. The added flexibility is expected to reduce returns and wastage. DEA has no basis to estimate the cost savings due to reduced returns and wastage or improvements to <span class=\"match\">patient</span> <span class=\"match\">care</span>; however, it"},{"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":"that allow providers to prioritize <span class=\"match\">caring</span> for <span class=\"match\">patients</span> and will significantly <span class=\"match\">improve</span> <span class=\"match\">patient</span> and family experience, engagement, and safety.\n \n \n Many commenters endorsed the proposal to expand the \n segmentation \n <span class=\"match\">condition's</span> coverage stating that it would lead to <span class=\"match\">improved</span> <span class=\"match\">patient</span> privacy and provided several examples of situations where health <span class=\"match\">care</span> providers are unable to segment granular health data. Some commenters specifically referenced the benefits of the proposal for health <span class=\"match\">care</span> providers who treat <span class=\"match\">patients</span> exposed to violence and who request"},{"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":"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":"the prosperity of the 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> Protection and Affordable <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> Protection and Affordable <span class=\"match\">Care</span> Act; Marketplace Integrity and Affordability"},{"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":"Additionally, <span class=\"match\">improving</span> the equitable access, exchange, and use of EHI would help enable <span class=\"match\">patient</span>-centric <span class=\"match\">care</span>, which is expected to <span class=\"match\">improve</span> 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"},{"title":"Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure","type":"Proposed Rule","abstract":"The Department is proposing a regulation that would require providers of pharmacy benefit management services and affiliated providers of brokerage and consulting services to disclose information about their compensation to fiduciaries of self-insured group health plans subject to the Employee Retirement Income Security Act (ERISA). These disclosures are needed so that fiduciaries can assess the reasonableness of the contracts or arrangements with these service providers, including the reasonableness of the service providers' compensation. These disclosure requirements would apply for purposes of ERISA's statutory prohibited transaction exemption for services arrangements. This proposal implements section 12 of President Trump's Executive Order 14273, Lowering Drug Prices by Once Again Putting Americans First, which instructs the Department to propose regulations to improve employer health plan transparency into the direct and indirect compensation received by pharmacy benefit managers. If finalized, this regulation would affect sponsors and other fiduciaries of self-insured group health plans and certain service providers to such plans.","document_number":"2026-01907","html_url":"https://www.federalregister.gov/documents/2026/01/30/2026-01907/improving-transparency-into-pharmacy-benefit-manager-fee-disclosure","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-01-30/pdf/2026-01907.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-01907.pdf?1769721310","publication_date":"2026-01-30","agencies":[{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"}],"excerpts":"disclosures.\n \n \n \n 329 \n  86 FR 66662, \n Prescription Drug and Health <span class=\"match\">Care</span> Spending, \n (November 23, 2021), \n https://www.federalregister.gov/documents/2021/11/23/2021-25183/prescription-drug-and-health-<span class=\"match\">care</span>-spending. \n \n \n \n \n 330 \n  77 FR 28790, \n Medical Loss Ratio Requirements Under the <span class=\"match\">Patient</span> Protection and Affordable <span class=\"match\">Care</span> \n Act, (May 16, 2012), \n https://www.federalregister.gov/documents/2012/05/16/2012-11753/medical-loss-ratio-requirements-under-the-<span class=\"match\">patient</span>-protection-and-affordable-<span class=\"match\">care</span>-act. \n \n \n \n \n 331 \n  CMS, \n Part D Reporting Requirements,"},{"title":"Registering Emergency Medical Services Agencies Under the Protecting Patient Access to Emergency Medications Act of 2017","type":"Rule","abstract":"The \"Protecting Patient Access to Emergency Medications Act of 2017,\" (the Act) which became law on November 17, 2017, amended the Controlled Substances Act (CSA) to allow for a new registration category for emergency medical services agencies that handle controlled substances. It also established standards for registering emergency medical services agencies, and set forth new requirements for delivery, storage, and recordkeeping related to their handling of controlled substances. In addition, the Act allows emergency medical services professionals to administer controlled substances outside the physical presence of a medical director or authorizing medical professional pursuant to a valid standing or verbal order. The Drug Enforcement Administration is publishing this final rule to conform its regulations to the statutory amendments of the CSA and to otherwise implement its requirements. This final rule adopts, with minor modifications, the notice of proposed rulemaking published on October 5, 2020.","document_number":"2026-02288","html_url":"https://www.federalregister.gov/documents/2026/02/05/2026-02288/registering-emergency-medical-services-agencies-under-the-protecting-patient-access-to-emergency","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-02-05/pdf/2026-02288.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-02288.pdf?1770153307","publication_date":"2026-02-05","agencies":[{"raw_name":"DEPARTMENT OF JUSTICE","name":"Justice Department","id":268,"url":"https://www.federalregister.gov/agencies/justice-department","json_url":"https://www.federalregister.gov/api/v1/agencies/268","parent_id":null,"slug":"justice-department"},{"raw_name":"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"}],"excerpts":"director or authorizing medical professional in response to a request by the EMS professional with respect to a specific <span class=\"match\">patient</span>, either in the case of a mass casualty incident, or to ensure the proper <span class=\"match\">care</span> and treatment of a specific <span class=\"match\">patient</span>. \n IV. Regulatory Analyses \n As explained above, DEA is issuing this final rule to amend its regulations in order to make <span class=\"match\">them</span> consistent with the changes made to the CSA by the “Protecting <span class=\"match\">Patient</span> Access to Emergency Medications Act of 2017,” and to otherwise implement the Act's requirements. DEA conducted an analysis"},{"title":"Nonprescription Drug Product With an Additional Condition for Nonprescription Use","type":"Rule","abstract":"The Food and Drug Administration (FDA, the Agency, or we) is issuing a final rule to establish requirements for a nonprescription drug product with an additional condition for nonprescription use (ACNU). A nonprescription drug product with an ACNU is a drug product that could be marketed without a prescription if an applicant implements an additional condition to ensure appropriate self-selection or appropriate actual use, or both, by consumers without the supervision of a practitioner licensed by law to administer such drug. The final rule is intended to increase options for applicants to develop and market safe and effective nonprescription drug products and increase consumer access to appropriate, safe, and effective drug products, which could improve public health.","document_number":"2024-30261","html_url":"https://www.federalregister.gov/documents/2024/12/26/2024-30261/nonprescription-drug-product-with-an-additional-condition-for-nonprescription-use","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-12-26/pdf/2024-30261.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-30261.pdf?1734961513","publication_date":"2024-12-26","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":"Food and Drug Administration","name":"Food and Drug Administration","id":199,"url":"https://www.federalregister.gov/agencies/food-and-drug-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/199","parent_id":221,"slug":"food-and-drug-administration"}],"excerpts":"gov/safety/report-problem-fda/consumer-complaint-coordinators \n ). Accessed November 27, 2023.\n \n \n 7. National <span class=\"match\">Patient</span> Safety Agency, “Information Design for <span class=\"match\">Patient</span> Safety: A Guide to the Graphic Design of Medication Packaging,” 2nd edition, 2007 (available at \n https://webarchive.nationalarchives.gov.uk/ukgwa/20080727044055mp_/http://www.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=5599 \n ); National <span class=\"match\">Patient</span> Safety Agency, “Design for <span class=\"match\">Patient</span> Safety: A Guide to Labelling and Packaging of Injectable Medicines,” 1st edition, 2008 (available at \n https://www"},{"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":"repay based on household income.\n \n \n \n 5 \n  The <span class=\"match\">Patient</span> Protection and Affordable <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> Protection and Affordable <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> Protection and Affordable <span class=\"match\">Care</span> Act,” “Affordable <span class=\"match\">Care</span> Act,” or “ACA”.\n \n \n The ACA's individual market"},{"title":"Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 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":"2025-06271","html_url":"https://www.federalregister.gov/documents/2025/04/30/2025-06271/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-04-30/pdf/2025-06271.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-06271.pdf?1744402510","publication_date":"2025-04-30","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":"Determining Eligibility for Domiciliary Care","type":"Rule","abstract":"The Department of Veterans Affairs (VA) adopts as final, with minor changes, a proposed rule amending its medical and State Veterans Home (State home) regulations to update the criteria used by VA in determining eligibility for domiciliary care and to implement VA's authority to waive certain eligibility requirements for receipt of State home domiciliary care per diem.","document_number":"2024-24912","html_url":"https://www.federalregister.gov/documents/2024/10/30/2024-24912/determining-eligibility-for-domiciliary-care","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-30/pdf/2024-24912.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-24912.pdf?1730205920","publication_date":"2024-10-30","agencies":[{"raw_name":"DEPARTMENT OF VETERANS AFFAIRS","name":"Veterans Affairs Department","id":520,"url":"https://www.federalregister.gov/agencies/veterans-affairs-department","json_url":"https://www.federalregister.gov/api/v1/agencies/520","parent_id":null,"slug":"veterans-affairs-department"}],"excerpts":"expanding eligibility to domiciliary <span class=\"match\">care</span>. VA determined that basing eligibility for domiciliary <span class=\"match\">care</span> on metrics like annual income or incapacity to earn a living did not lead to <span class=\"match\">patient</span>-centered <span class=\"match\">care</span>. VA proposed these changes to modernize the regulatory approach to eligibility for domiciliary <span class=\"match\">care</span> to reflect the more <span class=\"match\">patient</span>-centered model veterans have grown to expect from VA. In <span class=\"match\">patient</span>-centered <span class=\"match\">care</span>, an individual's specific health needs and desired health outcomes are the driving force behind all health <span class=\"match\">care</span> decisions. In the proposed rule, VA"},{"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":"clinical needs, allowing appropriate payment and <span class=\"match\">improved</span> access to <span class=\"match\">care</span> for <span class=\"match\">patients</span> undergoing these complex surgeries. Several commenters agreed <span class=\"match\">patients</span> undergoing complex aortic arch procedures reflect a complex <span class=\"match\">patient</span> population that require increased resource utilization associated with their <span class=\"match\">care</span>. A commenter stated that the new MS-DRG would account for new technologies, resulting in a more tailored and appropriate payment to providers, which will inevitably result in better <span class=\"match\">patient</span> <span class=\"match\">care</span> and wider access to these complex aortic arch procedures"},{"title":"Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments","type":"Proposed Rule","abstract":"This proposed rule describes alternatives to modify the limit on the total payment rate and other requirements for State directed payments in Medicaid managed care. We propose these changes based on our authority to interpret and implement section 1902(a)(4) of the Social Security Act (the Act) with respect to prepaid inpatient health plans and prepaid ambulatory health plans, and section 1903(m)(2)(A)(iii) of the Act, which require that contracts between States and managed care organizations to provide payments under a risk- based contract for services and associated administrative costs that are actuarially sound. This rule also proposes to set a limit for certain targeted Medicaid payments in Medicaid fee-for-service. We propose this change based on our authority to interpret and implement section 1902(a)(30)(A) of the Act with respect to certain targeted Medicaid payments which require that payments be consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.","document_number":"2026-10292","html_url":"https://www.federalregister.gov/documents/2026/05/22/2026-10292/medicaid-program-medicaid-managed-care-state-directed-payments-and-medicaid-fee-for-service-targeted","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-22/pdf/2026-10292.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10292.pdf?1779308109","publication_date":"2026-05-22","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"services only from a managed <span class=\"match\">care</span> plan's network of providers or primary <span class=\"match\">care</span> provider, including through PCCMs and PCCM entities.\n \n B. Relevant Medicaid Managed <span class=\"match\">Care</span> Rules \n \n In the May 6, 2016 \n Federal Register \n (81 FR 27498), we published the “Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed <span class=\"match\">Care</span>, CHIP Delivered in Managed <span class=\"match\">Care</span>, and Revisions Related to Third Party Liability” final rule (hereinafter referred to as “the 2016 final rule”) that modernized the Medicaid and CHIP managed <span class=\"match\">care</span> regulations to reflect changes"}]}