Although provider groups last week applauded President Bush's command to delay and rewrite many federal healthcare regulations HCFA and other agencies have drafted, they said they didn't know specifically which regulations would be affected by the order.
But on the list of possible suspensions are a rule closing a loophole that allowed states to artificially increase the federal contribution to their Medicaid programs and a regulation governing access to confidential patient records.
Shortly after Bush was sworn in as president on Jan. 20, Andrew Card, White House chief of staff, sent a memo to federal agencies directing them to withdraw proposed or final regulations that have yet to be published in the Federal Register. Card's memo orders agencies to allow Bush's appointees to review the regulations before sending them to the Federal Register, where proposed rules are published for comment and final regulations must be published before they take effect.
In cases in which the Federal Register has published a regulation but it has not yet taken effect, Card instructed the agencies to delay the effective date for 60 days.
Card said agencies should exempt from delay any regulation that addresses an emergency or immediate health and safety issue, as well as regulations required under the terms of existing laws or court orders. Though they were unsure of what regulations will be affected, provider groups said the Bush administration is responding to their call for less red tape (Jan. 22, p. 10).
"We're viewing this as a willingness to look at regulation and the burden it places on the private sector," said Mary Beth Savary Taylor, director of executive branch relations with the American Hospital Association and an adviser to Bush's transition team.
It's in part a reaction to the last days of the lame-duck Clinton administration, which published more pages of regulation in its final three months in office than any previous departing administration. From early last November through Jan. 23, agencies under Clinton had published 25,605 pages of regulations in the Federal Register, according to the Mercatus Center, an Arlington, Va.-based think tank. That exceeds the previous high of 24,531 published under the lame-duck Carter administration in 1980-1981, according to the center.
Included in the last-minute Clinton regulations are final regulations governing medical records privacy and health plan appeals. Also subject to possible review are regulations barring doctors from referring Medicare and Medicaid patients to providers in which they own an interest, Internal Revenue Service rules punishing people who wrongly profit from tax-exempt organizations, and a patients' bill of rights for Medicaid HMO enrollees.
But it wasn't clear if those regulations would be affected. Even congressional aides and agency officials were confused by the memo's implications.
A HCFA spokesman said the agency is cataloging regulations to determine which will be suspended or withdrawn for review.
Meanwhile, a final HHS regulation that governs access to patients' medical records is pending. That rule, published Dec. 28, 2000, doesn't take effect until Feb. 26, which means it could be delayed for 60 days. Yet the rule was mandated under the provisions of the Health Insurance Portability and Accountability Act of 1996, so it could be exempted from the moratorium.
AHA officials said their research on the privacy regulation had led them to believe that the privacy regulation would be exempted.