Provider organizations have answered the Department of Health and Human Services’ (HHS’) call for deregulation suggestions with their policy change wish lists, tackling topics from prior authorization to coding to patient data access.
In line with the administration’s push for a 10:1 deregulation agenda, HHS Secretary Robert F. Kennedy Jr. launched the department’s 60-day request for information (RFI) in May.
Similar calls have been made by other wings of the executive branch, such as the Office of Management and Budget, Federal Trade Commission and Department of Justice, as well as by sub-agencies of HHS like the Centers for Medicare and Medicaid Services in parallel with its statutory rulemaking.
Kennedy, in a video announcing the RFI, said the department was concerned about “outdated or unnecessary regulations” that hamper competition or prevent providers from focusing on issues like chronic disease.
“We’re going to maintain and even strengthen the regulations that genuinely protect the public, and we will reduce and eliminate regulations that thwart innovation and gum up the system with paperwork,” RFK Jr. said at the time. “We will especially focus on eliminating regulations that prevent providers from putting patients first.”
Monday marked the close of the RFI’s public comment period. Here’s what hospital and clinician groups highlighted as priorities for HHS.
Hospitals and health systems
The American Hospital Association (AHA), in its letter to HHS, again pointed to a list of 100 administrative, quality reporting, workforce and technology suggestions it provided for other agencies’ RFIs. However, language in Monday’s letter was more tailored around the goals of chronic disease prevention, nutrition and wellness that have been the core of RFK Jr.’s Make America Healthy Again movement.
Still, first and foremost among the letter’s recommendations were suggestions to standardize electronic prior authorization processes and streamline provider and insurer price transparency requirements, both of which AHA framed as contributing to care barriers.
Other topline notes from AHA called for advancing tech and innovation by removing various telehealth site restrictions and in-person visit requirements. To better facilitate “whole-person care” by eliminating a block on providers’ access to certain patient health information on substance use disorder (34 CFR Part 2) and by scaling back physician self-referral and kickback regulations to “promote value-based care.” Pointing to healthcare workforce burnout and administrative burdens, AHA also called for eliminating duplicate paperwork tied to interdisciplinary care plans and axing Medicare restrictions that limit advanced practice providers and nurse practitioners from practicing at the top of their license.
The Federation of American Hospitals (FAH), which represents for-profit hospitals and health systems, headlined its letter by pointing a finger at Medicare Advantage plans’ “abuses of prior authorization” and other administrative requirements. It called for HHS to require coverage parity between Medicare Advantage and traditional Medicare, prioritize compliance with the Medicare Two-Midnight Rule and give beneficiaries more insight into plans’ denials—all of which FAH said would cut down on such practices and reduce the need for providers to devote resources to related administrative tasks.
Among its other recommendations, FAH echoed AHA’s points on telehealth restrictions, asked HHS to back off expectations of rigid nurse-to-patient ratios as a condition of Medicare participation, remove several specific quality and reporting measures, halt proposed mandatory participation in payment models like the Transforming Episode Accountability Model (TEAM), withdraw and narrow recently finalized Conditions of Participation around maternal health and emergency care, and withdraw and take another crack at proposed cybersecurity standards for hospitals.
Clinicians
The American Medical Association (AMA) kicked off its suggestions by pointing to the Merit-based Incentive Payment System (MIPS), which it said has failed to show improvements in outcomes or spending but “continues to impose significant compliance costs on physician practices.”
The physician association detailed a slew of recommended changes to the system, which include the reduction of “unnecessary” quality measures and “arbitrary scoring rules.” AMA also called for the system to award multi-category credit, and to increase its use of EHRs and other technologies “while minimizing wasteful ‘check the box’ reporting exercises.”
Beyond the MIPS suggestions, AMA urged HHS to toss the Biden administration’s blocks on expansions to physician-owned hospitals. It also called for a “duplicative, counter-productive” July 2024 final rule establishing payment disincentives for information blocking by physicians in favor of an “education-first, proportional approach.”
Prior authorization also caught flak from doctors, who commended the agency’s efforts to reform prior authorization in recent rulemaking while stressing the need to maintain enforcement of those regulations despite insurers’ recent promise to rein things in. It also asked the agency to seek reductions in the overall volume of prior authorization in plans, such as by eliminating the requirements for services and drugs with high approval rates, alongside calls for standardization, transparency and shorter processing times for plans.
Associations representing nurses and physician associates broadly pointed to regulatory barriers that prevent those clinicians from practicing at the top of their license or require supervision or sign-offs from physicians for certain types of care.