Quiero saber acerca de...

51768

Federal Register / Vol. 86, No. 177 / Thursday, September 16, 2021 / Proposed Rules
the provisions of section 603 of the RFA. For purposes of section 1102b of the SSA, the Departments define a small rural hospital as a hospital that is located outside of a metropolitan statistical area and has fewer than 100
beds. While this rule is not subject to section 1102 of the SSA, the Departments have determined that these proposed rules would only affect small rural hospitals if they are subject to an enforcement action. However, as discussed earlier in the RIA, a facility subject to investigation would incur a cost of approximately $354. Therefore, the Departments are of the view that these proposed rules would not have a significant impact on the operations of a substantial number of small rural hospitals. The Departments seek comment on this analysis.
F. Unfunded Mandates Section 202 of the Unfunded Mandates Reform Act of 1995 UMRA
requires that agencies assess anticipated costs and benefits and take certain other actions before issuing a proposed rule that includes any Federal mandate that may result in expenditures in any 1 year by a state, local, or Tribal governments, in the aggregate, or by the private sector, of $100 million in 1995 dollars, updated annually for inflation. Currently, that threshold is approximately $158
million. As discussed earlier in the RIA, plans, issuers, providers, and facilities, including providers of air ambulance services, would incur costs to comply with the proposed provisions of these proposed rules. The Departments estimate the combined impact on state, local, or Tribal governments and the private sector would not be above the threshold.
G. Federalism Executive Order 13132 establishes certain requirements that Federal agencies must meet when they issue proposed rules that imposes substantial direct costs on state and local governments, preempts state law, or otherwise has federalism implications.
In compliance with the requirement of Executive Order 13132 that agencies examine closely any policies that may have federalism implications or limit the policy making discretion of the states, the Departments have engaged in efforts to consult with and work cooperatively with affected states, including participating in conference calls with and attending conferences of the NAIC, and consulting with state insurance officials on an individual basis.
While developing this rule, the Departments attempted to balance the
VerDate Sep<11>2014

16:57 Sep 15, 2021

Jkt 253001

states interests in regulating health insurance issuers, providers, including providers of air ambulance services, and facilities with the need to ensure market stability. By doing so, the Departments complied with the requirements of Executive Order 13132.
Section 2799B4a1 of the PHS Act provides that states serve as the primary enforcement authority for these new requirements.63 Section 2799B4a2
of the PHS Act provides that if the Secretary of HHS determines that a state has failed to substantially enforce any of these new requirements, then HHS shall assume enforcement of such provision.
Therefore, the proposed amendments in this rulemaking would apply the process outlined in 45 CFR 150.201
through 150.221. by which HHS
determines that a state is not substantially enforcing a PHS Act provision to the enforcement of the requirements in section 2799B4. The remaining subparts of 45 CFR part 150
that relate to CMS enforcement of section 2799B4 would apply only when the Secretary of HHS makes the determination that a state has substantially failed to enforce.
Section 2799B4c of the PHS Act provides that the sections specified in subsection a1 shall not be construed to supersede any provision of state law which establishes, implements, or continues in effect any requirement or prohibition except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of such a section. These proposed rules would not preempt any state law except to the extent that the Secretary of HHS makes the determination that a state has substantially failed to enforce.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services, approved this document on August 26, 2021.
List of Subjects 5 CFR Part 890
Administrative practice and procedure, Government employees, Health facilities, Health insurance, Health professions, Hostages, Iraq, Kuwait, Lebanon, Military personnel, Reporting and recordkeeping requirements, Retirement.
63 45 CFR 150.201 currently provides that . . . each State enforces PHS Act requirements with respect to health insurance issuers that issue, sell, renew, or offer health insurance coverage in the State.

PO 00000

Frm 00040

Fmt 4701

Sfmt 4702

26 CFR Part 54
Excise taxes, Health care, Health insurance, Pensions, Reporting and recordkeeping requirements.
29 CFR Part 2590
Continuation coverage, Disclosure, Employee benefit plans, Group health plans, Health care, Health insurance, Medical child support, Reporting and recordkeeping requirements.
45 CFR Part 144
Health care, Health insurance, Reporting and recordkeeping requirements.
45 CFR Part 148
Administrative practice and procedure, Health care, Health insurance, Insurance companies, Penalties, Reporting and recordkeeping requirements.
45 CFR Part 149
Balance billing, Health care, Health insurance, Reporting and recordkeeping requirements, Surprise Billing, State regulation of health insurance, Transparency in coverage.
45 CFR Part 150
Administrative practice and procedure, Health care, Health insurance, Penalties, Reporting and recordkeeping requirements.
Laurie Bodenheimer, Associate Director, Healthcare and Insurance, Office of Personnel Management.
Douglas W. ODonnell, Deputy Commissioner for Services and Enforcement, Internal Revenue Service.
Ali Khawar, Acting Assistant Secretary, Employee Benefits Security Administration, Department of Labor.
Xavier Becerra, Secretary, Department of Health and Human Services.

OFFICE OF PERSONNEL
MANAGEMENT
For the reasons stated in the preamble, the Office of Personnel Management proposes to amend 5 CFR
part 890 as follows:
PART 890FEDERAL EMPLOYEES
HEALTH BENEFITS PROGRAM
1. The authority citation for part 890
continues to read as follows:

Authority: 5 U.S.C. 8913; Sec. 890.102 also issued under sections 11202f, 11232e, and 11246b of Pub. L. 10533, 111 Stat. 251;
Sec. 890.111 also issued under section 1622b of Pub. L. 104106, 110 Stat. 521 36
U.S.C. 5522; Sec. 890.112 also issued under section 1 of Pub. L. 110279, 122 Stat. 2604

E:FRFM16SEP2.SGM

16SEP2