I am Just a Bill

Today is election day.  I wanted to talk about the process by which laws are passed and regulations created in healthcare.

Recently, the fall of the Chevron Doctrine has added an additional layer of complexity to regulatory interpretation, raising new questions about the future of healthcare regulation in the United States.

The legislative process begins in Congress, where bills are proposed by members of the House of Representatives or the Senate. Bills can be prompted by public needs, lobbying efforts from healthcare groups, or political initiatives. For instance, major pieces of healthcare legislation, like the Patient Protection and Affordable Card Act (ACA), are proposed as bills, debated in committees, and undergo a series of amendments before being voted on. If passed by both the House and Senate, the bill goes to the President, who can sign it into law or veto it. Upon becoming law, executive agencies are responsible for interpreting and implementing the statutes, which may involve drafting regulations.

Once a healthcare law is passed, regulatory agencies, such as the U.S. Department of Health and Human Services (HHS) or the Centers for Medicare & Medicaid Services (CMS), are tasked with drafting regulations that explain how the law will be applied in practice. This process begins with a Notice of Proposed Rulemaking (NPRM), where agencies publish proposed rules in the Federal Register, inviting comments from the public, stakeholders, and industry experts. The public comment period allows input from healthcare providers, insurance companies, advocacy groups, and individuals who may be impacted by the regulation.

After reviewing comments, the agency may revise the proposed rules and issue a final rule. This rule is then published in the Code of Federal Regulations (CFR), becoming binding. These rules clarify ambiguous language in legislation, set standards for compliance, and provide specifics that laws do not include. For example, CMS regulations under the ACA outline requirements for Medicaid expansion, insurance coverage standards, and reporting obligations.

Judicial review plays a significant role in shaping healthcare regulations. Courts may review regulations to ensure they do not exceed the authority granted by Congress or conflict with constitutional principles. The Chevron Doctrine, established by the Supreme Court in *Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc.* (1984), historically guided courts in reviewing agency interpretations of statutes. Under Chevron, courts would defer to an agency’s interpretation of an ambiguous statute, provided it was reasonable and not explicitly contradicted by Congress.

In healthcare, this meant that agencies like CMS had some flexibility in interpreting statutes under their purview. This deference allowed agencies to address complex, technical aspects of healthcare that require expertise beyond the judiciary’s scope.

The loss of Chevron deference may also lead to increased litigation as stakeholders challenge agency interpretations more frequently, believing that courts will more closely review agency decisions. This could slow the regulatory process and lead to greater uncertainty in healthcare compliance, especially as courts may lack the specialized knowledge required to make informed decisions on technical healthcare issues.

This new landscape may lead to slower and more litigious regulatory processes, impacting the ability of the healthcare system to adapt swiftly to changing needs and developments. The full implications of this shift are still unfolding, but it is clear that regulatory agencies will need to adjust their approaches to policy implementation, and healthcare stakeholders may need to prepare for a more uncertain regulatory environment.

Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

HHS Under the Microscope

HHS Under the Microscope

While President-elect Trump’s pick for U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., put the agency in even international newspapers

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024
Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Advanced Outpatient Clinical Documentation Integrity: Mastering Complex Narratives and Compliance

Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.

September 12, 2024

Trending News

Featured Webcasts

Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024
The OIG Update: Targets and Tools to Stay in Compliance

The OIG Update: Targets and Tools to Stay in Compliance

During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.

September 19, 2024

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!