This morning Deputy Secretary Bill Corr released a statement announcing the Department's plan to retrospectively review existing health care regulations. Regulatory review is about as much fun as filing taxes while undergoing a root canal... an unmedicated root canal. But the Administration's willingness to undertake such a painstaking process is yet another sign of their commitment to providing all Americans with healthcare that is economical, efficient, and, most importantly, effective.
Regulations are the flesh on the bones of law. After Congress passes a law, executive branch agencies are left to formalize specific requirements. For example, the health reform law talked about creating accountable care organizations but the small details were announced late this spring by HHS. How much detail? Try 429 pages of proposed regulations to clearly outline the plethora of requirements for such organizations.
Of particular interest to me is the interplay between Medicare (which typically covers older adults and some persons with disabilities) and Medicaid (which typically covers low-income children and their parents and people in institutional-level care, such as nursing homes). As our population ages, we'll have more people eligible for Medicare and Medicaid. In theory, whatever isn't covered by Medicare should be paid by Medicaid. In reality, these programs don't always play nicely since what Medicare covers differs from what is covered by Medicaid.
Even more complicated and increasingly common are people who have private insurance or military benefits and are eligible for Medicaid. Trying to coordinate benefits between private insurers, especially those not covered by the complex ERISA rules, and Medicaid is becoming a time suck for states.
The attention to telemedicine is interesting too. Historically, Medicaid and Medicare refused to pay non face-to-face services. In the last few years that has changed and some states are using telemedicine to overcome health care shortages -- an area that is also under exploration as it has been three decades since we first defined "shortage area."
I think it is excellent that the administration is undertaking this project in light of so many regulations to come: final regulations for ACOs, regulations on the basic benefit package, etc. Attention today will prevent confusion and lawsuits later.