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B-333263 May 18, 2021 1 (2021-05-18)

handle is hein.gao/gaoltv0001 and id is 1 raw text is: ) 1O o U.S. GOVERNMENT ACCOUNTABILITY OFFICE A Century of Non-Partisan Fact-Based Work 441 G St. N.W. Washington, DC 20548 B-333263 May 18, 2021 The Honorable Ron Wyden Chairman The Honorable Mike Crapo Ranking Member Committee on Finance United States Senate The Honorable Frank Pallone, Jr. Chairman The Honorable Cathy McMorris Rodgers Ranking Member Committee on Energy and Commerce House of Representatives Subject: Department of Health and Human Services, Centers for Medicare & Medicaid Services: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) entitled Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards (RIN: 0938-AU18). We received the rule on May 4, 2021. It was published in the Federal Register as a final rule on May 5, 2021. 86 Fed. Reg. 24140. The effective date is July 6, 2021, but some of the provisions became effective on the date of publication. According to CMS, the final rule sets forth payment parameters and provisions related to the risk adjustment program and cost-sharing parameters. CMS stated it includes changes related to special enrollment periods; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; income verification by Exchanges; and other related topics. CMS stated that the final rule also revises the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. The Congressional Review Act (CRA) requires a 60-day delay in the effective date of a major rule from the date of publication in the Federal Register or receipt of the rule by Congress, whichever is later. 5 U.S.C. § 801(a)(3)(A). The 60-day delay in effective date can be waived however if the agency finds for good cause that delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the findings and its reasons in the rule issued. 5 U.S.C. §§ 553(B)(3)(B), 808(2). CMS determined it had good cause to waive the 60-day delay for some of the provisions of the final rule because CMS needed to implement

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