MHS & VA and MHS & CMS Joint Rulemaking and Policy Manuals


MHS and VA already have joint contracts and shared facility agreements. MHS and VA joint Federal Register rulemaking expedites drafting and publishing of regulations regarding assessment of disabilities and affects MHS readiness regarding military members ready to deploy. MHS and VA currently draft separate regulations regarding disabilities which is inefficient and often ineffective. MHS and VA joint rulemaking of regulations enhances population health by encouraging healthy behaviors among both MHS and VA beneficiaries. MHS and VA joint rulemaking of regulations enhances MHS and VA experience of care by providing beneficiaries the highest quality care. MHS and VA joint rulemaking of regulations significantly reduces costs by sharing facilities and removing inefficiencies. A pilot for MHS and VA rulemaking could begin immediately and at minimum cost to the agencies. MHS and VA closely cooperate on multiple health care issues. A pilot could assess MHS and VA joint drafts of proposed rules regarding shared facilities, disability assessments, federal pricing of pharmaceuticals, and other areas.

MHS and CMS could also conduct joint rulemaking. TRICARE follows Medicare reimbursement whenever practicable. TRICARE reimburses sole community hospitals, long term care hospitals, rehabilitation hospitals, and ambulatory surgery centers differently from Medicare regulations. MHS annually pays hundreds of millions of dollars more in not using Medicare’s reimbursement methodology. MHS has attempted to rectify reimbursement methodologies but has been thwarted by the cumbersome rulemaking process. For example, the sole community hospital proposed rule was published in the Federal Register on July 5, 2011, but the final rule still has not been published.

A pilot of joint rulemaking between CMS and MHS would avoid discrepancies between Medicare and TRICARE reimbursement and expedite MHS rulemaking by effectively and efficiently drafting and publishing joint rules. The pilot could begin immediately at minimum cost. This would save considerable time and effort involved with TRICARE rulemaking. TRICARE reimbursement could be based on Medicare reimbursement with only exceptions from Medicare appearing in 32 CFR 199.14. The current sections in 32 CFR 199.14 can be reduced significantly if applicable Medicare regulation is instead referenced. Likewise, the TRICARE Policy and Reimbursement Manuals could reference applicable Medicare Manual provisions instead of drafting its own version of Medicare rules. TRICARE could also incorporate Medicare’s annual reimbursement increases instead of making its own calculations.

MHS and CMS joint Federal Register rulemaking affects MHS readiness regarding military members ready to deploy by improving beneficiary access to care and benefits. MHS and CMS currently draft separate regulations regarding benefits which is inefficient and often ineffective. MHS and CMS joint rulemaking of regulations enhances population health by encouraging healthy behaviors among both MHS and CMS beneficiaries. MHS and CMS joint rulemaking of regulations enhances MHS and CMS experience of care by providing beneficiaries the highest quality care. MHS and CMS joint rulemaking of regulations significantly reduces costs by removing inefficiencies. A pilot for MHS and CMS rulemaking could begin immediately and at minimum cost to the agencies. MHS and CMS closely cooperate on multiple health care issues. A pilot could assess MHS and CMS joint drafts of proposed rules regarding skilled nursing facilities, long term care hospitals, rehabilitation hospitals, and ambulatory surgery centers.

Overlapping agency functions might easily produce inefficiencies if two or more agencies build their own policymaking and enforcement systems where a single apparatus would be adequate. Policy decisions arrived at through strong interagency coordination likely will attract greater deference. Coordination between agencies provides increased efficiency, effectiveness and accountability, and the benefits of coordination will frequently be substantial. It reduces regulatory costs for both government and the private sector, improves expertise, and ameliorates the risk of bureaucratic drift without compromising transparency. Coordination can also help to preserve the functional benefits of shared or overlapping authority, such as promoting interagency competition and accountability, while minimizing dysfunctions like discordant policy.

Many areas of regulation are characterized by fragmented and overlapping delegations of power to administrative agencies. Congress often assigns more than one agency the same or similar functions or divides authority among multiple agencies, giving each responsibility for part of a larger whole. Instances of overlap and fragmentation are common.

A key advantage may be the potential to harness the expertise and competencies of specialized agencies. But that potential can be wasted if the agencies work at cross-purposes or fail to capitalize on one another’s unique strengths and perspectives. By improving efficiency, effectiveness, and accountability, coordination can help to overcome potential dysfunctions created by shared regulatory space.

Coordination that takes the form of interagency consultation can improve the overall quality of decision making by introducing multiple perspectives and specialized knowledge, and structuring opportunities for agencies mutually to test their information and ideas. Coordination instruments can also equip and incentivize agencies to monitor each other constructively, which should help both the President and Congress to better manage agency policy choices and compliance with statutes. It is plausible too, that greater coordination will make it harder for interest groups to capture the administrative process or to play agencies against each other.

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