Document ID: FDA-2021-Z-0025-0001
Agency: fda
Document Type: Rule
Title: Securing Updated and Necessary Statutory Evaluations Timely
Posted Date: 2021-01-19T05:00Z

[Federal Register Volume 86, Number 11 (Tuesday, January 19, 2021)]
[Rules and Regulations]
[Pages 5694-5764]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-00597]

[[Page 5693]]

Vol. 86

Tuesday,

No. 11

January 19, 2021

Part VII

 Department of Health and Human Services

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21 CFR Part 6

42 CFR Parts 1, 404, et al.

45 CFR Parts 8, 200, et al.

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Securing Updated and Necessary Statutory Evaluations Timely; Final Rule

  Federal Register / Vol. 86 , No. 11 / Tuesday, January 19, 2021 / 
Rules and Regulations  

[[Page 5694]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 6

Public Health Service

42 CFR Part 1

Centers for Medicare and Medicaid Services

42 CFR Part 404

Office of the Inspector General

42 CFR Part 1000

Office of the Secretary

45 CFR Part 8

Administration for Children and Families

45 CFR Parts 200, 300, 403, 1010, and 1390

[Docket No. HHS-OS-2020-0012]
RIN 0991-AC24

Securing Updated and Necessary Statutory Evaluations Timely

AGENCY: Department of Health and Human Services (HHS).

ACTION: Final rule.

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SUMMARY: The Regulatory Flexibility Act (RFA) requires agencies to 
publish plans to conduct periodic reviews of certain of their 
regulations. Multiple Executive Orders also require agencies to submit 
plans for periodic reviews of certain regulations. To further comply 
with the RFA and Executive Orders, and to ensure the Department's 
regulations have appropriate impacts, the U.S. Department of Health and 
Human Services (HHS or the Department) issues this final rule amending 
its regulations to set expiration dates for the Department's 
regulations (subject to certain exceptions), unless the Department 
periodically assesses the regulations to determine if they are subject 
to the RFA, and if they are, performs a review that satisfies the 
criteria in the RFA.

DATES: This final rule is effective on March 22, 2021.

FOR FURTHER INFORMATION CONTACT: James Lawrence, 200 Independence 
Avenue SW, Washington, DC 20201; or by email at reviewnprm@hhs.gov; or 
by telephone at 1-877-696-6775.

SUPPLEMENTARY INFORMATION: This final rule is organized as follows:

Table of Contents

I. Summary
II. Background
III. Statutory Authority and Legal Basis for This Final Rule
IV. Provisions of Proposed Rule and Response to Public Comments
V. Regulatory Impact Analysis

I. Summary

    On November 4, 2020, HHS published in the Federal Register a notice 
of proposed rulemaking titled ``Department of Health and Human Services 
Securing Updated and Necessary Statutory Evaluations Timely'' 
(hereinafter, ``proposed rule'').\1\ On November 23, 2020, the 
Department held a public hearing on the proposed rule.\2\ For the 
reasons described herein, after considering public comments on the 
proposed rule, HHS now finalizes the proposed rule as amended. This 
final rule will enhance the Department's implementation of section 3(a) 
of the Regulatory Flexibility Act (RFA), 5 U.S.C. 610, and various 
executive orders, and improve accountability and the performance of its 
regulations.\3\ The RFA requires federal agencies to publish in the 
Federal Register ``a plan for the periodic review of the rules issued 
by the agency which have or will have a significant economic impact 
upon a substantial number of small entities'' in order ``to determine 
whether such rules should be continued without change, or should be 
amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant impact of the rules 
upon a substantial number of small entities.'' 5 U.S.C. 610(a). In 
conducting this retrospective review, agencies must consider a variety 
of factors, including the continued need for the rule, legal issues, 
public input, overlap and duplication with other federal or State and 
local governmental rules, and technological, economic, or other 
changes. 5 U.S.C. 610(b). Agency compliance with 5 U.S.C. 610 may be 
subject to judicial review. See 5 U.S.C. 611(a).
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    \1\ 85 FR 70096 (Nov. 4, 2020).
    \2\ The transcript of the public hearing is available on the 
docket for the proposed rule. See https://beta.regulations.gov/docket/HHS-OS-2020-0012/document.
    \3\ Unless otherwise indicated, all references to HHS in this 
proposed rule include HHS' constituent agencies and other 
components.
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    Several Executive Orders have also directed agencies to submit 
plans for the periodic review of certain of their regulations.\4\
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    \4\ See, e.g., Exec. Order No. 12866 of Sept. 30, 1993, 58 FR 
51735 (Oct. 4, 1993), Exec. Order No. 13563 of Jan. 18, 2011, 76 FR 
3821 (Jan. 21, 2011).
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    The Department has tried to carry out the evidence-based approach 
to regulation prescribed by Congress and the executive orders, but HHS' 
efforts have met varying levels of success. Several States, as well as 
jurisdictions outside the United States, have experimented with 
different ways of ensuring agencies engage in retrospective regulatory 
reviews so that legal requirements are updated in view of emerging 
evidence and changed circumstances. Among the lessons that have emerged 
is that while statutory mandates are helpful, one of the most important 
factors for ensuring agencies conduct retrospective reviews of their 
regulations is to provide for the sunset or automatic expiration of 
certain regulatory requirements after a period of time unless a 
retrospective review determines that the regulations should be 
maintained.
    Therefore, in order to ensure evidence-based regulation that does 
not become outdated as conditions change, HHS finalizes this rule to 
provide that, subject to certain exceptions, all regulations issued by 
the Secretary or his delegates or sub-delegates in Titles 21, 42, and 
45 of the CFR shall expire at the end of (1) five calendar years after 
the year that this final rule first becomes effective, (2) ten calendar 
years after the year of the Section's promulgation, or (3) ten calendar 
years after the last year in which the Department Assessed and, if 
required, Reviewed \5\ the Section, whichever is latest. The RFA and 
executive orders have only resulted in limited retrospective review by 
the Department. The Department believes this final rule will effectuate 
the desire for periodic retrospective reviews expressed in the RFA and 
Executive Orders, as well as ensure the Department's regulations are 
having appropriate impacts and have not become outdated. The literature 
and the Department's experience suggest that many regulations are 
having estimated impacts that, over time, differ from what was 
estimated at the time the regulations were promulgated. This final rule 
will enhance both (1) the fulfillment of the existing policies that led 
to the Department's regulations and (2) the Department's longstanding 
desire

[[Page 5695]]

to comply with the RFA and periodically review its regulations.
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    \5\ ``Section,'' ``Assess,'' and ``Review'' are capitalized in 
this preamble where those terms have the definitions ascribed to 
them in the text of this final rule.
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II. Background

A. The Regulatory Flexibility Act

    In 1980, Congress enacted the Regulatory Flexibility Act (RFA), 
Public Law 96-354, 94 Stat. 1164 (1980) (codified as amended at 5 
U.S.C. 601-612). Congress stated that ``the purpose of this Act [is] to 
establish as a principle of regulatory issuance that agencies shall 
endeavor, consistent with the objectives of the rule and of applicable 
statutes, to fit regulatory and informational requirements to the scale 
of the businesses, organizations, and governmental jurisdictions 
subject to regulation.'' 94 Stat. at 1165. Consistent with this 
purpose, section 3(a) of the RFA requires agencies to publish in the 
Federal Register a ``plan for the periodic review of rules which have 
or will have a significant economic impact upon a substantial number of 
small entities.'' 5 U.S.C. 610(a). The ``purpose of the review shall be 
to determine whether such rules should be continued without change, or 
should be amended or rescinded . . . to minimize any significant 
economic impact of the rules upon a substantial number of small 
entities.'' Id. In conducting this review, Congress provided that 
agencies ``shall consider the following factors'':
    (a) The continued need for the rule;
    (b) The nature of complaints or comments received concerning the 
rule from the public;
    (c) The complexity of the rule;
    (d) The extent to which the rule overlaps, duplicates or conflicts 
with other Federal rules, and, to the extent feasible, with State and 
local governmental rules; and
    (e) The length of time since the rule has been evaluated or the 
degree to which technology, economic conditions, or other factors have 
changed in the area affected by the rule.
    5 U.S.C. 610(b)(1)-(5). Congress required agencies to conduct an 
initial review within ten years of the effective date of the RFA, as 
well as subsequent reviews ``within ten years of the publication of'' 
future final rules. 5 U.S.C. 610(a).
    The retrospective review provided for in 5 U.S.C. 610 is a 
congressional mandate. Under the plain terms of the Act, having a plan 
for such reviews is not optional. Congress fashioned a private right of 
action for small entities to ensure agencies satisfy 5 U.S.C. 610. See 
5 U.S.C. 611(a)(1) (``For any rule subject to this chapter, a small 
entity that is adversely affected or aggrieved by final agency action 
is entitled to judicial review of agency compliance with the 
requirements of sections 601, 604, 605(b), 608(b), and 610 in 
accordance with chapter 7.''). Originally, as one commentator 
explained, the RFA ``contain[ed] an extremely qualified and ambiguous 
provision for judicial review.'' \6\ In 1996, Congress amended the RFA 
to more clearly provide for judicial review of violations of 5 U.S.C. 
610.\7\ As one House Committee report explained, the lack of judicial 
review made ``agencies completely unaccountable for their failure to 
comply with its requirements,'' a problem the amendment attempted to 
solve.\8\
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    \6\ Paul R. Verkuil, A Critical Guide to the Regulatory 
Flexibility Act, 1982 Duke L.J. 213, 259 (1982).
    \7\ Contract with America Advancement Act of 1996, Public Law 
104-121, 110 Stat. 847, 865-66 (1996).
    \8\ H.R. Rep. No. 104-500, at 3 (1996).
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B. Executive Orders Directing Agencies To Review Existing Regulations

    Other efforts to conduct retrospective regulatory review both 
predate and have continued after passage of the RFA. In 1978, President 
Carter issued an executive order on improving federal regulations.\9\ 
The order directed agencies to ``periodically review their existing 
regulations.'' \10\ In determining which existing regulations to 
review, the order required agencies to consider, among other things, 
whether ``technology, economic conditions or other factors have changed 
in the area affected by the regulation.'' \11\ The Executive Order 
considered suggestions from the public that all regulations be 
reviewed, usually 3-5 years after issuance. But the Carter 
Administration instead instructed that, due to agency resource 
limitations, agencies should concentrate their reviews on those 
regulations which no longer serve their intended purpose, that have 
caused administrative difficulties, or that have been affected by new 
developments.\12\ The executive order also considered, but rejected, 
the idea of including a sunset provision in regulations on the ground 
that agencies cannot entirely eliminate regulations unless the law that 
authorized the regulations allows it.\13\ However, the Department 
believes that executive order did not consider that the authorizing 
statutes for many regulations permit those regulations to be rescinded. 
Moreover, as discussed below, experience since 1978 has shown it is 
difficult to adequately conduct retrospective regulatory review if 
regulations do not contain sunset provisions.
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    \9\ Exec. Order No. 12044 of Mar. 23, 1978, 43 FR 12661 (Mar. 
24, 1978) (revoked by Exec. Order No. 12291 of Feb. 17, 1981, 46 FR 
13193 (Feb. 19, 1981)).
    \10\ 43 FR at 12663.
    \11\ Id.
    \12\ Id. at 12669. As discussed below, the Department is 
reviewing a different subset of its regulations than was directed by 
Exec. Order No. 12044, in part because the RFA's directive to review 
regulations that have a significant economic impact upon a 
substantial number of small entities had not yet been enacted at the 
time of Exec. Order No. 12044. Moreover, Exec. Order No. 12044 was 
responding to suggestions that the review be performed every three 
to five years. The Department's reviews will be performed every ten 
years (except for regulations that have already been in effect for 
ten years), which should lessen the burden on the Department's 
resources.
    \13\ Id. at 12669.
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    Like the Carter Administration, every subsequent administration has 
directed agencies to engage in retrospective review of existing 
regulations. In 1981, President Reagan ordered agencies to ``review[ ] 
existing regulations'' in view of cost-benefit principles and potential 
alternatives.\14\ In 1992, President George H.W. Bush issued a 
memorandum instructing agencies to conduct a 90-day review ``to 
evaluate existing regulations and programs and to identify and 
accelerate action on initiatives that will eliminate any unnecessary 
regulatory burden or otherwise promote economic growth.'' \15\ 
President Clinton similarly called for review of existing regulations 
to determine whether they have become ``unjustified or unnecessary as a 
result of changed circumstances,'' and ``to confirm that regulations 
are both compatible with each other and [are] not duplicative or 
inappropriately burdensome in the aggregate.'' \16\ Specifically, that 
Executive Order required agencies to submit to the Office of 
Information and Regulatory Affairs (OIRA) a program under which the 
agency ``will periodically review its existing significant regulations 
to determine whether any such regulations should be modified or 
eliminated so as to make the agency's regulatory program more effective 
in achieving the regulatory objectives, less burdensome, or in greater 
alignment with the President's priorities and the principles set forth 
in this Executive Order.'' \17\ The George W. Bush Administration's 
Acting OIRA Administrator noted that the Bush Administration was ``in 
the

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process of reviewing a variety of existing regulations and regulatory 
programs in an effort to identify areas where sensible changes will 
yield greater benefits for the public at lower costs.'' \18\
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    \14\ Exec. Order No. 12291 of Feb. 17, 1981, 46 FR 13193, 13193 
(Feb. 19, 1981) (revoked by Exec. Order 12866 of Sept. 30, 1993, 58 
FR 51735 (Oct. 4, 1993)); see also Exec. Order 12498 of Jan. 4, 
1985, 50 FR 1036 (Jan. 8, 1985) (creating annual regulatory planning 
program), revoked by Exec. Order 12866 of Sept. 30, 1993, 58 FR 
51735 (Oct. 4, 1993).
    \15\ Memorandum on Reducing the Burden of Government Regulation 
(Jan. 28, 1992).
    \16\ Exec. Order No. 12866 of Sept. 30, 1993, 58 FR 51735 (Oct. 
4, 1993).
    \17\ Id.
    \18\ Draft Report to Congress on the Costs and Benefits of 
Federal Regulations Introduction, 66 FR 22041, 22054 (May 2, 2001).
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    President Obama also instructed agencies to engage in retrospective 
regulatory review. In 2011, President Obama issued an executive order 
ordering agencies ``[t]o facilitate the periodic review of existing 
significant regulations . . . to promote retrospective analysis of 
rules that may be outmoded, ineffective, insufficient, or excessively 
burdensome, and to modify, streamline, expand, or repeal them in 
accordance with what has been learned.'' \19\ Similarly, in 2012, 
President Obama noted that retrospective review has particular 
relevance ``[d]uring challenging economic times,'' and that agencies 
should consider whether regulations ``should be modified or streamlined 
in light of changed circumstances, including the rise of new 
technologies.'' \20\
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    \19\ Exec. Order No. 13563 of Jan. 18, 2011, 76 FR 3821, 3822 
(Jan. 21, 2011); see also Exec. Order No. 13579 of July 11, 2011, 76 
FR 41587, 41587 (July 14, 2011) (applying the same requirement to 
independent regulatory agencies).
    \20\ Exec. Order No. 13610 of May 10, 2012, 77 FR 28469, 28469 
(May 14, 2012).
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    President Trump has attempted to identify existing undue regulatory 
burdens and facilitate retrospective review of regulations. For 
example, in January 2017, President Trump issued an executive order 
requiring agencies to identify at least two regulations to be repealed 
for every one regulation proposed or otherwise promulgated.\21\ 
Similarly, a 2017 OIRA report to Congress explained, ``Rules should be 
written and designed to facilitate retrospective analysis of their 
effects, including consideration of the data that will be needed for 
future evaluation of the rules' ex post costs and benefits.'' \22\ In 
May 2020, in response to the COVID-19 pandemic, President Trump ordered 
agencies to ``identify regulatory standards that may inhibit economic 
recovery'' and to ``consider taking appropriate action, consistent with 
applicable law,'' including modifying, waiving, or rescinding those 
regulatory requirements.\23\
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    \21\ Exec. Order No. 13771 of Jan. 30, 2017, 82 FR 9339, 9339 
(Feb. 3, 2017).
    \22\ Office of Mgmt. & Budget, 2017 Report to Congress on the 
Benefits and Costs of Federal Regulations and Agency Compliance with 
the Unfunded Mandates Reform Act at 5 (2017), https://www.whitehouse.gov/wp-content/uploads/2019/12/2019-CATS-5885-REV_DOC-2017Cost_BenefitReport11_18_2019.docx.pdf; see also id. at 
16 (``[I]t is important to consider retrospective, as opposed to ex 
ante, estimates of both benefits and costs.'').
    \23\ Exec. Order No. 13924 of May 19, 2020, 85 FR 31353, 31354 
(May 22, 2020).
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    In addition to the executive orders, other executive branch actions 
have sought to spur agencies to conduct the reviews called for by 5 
U.S.C. 610. One example was the Regulatory Review and Reform (r3) 
initiative, which the Small Business Administration launched in part to 
improve compliance with 5 U.S.C. 610 and further the goals of periodic 
reviews. The r3 initiative was a long-term project to help agencies 
pinpoint existing federal rules that warrant review--and to revise 
those rules if they are found to be ineffective, duplicative, out of 
date, or otherwise deficient.\24\
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    \24\ Testimony of The Hon. Thomas M. Sullivan, Chief Counsel for 
Advocacy, U.S. SBA, U.S. House of Representatives Comm. on Small 
Bus. Subcomm. on Reg.'s, Health Care and Trade (July 30, 2008), 
https://www.sba.gov/sites/default/files/files/test08_0730.pdf 
(``Historically, federal agency compliance with section 610 has been 
limited.'').
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    Consistent with these actions, HHS has conducted retrospective 
reviews of some of its regulations. For example, pursuant to Executive 
Order 13563, HHS published a list of regulations the Department 
identified as candidates for retrospective review.\25\ The Department 
also took action. For example, HHS, citing Executive Order 13563, 
eliminated certain restrictions on the use of telemedicine in rural 
areas.\26\
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    \25\ See also Retrospective Review of Existing Rules, U.S. Dept. 
of Health & Human Servs., https://www.hhs.gov/open/retrospective-review/index.html.
    \26\ See Medicare and Medicaid Programs: Changes Affecting 
Hospital and Critical Access Hospital Conditions of Participation: 
Telemedicine Credentialing and Privileging, 76 FR 25550 (May 5, 
2011); see also Medicare and Medicaid Programs; Regulatory 
Provisions To Promote Program Efficiency, Transparency, and Burden 
Reduction; Part II, 79 FR 27106 (May 12, 2014) (finalizing several 
rules to remove unnecessary regulatory and reporting requirements 
previously imposed on hospitals and other health care providers).
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    Nonetheless, the Department has only conducted retrospective review 
of regulations to a very limited extent. One academic analysis 
determined that, in response to Executive Order 13563, the Department 
planned 83 retrospective analyses in 2012 and completed 33 analyses 
with final action by August 31, 2013.\27\ By contrast, the Department 
issued 247 rules between the date Executive Order 13563 was issued and 
August 31, 2013.\28\ As of July 2016, the Department had 40 planned 
retrospective analyses and by April 2017 had completed analyses with 
final action on 19 of them.\29\ These findings are consistent with 
government assessments that the Department's efforts to comply with 5 
U.S.C. 610 have at times been lacking.\30\
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    \27\ Connor Raso, Assessing regulatory retrospective review 
under the Obama administration, Brookings Inst., (Jun. 15, 2017), 
https://www.brookings.edu/research/assessing-regulatory-retrospective-review-under-the-obama-administration/.
    \28\ Id.
    \29\ Id.
    \30\ See, e.g., Curtis W. Copeland, Cong. Rsch. Serv., RL32801, 
Reexamining Rules: Section 610 of the Regulatory Flexibility Act 7-8 
(2008); U.S. Gov't Accountability Off., GAO/GGD-94-105, Regulatory 
Flexibility Act: Status of Agencies' Compliance 12 (1994) (quoting a 
1983 Small Business Administration report that stated that the 
Department's section 610 review plan was `` `very general,' and, as 
a result, `it is difficult to measure progress and to make 
recommendations with respect to future review' ''); see also 
Testimony of The Hon. Thomas M. Sullivan, Chief Counsel for 
Advocacy, U.S. SBA, U.S. House of Representatives Comm. on Small 
Bus. Subcomm. on Reg.'s, Health Care and Trade (July 30, 2008), 
https://www.sba.gov/sites/default/files/files/test08_0730.pdf 
(``Historically, federal agency compliance with section 610 has been 
limited.'').
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    Commenters on the proposed rule listed the following as examples of 
regulations that they and/or Congress have requested the Department to 
review, but that the commenters claimed were not reviewed:
     Regulations mandated for review by the 21st Century Cures 
Act, Public Law 114-255, sec. 2034, 130 Stat. 1033 (2016). Section 2034 
of that Act, according to the commenters, requires the Secretary to 
lead a review by research funding agencies of all regulations and 
policies related to the disclosure and reporting of financial conflicts 
of interest to reduce administrative burden on federally funded 
researchers. It also calls for the Secretary to harmonize the 
differences between the Basic HHS Policy for the Protection of Human 
Research Subjects (45 CFR part 46, subpart A) and the FDA regulations 
for the protection of human subjects (21 CFR parts 50 and 56). 
Commenters stated that these regulations are well overdue for 
assessment and review.
     Regulations covering access to skilled therapy services, 
which commenters say must be updated to reflect the national settlement 
in the Jimmo v. Sebelius litigation to codify the fact that skilled 
services are covered for Medicare beneficiaries not just to improve 
function, but to maintain or prevent deterioration in function.
     The dockets established by FDA's Center for Food Safety 
and Applied Nutrition and Center for Veterinary Medicine on Sept. 8, 
2017,\31\ in which the Centers requested comments and

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information to assist in identifying existing regulations and related 
paperwork requirements that could be modified, repealed or replaced, 
consistent with the law, to achieve meaningful burden reduction while 
allowing FDA to achieve its public health mission and fulfill statutory 
obligations. The commenters stated these were examples of incomplete 
regulatory review initiatives.\32\ Commenters stated that despite 
submitting extensive comments that detailed numerous regulations that 
they believe could be modified, repealed or replaced, the agency did 
not take any further action.
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    \31\ E.g., Nonrulemaking Docket FDA-2017-N-5093: Review of 
Existing General Regulatory and Information Collection Requirements 
of the Food and Drug Administration, https://beta.regulations.gov/docket/FDA-2017-N-5093.
    \32\ See Review of Existing General Regulatory and Information 
Collection Requirements of the Food and Drug Administration, 82 FR 
42506 (Sept. 8, 2017); FDA-2017-N-5093, https://beta.regulations.gov/docket/FDA-2017-N-5093.
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    A review conducted for the Department in 2019 (discussed in more 
detail in Section C) concluded that related good governance stewardship 
actions were deprioritized and relegated to ``rainy day'' activities 
that Department operating divisions would get around to when they 
could.\33\ However, the rainy day in many cases has never arrived.
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    \33\ See infra n.68 and accompanying text.
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    Scholars have also posited reasons why agencies may be reluctant to 
perform retrospective reviews. One administrative law expert now at 
Northwestern University has written:

    [E]ven with sufficient resources, agencies may not be properly 
incentivized. They are less likely to be found at fault for not 
conducting rigorous periodic reviews. Many rules, even those with 
significant effects, are often not on the public's radar once 
adopted. Challenging agency regulation under the RFA is more 
difficult than under the Administrative Procedure Act (APA) because 
there is no comment process and standing is granted to more limited 
parties. The harm to the public resulting from a cursory analysis is 
also much less clear. If sufficient interests exist to modify the 
rule, strong interest groups will directly lobby the agency to 
modify the rule. But in this case, a brand new rulemaking effort 
emerges.
    There are also political reasons and moral hazard concerns 
associated with performing retrospective analyses. In most cases, 
retrospective analyses of existing regulations are routine business 
matters left to be handled by staff members, rather than political 
appointees. Political appointees, such as agency heads, tend to come 
with specific regulatory agendas of their own. By contrast, staff 
members at regulatory agencies are best viewed as career members who 
have a vested interest in seeing their agencies continue to exist 
and thrive. All else equal, they are not inclined to acknowledge 
that the work of their agency is inefficient or unnecessary, and 
even less inclined to conduct analyses that may lead to a curtailing 
of the agency's authority. Whatever the reasons may be, serious ex 
post reviews are few and far between. A majority of rules, once 
adopted, will likely persist without significant ex post 
modification. As to how many agency rules currently implemented may 
be costing more resources than yielding benefits is anyone's 
guess.\34\
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    \34\ Yoon-Ho Alex Lee, An Options Approach to Agency Rulemaking, 
65 Admin. L. Rev. 881, 895-96 (2013).

Thus, the Department concludes that it needs to impose a strong 
incentive on itself to perform retrospective review, given these 
countervailing incentives to not perform such reviews and the limited 
number of retrospective reviews that the Department has performed over 
the last 40 years. As discussed in more detail in the regulatory impact 
analysis infra, the Department has the resources to periodically review 
the impacts of its regulations.

C. Limitations in Government Projections Counsel in Favor of Widespread 
Retrospective Regulatory Review

    The Congressional and Presidential directives to periodically 
review existing regulations are sound policy. When the Department first 
issues a regulation, it makes an educated guess about the regulation's 
impact. Several years after the regulation is promulgated, the 
Department has a somewhat greater basis for assessing its real-world 
impacts and can refine the regulation or agency enforcement practices, 
as appropriate. This would further democratic values such as 
accountability, administrative simplification, transparency, and 
performance measurement and evaluation.
    Indeed, the literature indicates that government projections of 
regulatory impacts would benefit from refinement based on experience 
after the regulations are implemented. The literature suggests the need 
for refinement is widespread, so widespread review would yield greater 
benefits than review of a handful of regulations. In 2005, the Office 
of Management and Budget (OMB) provided an overview of a sample of 
retrospective analyses based on an examination of forty-seven case 
studies.\35\ OMB considered a pre-regulation estimate to be accurate if 
the post-regulation estimate was within +/- 25 percent of the pre-
regulation estimate.\36\ This measure of accuracy reveals the 
difficulty and uncertainty inherent in prospective cost-benefit 
analysis. OMB found that agencies often inaccurately estimated the 
benefits of regulations in its sample of regulations, and agencies were 
more likely to overestimate benefits than to underestimate them, where 
benefits were estimated.\37\ Agencies overestimated benefits in 19 of 
39 sampled regulations, whereas they underestimated benefits in only 
two of the 39 regulations.\38\ In two cases, agencies overestimated 
benefits by a factor of 10.\39\ Second, agencies sometimes 
overestimated the benefit-cost ratio, and in that sense were a bit too 
optimistic about the consequences of their rules. Agency estimates were 
accurate in only 11 rules, while the ratio was overestimated in 22 
rules and underestimated in 14 rules.\40\ Third, agencies also 
overestimated and, less frequently, underestimated costs in the sampled 
regulations. Agency cost estimates were accurate for only 12 rules, 
overestimated for 16 rules, underestimated for 12 rules, and not 
estimated for seven rules.\41\
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    \35\ Office of Mgmt. & Budget, Validating Regulatory Analysis: 
2005 Report to Congress on the Costs and Benefits of Federal 
Regulations and Unfunded Mandates on State, Local, and Tribal 
Entities, at 46-47 (2005), http://perma.cc/R8LX-BQMJ (collecting 
studies comparing ex ante and ex post analyses of regulations' costs 
and benefits, including examples where cost and benefit estimates 
were off by more than a factor of ten).
    \36\ Id. at 42.
    \37\ Id. at 43-46.
    \38\ Id. at 47.
    \39\ Id. at 43.
    \40\ Id. at 47.
    \41\ Id.
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    Academic studies have also identified inaccuracies in agency 
estimates, relative to an ex post re-estimation. For example, one study 
of sixty-one rules for which benefit-cost ratios could be compared 
before and after the fact (including some not included in the OMB 
review) found that the estimated ratios were essentially accurate in 
only sixteen of the sixty-one cases, though the study found no bias in 
estimates of benefit-cost ratios.\42\ In this analysis, Dr. Harrington 
criticized certain aspects of the OMB analysis. But it is notable that, 
even though OMB and Dr. Harrington used somewhat differing methods and 
reviewed samples of regulations that did not completely overlap, they 
both found ex ante estimates to be in many cases lacking. Dr. 
Harrington concluded his analysis by noting that ``the results

[[Page 5698]]

demonstrate the value of ex post analysis. It is frustrating that there 
is so little of it, especially when so many close observers, from all 
points of view, claim to be in favor of it.'' \43\
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    \42\ Winston Harrington, Grading Estimates of the Benefits and 
Costs of Federal Regulation, Res. for the Future, Discussion Paper 
06-39, 2006, at 33, http://papers.ssrn.com/sol3/papers.cfm?abstract_id=937357. Dr. Harrington used the same measure 
of accuracy as OMB. While both OMB and Dr. Harrington noted that 
using +/- 25% as the measure of accuracy could be arbitrary, it is 
nonetheless informative that in many cases the ex ante estimates in 
the sampled regulations differed from ex post estimates by more than 
+/-25%.
    \43\ Id. at 34.
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    A more recent study of a sample of federal regulations found that 
of the eight regulations for which the author was able to make ex ante 
and ex post cost comparisons, six regulations involved overestimates of 
costs, two involved underestimates of costs, and none were deemed 
accurate.\44\ A regulation was deemed accurate if the regulation's 
regulatory impact analysis fell roughly within +2/-5% of the ex post 
observation.\45\ Of the 18 regulatory requirements for which the author 
was able to compare benefits (also referred to as ``effectiveness'' in 
the study) estimates on an ex ante and ex post basis, he found that 10 
involved overestimates, six were underestimates, and two were 
relatively accurate.\46\
---------------------------------------------------------------------------

    \44\ Richard Morgenstern, Retrospective Analysis of U.S. Federal 
Environmental Regulation, 9 J. of Benefit Cost Anal., no. 2, 2018, 
at 294, https://www.cambridge.org/core/services/aop-cambridge-core/content/view/891E36D3DBCEB79C969278488E5E1897/S2194588817000173a.pdf/retrospective_analysis_of_us_federal_environmental_regulation.pdf.
    \45\ Id.
    \46\ Id.; see also Cynthia Morgan & Nathalie B. Simon, National 
primary drinking water regulation for arsenic: A retrospective 
assessment of costs, 5 J. Benefit Cost Anal. no. 2, 2014, at 259-84, 
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A7B29CE98E650B424E92FF292A8FFC89/S2194588800000774a.pdf/national_primary_drinking_water_regulation_for_arsenic_a_retrospective_assessment_of_costs.pdf (finding that the EPA methodology 
overestimated predicted capital costs from its arsenic rule in most 
studied cases, especially as the size of the system increases (as 
measured by the design flow rate)).
---------------------------------------------------------------------------

    These studies all found that in most cases the sampled ex ante 
estimates were not within +/-25% of the ex post observations. The 
studies suggest many federal regulations are estimated after the fact 
to have real-world impacts that differ from the estimated impacts at 
the time the regulations were promulgated. Although these samples were 
not necessarily representative, it would not be unreasonable to think 
that the Department could make major improvements by conducting 
widespread review of its regulations, rather than merely reviewing the 
small number of regulations that interested parties ask the Department 
to consider revising.\47\
---------------------------------------------------------------------------

    \47\ This is not to suggest that prospective regulatory impact 
analyses are not helpful. To the contrary, they add tremendous value 
and greatly improve agency rule makings. But as explained elsewhere 
herein, even when an agency's cost-benefit analysis uses sound 
science and the best available information to estimate the costs, 
benefits or other impacts associated with a rule, technological 
innovation or subsequent changes in the law, among other things, can 
result in an ex post assessment of impacts differing from the 
agency's estimates at the time it promulgated the rule.
---------------------------------------------------------------------------

Reasons Regulatory Projections Differ From Regulations' Real-World 
Impacts
    There are several reasons why regulations' ex ante cost-benefit 
estimates tend to be inaccurate. First, changes in the legal landscape 
can cause government projections to become obsolete. For example, in 
February 2010, officials in the Centers for Medicare and Medicaid 
Services' Office of the Actuary (OACT) issued health spending and 
coverage projections through 2019.\48\ A month later, Congress enacted 
the Patient Protection and Affordable Care Act, Public Law 111-148, 124 
Stat. 119 (``ACA''), and the Health Care and Education Reconciliation 
Act of 2010, Public Law 111-152, 124 Stat. 1029. Largely as a result of 
the ACA's passage, in October 2010 OACT issued revised projections 
forecasting that by 2019 the insured share of the population would be 
92.7 percent--roughly ten percentage points higher than OACT projected 
nine months earlier.\49\
---------------------------------------------------------------------------

    \48\ See Truffer CJ, et al. Health Spending Projections Through 
2019: The Recession's Impact Continues, 29 Health Aff. no. 3, 2010, 
at 522-29, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2009.1074.
    \49\ See Sisko, et al., National Health Spending Projections: 
The Estimated Impact Of Reforms Through 2019, 29 Health Aff. no. 10, 
at 1936, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2010.0788.
---------------------------------------------------------------------------

    Second, changes in technology can also render projections 
inaccurate. One study has noted that even when an agency's benefit-cost 
analysis uses sound science and the best available information to 
estimate the costs associated with a rule, technological innovation can 
result in an ex post assessment of costs differing from the agency's 
cost estimates at the time it promulgated the rule.\50\ As an example 
of technology's impact on regulations, in 2019 the Food and Drug 
Administration (FDA) issued a rule amending requirements for medical 
device premarket submissions to remove requirements for paper and 
multiple copies, and replace these requirements with requirements for a 
single submission in electronic format.\51\ Changes in technology had 
rendered the requirement for multiple copies, whether in electronic 
format or paper form, no longer necessary.\52\ Had the Department 
reviewed more of its regulations, it might have learned of additional 
instances where technological changes counsel in favor of amendment. In 
addition, some scholars have suggested that in some cases changes in 
technology can reduce the costs of complying with regulatory 
mandates.\53\ If retrospective reviews conclude that technology has 
reduced compliance costs, that can inform the Department's decision 
about if or how to amend a regulation.
---------------------------------------------------------------------------

    \50\ Cynthia Morgan & Nathalie B. Simon, National primary 
drinking water regulation for arsenic: A retrospective assessment of 
costs, 5 J. Benefit Cost Anal. no. 2, 2014, at 259-84, https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A7B29CE98E650B424E92FF292A8FFC89/S2194588800000774a.pdf/national_primary_drinking_water_regulation_for_arsenic_a_retrospective_assessment_of_costs.pdf. One example referred to in this study is 
that technological innovation or regulatory or technical constraints 
could result in water systems using different treatment technologies 
for arsenic removal than assumed by the agency when it promulgated a 
regulation.
    \51\ Medical Device Submissions: Amending Premarket Regulations 
That Require Multiple Copies and Specify Paper Copies To Be Required 
in Electronic Format, 84 FR 68334 (Dec. 16, 2019).
    \52\ Id. at 68334.
    \53\ See, e.g., Cass R. Sunstein, The Regulatory Lookback, 94 
B.U. L. Rev. 579, 599 (2014).
---------------------------------------------------------------------------

    Yet another reason for potential divergence between prospective and 
retrospective regulatory impact estimates is non-compliance with the 
regulation being assessed. One study found differing accuracy for 
prospective per-unit cost estimates and prospective aggregate cost 
estimates; where there is substantial non-compliance with the 
regulation being analyzed, cost estimates per unit can sometimes be 
reasonably accurate while aggregates are simultaneously 
overestimated.\54\ (Non-compliance would, of course, also affect the 
accuracy of benefits estimates.\55\) As such, ex post analysis has the 
potential to inform not just decisions about codified regulatory 
requirements but also about agency enforcement practices.
---------------------------------------------------------------------------

    \54\ Winston Harrington, Richard D. Morgenstern and Peter 
Nelson, On the Accuracy of Regulatory Cost Estimates, J. Policy 
Anal. & Management 2000, 19(2): 297-322.
    \55\ See, e.g., Si Kyung Seong and John Mendeloff, Assessing the 
Accuracy of OSHA's Projections of the Benefits of New Safety 
Standards, Am. J. Industrial Medicine 2004, 45(4): 313-328.
---------------------------------------------------------------------------

Institutionalizing Retrospective Review To Refine Projections That Were 
Lacking
    While the prospective cost-benefit analyses performed in connection 
with the promulgation of rules are quite useful, former OIRA 
Administrator Cass Sunstein has explained that ``[w]hen agencies issue 
rules, they have to speculate about benefits and costs.'' \56\ 
Therefore,[a]fter rules are in place, [agencies] should test those 
speculations, and they should use what they learn when revisiting a 
regulation

[[Page 5699]]

or issuing a new one.'' \57\ Professor Sunstein described this as ``one 
of the most important steps imaginable'' for regulatory reform, ``not 
least because it can reduce cumulative burdens and promote the goal of 
simplification.'' \58\ He has noted that agencies' failure ``until very 
recently . . . to gather, let alone act on'' retrospective reviews is 
``an astonishing fact.'' \59\
---------------------------------------------------------------------------

    \56\ Cass R. Sunstein, The Regulatory Lookback, 94 B.U. L. Rev. 
579, 591 (2014).
    \57\ Id.
    \58\ Id.
    \59\ Id. at 588.
---------------------------------------------------------------------------

    Michael Greenstone, who served as Chief Economist on the Council of 
Economic Advisors between 2009 and 2010, similarly concluded that the 
``single greatest problem with the current system is that most 
regulations are subject to a cost-benefit analysis only in advance of 
their implementation. This is the point when the least is known and any 
analysis must rest on many unverifiable and potentially controversial 
assumptions.'' \60\ According to Professor Greenstone, the lack of a 
regulatory lookback created a system ``largely based on faith, rather 
than evidence,'' where the agency ``all too frequently takes shots in 
the dark and we all too infrequently fail to find out if we have hit 
anything--or even worse, we only find out when things have gone 
horribly wrong.'' \61\ As he explained, ``it is nearly impossible to 
imagine'' only prospective, and not retrospective, evaluations ``being 
used in other contexts where people's lives are on the line. For 
example, I am confident that there would be a deafening uproar of 
protest if the FDA announced that it would approve drugs without 
testing them in advance. Yet, this is largely what we do with 
regulations that affect our health and well-being.'' \62\
---------------------------------------------------------------------------

    \60\ Michael Greenstone, Toward a Culture of Persistent 
Regulatory Experimentation and Evaluation, in New Perspectives on 
Regulation 111, 113 (David Moss & John Cisternino eds., 2009). It 
should not be inferred, however, that retrospective analysis is free 
of assumptions (including potentially controversial assumptions) or 
is generally without challenges, especially with respect to 
establishing relevant counterfactuals. For discussion and recent 
examples related to just two of the many areas of Department 
regulatory activity, see Trinided Beleche et al., Are Graphic 
Warning Labels Stopping Millions of Smokers? A Comment on Huang, 
Chaloupka, and Fong, 15 Econ Journal Watch 129 (2018) and Aaron 
Kearsley et al., A Retrospective and Commentary on FDA's Bar Code 
Rule, 9 J. Benefit-Cost Analysis 496 (2018). Moreover, to the extent 
that retrospective analysis is used to inform policy choices going 
forward, it becomes, or is at least being used as, prospective 
analysis and thus relies on assumptions about the future, including 
as regards technology and the legal and regulatory landscape. But 
since retrospective analysis is conducted after some real-world 
experience living under the regulation, it can in many cases be an 
improvement over earlier prospective analysis.
    \61\ Michael Greenstone, Toward a Culture of Persistent 
Regulatory Experimentation and Evaluation, in New Perspectives on 
Regulation 111, 111-12 (David Moss & John Cisternino eds., 2009); 
see also Office of Mgmt. & Budget, 2017 Report to Congress on the 
Benefits and Costs of Federal Regulations and Agency Compliance with 
the Unfunded Mandates Reform Act at 5 (2017), https://www.whitehouse.gov/wp-content/uploads/2019/12/2019-CATS-5885-REV_DOC-2017Cost_BenefitReport11_18_2019.docx.pdf (``The aim of 
retrospective analysis is to understand and improve the accuracy of 
prospective analysis and to provide a basis for potentially 
modifying rules as a result of ex post evaluations.'').
    \62\ Michael Greenstone, Toward a Culture of Persistent 
Regulatory Experimentation and Evaluation, in New Perspectives on 
Regulation 111, 114 (David Moss & John Cisternino eds., 2009).
---------------------------------------------------------------------------

    If retrospective analysis ``could be firmly institutionalized,'' 
Professor Sunstein observed, then it ``would count as the most 
important structural change in regulatory policy since the original 
requirement of prospective analysis during the Reagan Administration.'' 
\63\
---------------------------------------------------------------------------

    \63\ Cass R. Sunstein, The Regulatory Lookback, 94 B.U. L. Rev. 
579, 589 (2014).
---------------------------------------------------------------------------

    Other administrative law experts have also urged agencies to more 
robustly institutionalize retrospective review of regulations. The 
Administrative Conference of the United States (ACUS) has ``urge[d] 
agencies to remain mindful of their existing body of regulations and 
the ever-present possibility that those regulations may need to be 
modified, strengthened, or eliminated in order to achieve statutory 
goals while minimizing regulatory burdens.'' \64\ More recently, the 
American Bar Association Section of Administrative Law and Regulatory 
Practice, has ``urge[d] [the Administration] to build on the efforts of 
previous administration[s] and take steps to institutionalize careful, 
in-depth retrospective review of existing rules.'' \65\
---------------------------------------------------------------------------

    \64\ Administrative Conference of the United States, 
Recommendation 2014-5, Appendix--Recommendations of the 
Administrative Conference of the United States, 79 FR 75114, 75114 
(Dec. 17, 2014); see also ABA Sec. of Admin. Law & Reg. Prac., 
Improving the Administrative Process: A Report to the President-
Elect of the United States (2016), 69 Admin. L. Rev. 205 (2017).
    \65\ ABA Sec. of Admin. Law & Reg. Prac., Improving the 
Administrative Process: A Report to the President-Elect of the 
United States (2016), 69 Admin. L. Rev. 205, 219 (2017) (emphasis in 
original).
---------------------------------------------------------------------------

The Need for a Greater Incentive To Institutionalize Retrospective 
Review
    Despite these many calls for retrospective review, as noted in 
section II.B., the Department has had limited success in implementing 
retrospective review in practice.\66\ In 2019, the Department piloted 
an approach to augment expert policy insights with artificial 
intelligence-driven data analysis of its regulations, which showed the 
need to more firmly institutionalize retrospective review. The 
artificial intelligence review found that 85% of Department regulations 
created before 1990 have not been edited; the Department has nearly 300 
broken citation references in the CFR (i.e. CFR sections that reference 
other CFR sections that no longer exist); more than 50 instances of 
regulatory requirements to submit paper documents in triplicate or 
quadruplicate; and 114 parts in the CFR with no regulatory entity 
listed, 17 of which may be misplaced.\67\ The Department concluded that 
some good governance stewardship recommendations ``were deprioritized 
and relegated to rainy day activities that [Department operating 
divisions] would get around to when they could.'' \68\ Unfortunately, 
in many cases the Department has for years not gotten around to 
addressing these issues.
---------------------------------------------------------------------------

    \66\ See also Yoon-Ho Alex Lee, An Options Approach to Agency 
Rulemaking, 65 Admin. L. Rev. 881, 894 (2013), (``one might think 
that agencies would faithfully take advantage of [] opportunities to 
conduct rigorous retrospective [cost-benefit analyses] of their 
existing regulations and test their effectiveness and efficiency. 
This would be the surest way of incorporating ex post learning in 
rule implementation. This is far from the truth in practice, 
however.'').
    \67\ Regulatory Streamlining & Analysis (Mar. 2019).
    \68\ Id. at 18
---------------------------------------------------------------------------

    As one observer recently explained:

    Retrospective review of existing regulations . . . is a 
perennial favorite target for advice on how to improve OIRA's 
processes. Every administration since President Carter has developed 
some program to modify, streamline, or expand existing regulations, 
and there is no shortage of advice on how to make the process run 
more efficiently. Yet, despite a few notable one-off successes from 
past retrospective review efforts, no past retrospective review 
campaign has ever truly succeeded in creating a long-term culture of 
retrospective review or of prospectively embedding into new 
regulations a process for data collection and pre-set targets for 
future lookbacks. Any future efforts around retrospective review, 
therefore, should be clear-eyed about past failures.\69\
---------------------------------------------------------------------------

    \69\ Jason Schwartz, Enhancing the Social Benefits of Regulatory 
Review, Institute for Policy Integrity, at 30 (Oct. 2020), https://policyintegrity.org/files/publications/Enhancing_the_Social_Benefits_of_Regulatory_Review.pdf. Several 
weeks after publishing this article, the author submitted a comment 
opposing the proposed rule. For the reasons discussed in the 
responses to public comments, the Department did not find those 
arguments compelling, but believes the quoted passage is a fair 
description of the problem this final rule aims to solve. The 
Department is trying to be clear-eyed about past failures, and has 
concluded that a strong incentive, such as that included in this 
final rule, is commensurate with the problem to be solved and to 
more firmly institutionalize retrospective review.

    For the reasons discussed in this final rule, the Department 
believes a stronger

[[Page 5700]]

incentive is needed to achieve the benefits of retrospective 
review.\70\ This final rule creates a mechanism to more firmly 
institutionalize the retrospective reviews that Professors Sunstein and 
Greenstone, as well as ACUS and others, have called for.
---------------------------------------------------------------------------

    \70\ Regulatory Streamlining & Analysis (Mar. 2019) (it 
``appears the current set of governance structures, incentives and 
processes to promulgate regulatory reform need strengthening to be 
more effective'').
---------------------------------------------------------------------------

D. The Experiences of States and Other Jurisdictions With Automatic 
Expiration or ``Sunset'' Provisions

    This mechanism is based in part on the experiences of States and 
other jurisdictions. Several States incorporate retrospective 
regulatory review into their laws. New York, for example, requires 
retrospective review of regulations ``no later than in the fifth 
calendar year after the year in which the rule is adopted,'' and 
requires that rules be ``re-reviewed at five-year intervals'' 
thereafter. N.Y. A.P.A. Law sec. 207. Similarly, Texas requires State 
agencies to review rules four years after they go into effect and then 
subsequently at four-year intervals. Tex. Gov't Code sec. 2001.039. In 
addition to New York and Texas, State law requires some form of 
retrospective regulatory review in at least Alabama, Arizona, Illinois, 
Iowa, Michigan, Missouri, New Jersey, New Mexico, North Carolina, North 
Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, and 
Washington.\71\
---------------------------------------------------------------------------

    \71\ Ala. Code 41-22-5.2; Ariz. Rev. Stat. 41-1056; 5 Ill. Comp. 
Stat. Ann. 100/5-130; Iowa Code Ann. 17A.33; Mich. Comp. Laws 
10.151; Missouri Rev. Stat., Title XXXVI Sec.  536.175.5; N.J. Stat. 
Ann. 52:14B-5.1; N.M. Stat. 14-4A-6; N.C. Gen. Stat. 150B-21.3A; 
N.D. Cent. Code 28-32-18.1; Ohio Rev. Code Ann. 106.03; Okla. Stat. 
Ann. tit. 75, 307.1; 71 Pa. Stat. Ann. 745.2; R.I. Gen. Laws Ann. 
tit. 42, ch. 64.13; Tenn. Code Ann. 4-56-102; Wash Rev. Code Ann. 
43.70.041, 43.22.052.
---------------------------------------------------------------------------

    Some States with retrospective review requirements allow 
regulations to automatically expire or sunset after a period of time, 
unless reviewed or readopted. In New Jersey, regulations automatically 
expire ``seven years following the effective date of the rule'' unless 
extended by the agency. N.J. Stat. Ann. sec. 52:14B-5.1(b).\72\ Indiana 
allows regulations to expire on January 1 following the seven-year 
anniversary of their effective dates. Ind. Code sec. 4-22-2.5-2. The 
Governor of Florida recently instructed Florida government agencies to 
``include a sunset provision in all proposed or amended rules,'' which 
``may not exceed five years unless otherwise required by existing 
statute.'' \73\
---------------------------------------------------------------------------

    \72\ Although the New Jersey law permits the Governor, within 
five days of the expiration of a rule, to restore it, the Department 
does not include a similar provision in this proposed rule. That is 
because the RFA contains no such similar provision and the 
Department is giving itself ten years, as opposed to seven years, to 
perform Assessments and (when required) Reviews of Regulations.
    \73\ Letter from Gov. Ron DeSantis to Florida Agency Heads (Nov. 
11, 2019), https://www.floridahasarighttoknow.myflorida.com/content/download/147113/980326/FINAL_Directive_to_Agencies_11.19.pdf.
---------------------------------------------------------------------------

    Experience in the States suggests that sunset provisions can be an 
important tool to ensure reviews take place. An analysis of regulation 
in all 50 States found that for a reduction in both regulatory creation 
and enforcement, ``[t]he single most important policy in a state is the 
presence of a sunset provision.'' \74\ On the other hand, one report 
stated that, despite their initial popularity in the States,\75\ sunset 
provisions fell out of favor, not because they did not produce more 
cost-effective, cost-justified regulation, but because sunset 
requirements did not provide sufficient legislative control over 
executive agencies.\76\ But that observation is inapplicable to the 
Department, because this final rule concerns the Department's review of 
its own regulations. Noting the benefits of sunset provisions, the 
report added that sunset ``provisions have been responsible for the 
analysis of thousands of state regulations and, on average, the repeal 
of twenty to thirty percent of existing regulations and the 
modification of another forty percent.'' \77\
---------------------------------------------------------------------------

    \74\ Russell S. Sobel & John A. Dove, State Regulatory Review: A 
50 State Analysis of Effectiveness 36 (Mercatus Ctr., Working Paper 
No. 12-18, 2012), https://www.mercatus.org/system/files/State-Regulatory-Review-50-State-Analysis-Effectiveness.pdf.
    \75\ Jason A. Schwartz, 52 Experiments with Regulatory Review: 
The Political and Economic Inputs into State Rulemakings, Inst. for 
Policy Integrity, Rep. No. 6, at 33 (Nov. 2010), https://policyintegrity.org/files/publications/52_Experiments_with_Regulatory_Review.pdf.
    \76\ See id. (noting that ``North Carolina was first to repeal 
its sunset law, and many other states quickly followed suit'' after 
concluding that ``sunset provisions quickly proved to be an 
expensive, cumbersome, and disappointing method for enhancing 
legislative control'').
    \77\ Id. at 23-24. The report added, without citing a great deal 
of empirical evidence, that ``sunset requirements produce 
perfunctory reviews and waste resources.'' This appears to be based 
on a law review article that noted, not that retrospective reviews 
were per se perfunctory, but that ``unless adequate resources are 
provided, the reviews may be relatively perfunctory and meaningless, 
wasting whatever resources are expended.'' See Neil R. Eisner & 
Judith S. Kaleta, Federal Agency Reviews of Existing Regulations, 48 
Admin. L. Rev. 139, 160 (1996) (emphasis added). But this law review 
article noted that adding ``sunset'' dates to regulations unless 
they are reviewed was ``likely to ensure that a review is done.'' 
Id. As explained herein, the Department intends to commit adequate 
resources to its reviews if this proposed rule were to be finalized. 
The law review article said that sunset provisions should be used 
only in narrowly focused situations where it is determined that it 
is necessary to apply some ``pressure'' and only where assessments 
are made of the available resources and the benefits to be derived 
from the review. Id. But the article was written in 1996. As 
discussed herein, subsequent experience with efforts short of a 
forcing mechanism suggest that forcing mechanisms are needed to 
ensure review of a wide array of Department regulations, and that 
the benefits from these retrospective reviews would be substantial.
---------------------------------------------------------------------------

    Experience outside the United States also suggests the utility of 
sunset provisions. The Office for Economic Co-Operation and Development 
(OECD) analyzed regulatory practices in the European Union. In a 2010 
report, the OECD recommended, for ``[t]he management and 
rationalization of existing regulations,'' that Germany ``[k]eep up the 
`spring cleaning' of legislation at regular intervals'' and ``consider 
the inclusion of a review mechanism in individual draft regulations, or 
even [include] a sunset clause (beyond which the law automatically 
expires) where appropriate.'' \78\ With respect to the United Kingdom's 
regulatory program, the OECD noted ``sunset clauses are also helpful'' 
in order ``to remove unnecessary burdens in legislation.'' \79\ 
Throughout the 2010 report, the OECD repeatedly noted the value of 
retrospective regulatory review.\80\
---------------------------------------------------------------------------

    \78\ OECD, Better Regulation in Europe: Executive Summaries, 
GOV/RPC (2010)13, at 113, http://www.oecd.org/gov/regulatory-policy/45079126.pdf.
    \79\ Id. at 46.
    \80\ See, e.g., id. at 107 (``The ex post evaluation of 
regulations which is provided for in the impact assessment process 
provides a framework in principle for checking what really happens, 
and whether regulations have actually achieved the objectives 
originally set.'').
---------------------------------------------------------------------------

    In 2019, the OECD published an additional survey regarding 
regulatory review practices in the European Union. The OECD again noted 
the utility of sunset provisions, describing them as a ``useful 
`failsafe' mechanism to ensure the entire stock of subordinate 
regulation remains fit for purpose over time.'' \81\ The report noted 
as of its 2019 date that sunset provisions are in place for at least 
some regulations in nine different countries, including the United 
Kingdom, France, and Germany.\82\
---------------------------------------------------------------------------

    \81\ OECD, Better Regulation Practices across the European 
Union, at ch. 4, Box 4.1 (2019), https://www.oecd-ilibrary.org/sites/9789264311732-en/1/2/4/index.html?itemId=/content/publication/9789264311732-en&_csp_=07701faff9659027b81a5b5ae2ff041c&itemIGO=oecd&itemContentType=book.
    \82\ Id. at ch. 4, Table 4.1.
---------------------------------------------------------------------------

    In 2009, the Republic of Korea (ROK) enacted a law under which 
about 20% of the existing regulations are to be reviewed on a regular 
basis (about every 3 to 5 years) and become invalid if they

[[Page 5701]]

are found to lack feasibility.\83\ Under the ROK's ``review and 
sunset,'' there is a duty to carry out a review of a regulation on a 
specified schedule. This sunset clause was established upon the idea 
that even a rational regulation needs to be examined periodically to 
determine its grounds for remaining in force, as its validity may be 
compromised under any change in circumstances or its 
characteristics.\84\ An OECD report stated that ``[g]iven such 
rationale, the sunset clause is considered as a critical component of 
efforts in regulatory quality improvement.'' \85\
---------------------------------------------------------------------------

    \83\ OECD, Latest Developments on Korea's Regulatory Policy, at 
2, https://www.oecd.org/gov/regulatory-policy/45347364.pdf.
    \84\ OECD Reviews of Regulatory Reform, Regulatory Policy in 
Korea, Toward Better Regulation, at 86 (2017), https://publicadministration.un.org/unpsa/Portals/0/UNPSA_Submitted_Docs/2019/4cd3e219-c819-40f3-8246-7a024d9a82a9/2020%20UNPSA_the%20Regulatory%20Reform%20Sinmungo_Evaluation%20Report_27112019_032807_e4d166a9-f6ef-4a6c-9aaf-99748fa94284.pdf?ver=2019-11-27-032807-637.
    \85\ Id.
---------------------------------------------------------------------------

    These authorities indicate an emerging awareness that sunset 
provisions are useful in ensuring retrospective regulatory review. This 
is consistent with the Department's experience over the last 40 years, 
which suggests that, absent a sunset provision or automatic expiration 
date, Congressional and Presidential directives to perform periodic 
retrospective reviews of regulations have limited success.
    Indeed, previous Administrations have recognized the benefits of 
sunset provisions. In a June 2015 report, the Department of Treasury's 
Office of Economic Policy, the Obama Administration's Council of 
Economic Advisors, and the Department of Labor discussed sunset 
provisions as applied to occupational licensing.\86\ That report found 
evidence that sunset reviews that automatically terminate regulatory 
boards and agencies absent legislative action assist with ``removing 
unnecessary licensing.'' \87\ The report explained that sunset review 
can be ``useful because, even if licensing was justified when first 
introduced, technological and economic changes may have rendered it 
unnecessary or overly restrictive.'' \88\ The report found ``[p]eriodic 
examination of existing rules is thus helpful in maintaining the 
quality of occupational regulation.'' \89\
---------------------------------------------------------------------------

    \86\ Occupational Licensing: A Framework for Policymakers, The 
White House, at 48-50 (July 2015), https://obamawhitehouse.archives.gov/sites/default/files/docs/licensing_report_final_nonembargo.pdf.
    \87\ Id. at 48.
    \88\ Id. at 49.
    \89\ Id. The report also suggests that to strengthen sunset 
provisions in the States, sunset commissions responsible for 
conducting the cost-benefit analysis should be provided adequate 
resources; the cost-benefit review process should be insulated 
against political interference; a minimum number of votes should be 
required to overrule the sunrise agency's recommendation; and 
specialized committees within legislatures be appointed to work with 
the agency in charge of conducting the review. See id. at 42. As 
discussed herein, the Department believes it has adequate resources 
to conduct the required reviews. As discussed in footnote 92, it is 
not clear that a federal agency can legally completely insulate its 
reviews from supervision by the agency's leadership, but the 
Department believes that its retrospective reviews will generally be 
performed by career civil servants. Lastly, the Department cannot 
require Congress to appoint committees to work with the Department 
officials performing the retrospective reviews, but the Department 
would welcome the opportunity to discuss reviews with Congressional 
staff if Congress so chose. The report also suggested ``sunrise'' 
reviews can be more effective than sunset reviews. But for already-
existing regulations, the Department cannot perform sunrise reviews, 
so the Department is has decided to take advantage of the benefits 
of sunset reviews. Moreover, the Department already engages in 
``sunrise review'' to some extent when it develops regulatory 
flexibility analyses, see 5 U.S.C. 603, 604, and regulatory impact 
analyses (notably, such reviews did not occur for regulations that 
preceded the RFA, many of which still remain in effect).
---------------------------------------------------------------------------

    Professor Greenstone has similarly recommended the automatic repeal 
of regulations if their benefits and costs are not periodically 
assessed:

[Another] step in reforming our regulatory system is to require that 
all regulations contain rules specifying the date by which the 
regulatory review board has to assess their costs and benefits. If 
the regulatory review board fails to meet one of these deadlines, 
then the regulation should be repealed by default. The purpose of 
this sunset provision is to ensure that all regulations are 
evaluated carefully and do not stay on the books just because they 
have been on the books in the past.\90\
---------------------------------------------------------------------------

    \90\ Greenstone, Toward a Culture of Persistent Regulatory 
Experimentation and Evaluation, in New Perspectives on Regulation 
111, 121 (David Moss & John Cisternino eds., 2009).

    Professor Greenstone suggested that this review could cause the 
regulation to be expanded if supported by evidence.\91\ According to 
Professor Greenstone, this would ``ensure that ineffective regulations 
are removed and that society fully benefits from the effective ones.'' 
\92\
---------------------------------------------------------------------------

    \91\ Id.
    \92\ Id. at 123. Professor Greenstone made a separate suggestion 
that a regulatory review board be created with the authority to 
assess the effectiveness of regulations and repeal regulations 
deemed ineffective. The Department considered this in the proposed 
rule. First, the Department is concerned that such a board raises 
legal concerns, since many Department regulations can only be 
repealed by the Secretary, not by an independent board. Second, 
Professor Greenstone proposed the independent review board on the 
grounds that (1) it would remove the board's functions as much as 
possible from political control, and (2) those most deeply involved 
in implementing a regulation are likely to see the benefits more 
clearly than the costs. Id. at 119-121. While these concerns are 
understandable, the Department believes it is capable of performing 
the Review. As an initial matter, those who conduct the Review would 
not necessarily be those in the Department who implement the Section 
being Reviewed. Moreover, as described herein, Reviews must be 
performed in such a manner that they can withstand judicial review 
under the arbitrary and capricious standard. This would require the 
Reviews to meet a minimum standard of rigor and require them to 
consider relevant factors. Moreover, many regulations legally cannot 
be amended or repealed without authorization by a political 
appointee.
---------------------------------------------------------------------------

    This final rule seeks to advance democratic values and apply the 
lessons learned from States, foreign jurisdictions, and the academic 
community. This final rule would apply the benefits of automatic-
expiration-absent-periodic-review to a broader array of regulations 
than is currently being reviewed by the Department.

E. The Need for Widespread Retrospective Review

    The evidence suggests the Department should conduct retrospective 
review on a broad scale to improve impact estimates and enhance the 
Department's ability to fulfil the goals motivating its regulations. As 
explained in Section C, studies of federal regulations consistently 
find that, in most sampled regulations, the ex ante estimate of costs 
and benefits is not within +/-25% of the ex post observation. Although 
these samples were not necessarily representative, taken together they 
suggest that many federal regulations are estimated after the fact to 
have real-world impacts that differ from the estimated impacts at the 
time the regulations were promulgated. Therefore, HHS believes that 
review should be done on a broad scale, rather than reviewing a handful 
of regulations that happen to be brought to the Department's attention.
    The artificial intelligence review described in this final rule 
also suggests that large numbers of Department regulations would 
benefit from retrospective review. The artificial intelligence review 
identified that 85% of Department regulations created before 1990 have 
not been edited; the Department has nearly 300 broken citation 
references \93\ in the CFR; and there are more than 50 instances of HHS 
regulatory requirements to submit paper documents in triplicate or 
quadruplicate.\94\ This suggests that humans performing a comprehensive 
review of Department regulations would find large numbers of 
requirements that

[[Page 5702]]

would benefit from review, and possibly amendment or rescission.
---------------------------------------------------------------------------

    \93\ As discussed below, HHS has roughly 18,000 regulations 
total.
    \94\ 85 FR 70102.
---------------------------------------------------------------------------

    The HHS response to the COVID-19 pandemic also indicates that the 
Department should perform widespread retrospective reviews. During the 
COVID-19 pandemic, the Department's response has largely consisted of 
waiving regulatory requirements or exercising enforcement discretion to 
not enforce certain regulatory requirements to enhance the Nation's 
response to the pandemic. Examples include waivers to increase hospital 
capacity, ease restrictions on services rendered by medical residents, 
and allowing patients to seek more services via telehealth.\95\ On 
November 25, 2020, the Department published in the Federal Register a 
non-exhaustive list of 382 enforcement discretion announcements, 
waivers or changes to regulations, agency guidance materials, or 
compliance obligations made to respond to the COVID-19 pandemic and its 
impact on the healthcare industry. See Regulatory Relief to Support 
Economic Recovery; Request for Information (RFI), 85 FR 75720 (Nov. 25, 
2020) at Attachment A. The Department should learn from the pandemic 
and conduct widespread reviews to determine whether these or other 
regulatory requirements could hinder the Nation's response to a future 
emergency, or otherwise should be amended or rescinded. Determining 
whether the Department's existing 18,000 regulations are having 
appropriate impacts is a worthwhile enterprise, even if it somewhat 
reduces the time spent issuing new regulations. Some commenters at the 
November 23, 2020 public hearing on the proposed rule suggested that 
the proposed rule was akin to using a missile to kill a mouse. But the 
literature and the Department's experience indicate the problem is not 
a mere mouse.
---------------------------------------------------------------------------

    \95\ See, e.g., Coronavirus waivers and flexibilities, CMS.gov, 
https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.
---------------------------------------------------------------------------

    Thus, there is a need for widespread retrospective review, but it 
is nearly impossible to see how a satisfyingly comprehensive review 
could occur without a sunset mechanism. The Department recognizes that 
in many cases the Department had strong reasons for issuing its 
regulations. Examples of such motivations might include enhancing food 
safety,\96\ increasing access to health insurance,\97\ or increasing 
the incentive for Temporary Assistance for Needy Families recipients to 
work.\98\ These are all important policy goals that the Department 
wishes to achieve. This final rule is intended to further these goals, 
as well as the other goals motivating the Department's regulations. The 
literature and the Department's experience suggest that large numbers 
of regulations are having impacts that, over time, differ from what was 
estimated at the time the regulations were promulgated. Therefore, the 
Department needs to conduct periodic reviews of its regulations to 
determine whether the policy goals behind the regulations are in fact 
being effected (and if amending those regulations could more 
effectively further those goals).
---------------------------------------------------------------------------

    \96\ E.g., 21 CFR part 112.
    \97\ E.g., 45 CFR part 147.
    \98\ 45 CFR part 261.
---------------------------------------------------------------------------

    This final rule is not a reversal of a prior Department policy, but 
in fact an effort to enhance both (1) the fulfillment of the existing 
policies that led to the Department's regulations and (2) the 
Department's longstanding desire to comply with the RFA and 
periodically review its regulations. In any event, this final rule 
provides the reasoned explanation that would be required if it were a 
change in policy.\99\
---------------------------------------------------------------------------

    \99\ See FCC v. Fox TV Stations, Inc., 556 U.S. 502, 515-16 
(2009) (``[A] reasoned explanation is needed for disregarding facts 
and circumstances that underlay or were engendered by the prior 
policy,'' but the agency ``need not demonstrate to a court's 
satisfaction that the reasons for the new policy are better than the 
reasons for the old one; it suffices that the new policy is 
permissible under the statute, that there are good reasons for it, 
and that the agency believes it to be better, which the conscious 
change of course adequately indicates'') (emphasis in original).
---------------------------------------------------------------------------

F. Operationalization of This Final Rule

    In this section, the Department summarizes aspects of how it will 
operationalize this final rule.
    The proposed rule proposed creating a website where the Department 
would announce when it has commenced Assessments or Reviews. The 
proposed rule further proposed that the public could comment on 
regulations and submit comments requesting that the Department Assess 
or Review a regulation.\100\
---------------------------------------------------------------------------

    \100\ See, e.g., 85 FR 70120.
---------------------------------------------------------------------------

    In light of public comments, the Department is making these 
procedures more robust. Under this final rule, when the Department 
commences the process of performing an Assessment or Review, it shall 
state on a Department-managed website the sections of the Code of 
Federal Regulations whose Assessment or Review it is commencing. The 
Department shall also announce once a month in the Federal Register 
those new Assessments or Reviews that it has commenced in the last 
month. Some comments on the proposed rule said that announcements 
should be made in the Federal Register, which the public already 
monitors, rather than a separate website. Therefore, in response to 
these comments, in this final rule the Department commits to announcing 
once a month in the Federal Register which new Assessments and Reviews 
it has commenced. The Department will also create a docket on 
Regulations.gov for each Assessment or Review that the Department is 
conducting. These docket numbers will be referenced in the Federal 
Register announcements. The public will be able to submit comments to 
the dockets of each rulemaking being Assessed or Reviewed. Each docket 
shall specify the date by which comments must be received. There shall 
also be a general docket on Regulations.gov where the public can submit 
comments requesting that the Department Assess or Review a regulation. 
This addresses the commenters' concern about commenting on a Department 
website, rather than via the regular Federal Register method. The 
Department anticipates that the process will be similar to that 
currently used by the EPA.\101\ The Department also intends to publish 
the results of the Assessments and Reviews in the dockets for the 
applicable regulations.
---------------------------------------------------------------------------

    \101\ See, e.g., Regulatory Flexibility Act Section 610 Review 
of the Testing and Labeling Regulations Pertaining to Product 
Certification of Children's Products, Including Reliance on 
Component Part Testing, 85 FR 52078 (Aug. 24, 2020).
---------------------------------------------------------------------------

    To further aid the public and the Department, the Department is 
placing at https://www.hhs.gov/regulations/federal-registry/index.html 
a list of Department rule makings; the year they were initially 
promulgated; the last year the rule making was amended; and the Federal 
Register citation from the time the rule making was amended. This list 
was generated with artificial intelligence and the Department believes 
it is accurate, but it is conceivable that some Department regulations 
are not included. This list includes all Department regulations, 
including those that may be exempt from this final rule. The Department 
believes it would be informative to the public to provide a list of all 
Department regulations, as well as their Federal Register citations and 
promulgation dates. The Department intends to update this list annually 
with newly-issued regulations.
    In addition, the Department intends to create on its website a 
dashboard that shows its progress on its Assessments and Reviews, 
including when it commenced those Assessments and Reviews; its 
progress; and when it expects them to be completed. If they so

[[Page 5703]]

choose, the public can view this dashboard to see the Department's 
progress on its Assessments and Reviews of particular regulations. The 
dashboard will also help to keep the Department on track to timely 
complete Assessments and Reviews.\102\
---------------------------------------------------------------------------

    \102\ The Department's information technology personnel are 
currently undertaking a large data migration that had been planned 
for a long time. Therefore, the dashboard will not be active as of 
the date this final rule is published. But the Department intends 
for this dashboard to be active well in advance of 2026, when the 
first Assessments and Reviews must be completed.
---------------------------------------------------------------------------

    Finally, the Department will, within nine months of publication of 
this final rule, publish in the Federal Register its schedule for 
conducting Assessments and Reviews. The Department's goal is to provide 
the public with more information on which regulations it intends to 
Assess or Review in the next 24 months, so that the public can plan 
ahead for any desired engagement on those regulations. The Department 
will subsequently publish in the Federal Register its schedule for 
conducting Assessments and Reviews of regulations that the Department 
does not intend to review in the first 24 months. However, the 
Department expects that this schedule will be aspirational in nature to 
ensure Departmental flexibility to depart from the plan if needed to 
respond to changing circumstances. The Department will update the plan 
at appropriate intervals based on its progress.

III. Statutory Authority and Legal Basis for This Final Rule

    The statutory authorities supporting this final rule are the 
statutory authorities for the Department's existing regulations.\103\ 
85 FR 70103. The Department finalizes herein its proposal to amend its 
regulations to add expiration dates unless the Department periodically 
conducts the required Assessment or Review of the regulations, or an 
exception applies. Some of the Department's primary rulemaking 
authorities include:
---------------------------------------------------------------------------

    \103\ Including certain ones inadvertently not listed in the 
proposed rule.
---------------------------------------------------------------------------

     Section 701(a) of the Federal Food Drug and Cosmetic Act 
(FD&C Act), 21 U.S.C. 371(a), which authorizes the Secretary to 
``promulgate regulations for the efficient enforcement of [the FD&C 
Act], except as otherwise provided in this section'';
     Section 1102 of the Social Security Act, 42 U.S.C. 1302, 
which provides that the Secretary ``shall make and publish such rules 
and regulations, not inconsistent with this Act, as may be necessary to 
the efficient administration of the functions with which [he] is 
charged under this Act'';
     Section 1871 of the Social Security Act, 42 U.S.C. 1395hh, 
which provides that ``the Secretary shall prescribe such regulations as 
may be necessary to carry out the administration of the insurance 
programs under this title''; and
     5 U.S.C. 301, which provides that ``[t]he head of an 
Executive department or military department may prescribe regulations 
for the government of his department, the conduct of its employees, the 
distribution and performance of its business, and the custody, use, and 
preservation of its records, papers, and property. This section does 
not authorize withholding information from the public or limiting the 
availability of records to the public.''
    It complies with the Administrative Procedure Act (APA) to amend 
regulations to add dates by which the regulations expire unless a 
review of the regulation is timely performed. An agency can, through 
notice-and-comment rulemaking, amend its regulations to provide that 
they expire at a future date.\104\ An agency can also provide that its 
regulations expire when an event occurs or ceases to occur.\105\ That 
is what this final rule does.
---------------------------------------------------------------------------

    \104\ See, e.g., Amendment to the Interim Final Regulation for 
Mental Health Parity, 70 FR 42276, 42277 (July 22, 2005) (amending 
interim final rule to provide that ``the requirements of the MHPA 
interim final regulation apply to group health plans and health 
insurance issuers offering health insurance coverage in connection 
with a group health plan during the period commencing August 22, 
2005 through December 31, 2005. Under the extended sunset date, MHPA 
requirements do not apply to benefits for services furnished after 
December 31, 2005.''); see generally Clean Air Council v. Pruitt, 
862 F.3d 1, 9 (D.C. Cir. 2017) (an agency can amend or revoke a 
legislative rule through notice-and-comment rulemaking).
    \105\ See, e.g., Control of Communicable Diseases; Foreign 
Quarantine, 85 FR 7874, 7874 (Feb. 12, 2020) (providing that, unless 
extended, interim final rule ``will cease to be in effect on the 
earlier of (1) the date that is two incubation periods after the 
last known case of 2019-nCoV, or (2) when the Secretary determines 
there is no longer a need for this interim final rule''); Medicare 
and Medicaid Programs, Clinical Laboratory Improvement Amendments 
(CLIA), and Patient Protection and Affordable Care Act; Additional 
Policy and Regulatory Revisions in Response to the COVID-19 Public 
Health Emergency, 85 FR 54820, 54820 (Sept. 2, 2020) (providing that 
an interim final rule applies ``for the duration of the [public 
health emergency] for COVID-19''); U.S. Dep't of Transp., Final 
Regulatory Impact Analysis: Amendment to Federal Motor Vehicle 
Safety Standard 208 Passenger Car Front Seat Occupant Protection, at 
XII-35 (July 11, 1984), http://www-nrd.nhtsa.dot.gov/Pubs/806572.pdf 
(explaining that ``[i]f mandatory use laws are passed that will 
cover 67 percent of the population effective September 1, 1989, the 
rule will be rescinded'').
---------------------------------------------------------------------------

    Moreover, Agencies can--and often do--issue one rule that applies 
to many other agency rules, rather than amending or rescinding each 
affected regulation individually. To take one example, in 2008 the 
Department revised the definition of ``entity'' at 42 CFR 411.351. See 
73 FR 48434, 48751 (Aug. 19, 2008). The revised definition had the 
effect of changing the meaning of ``entity'' each time it was used in 
42 CFR part 411, subpart J. It would be burdensome to specify the 
meaning of ``entity'' each time it appears in Subpart J, so the 
Department issued one definition that broadly applied to all sections 
of Subpart J.
    There are many other examples where an Agency issues a regulation 
that applies to, amends, rescinds, or supersedes many other 
regulations.\106\ This avoids an unnecessarily cumbersome process. A 
court ruling that agencies must amend each individual regulation would 
call into question large numbers of agency regulations and impose 
substantial burdens on agencies (and the Office of the Federal 
Register, which would be required to print the same text over and over) 
when promulgating future regulations.
---------------------------------------------------------------------------

    \106\ See, e.g., 21 CFR 1.1(b) (``the definitions and 
interpretations of terms contained in sections 201 and 900 of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321 and 387) shall 
be applicable also to such terms when used in regulations 
promulgated under that act''); 7 CFR 786.113 (``Notwithstanding any 
other regulation, interest will be due from the date of the 
disbursement to the producer or other recipient of the funds''); 40 
CFR 455.21
     (``Notwithstanding any other regulation, process wastewater 
flow for the purposes of this subpart does not include wastewaters 
from the production of intermediate chemicals''); 45 CFR 611.12 
(``All regulations . . . heretofore issued by any officer of the 
Foundation which impose requirements designed to prohibit any 
discrimination against individuals on the ground of race, color, or 
national origin under any program to which this part applies, and 
which authorize the suspension or termination of or refusal to grant 
or to continue Federal financial assistance to any applicant for or 
recipient of such assistance for failure to comply with such 
requirements, are hereby superseded to the extent that such 
discrimination is prohibited by this part,'' with certain 
exceptions); 7 CFR 3430.1 (``In cases where regulations of this part 
conflict with existing regulations of NIFA in Title 7 (i.e., 7 CFR 
parts 3400 through 3499) of the Code of Federal Regulations, 
regulations of this part shall supersede''); 24 CFR 943.118 (``The 
participating PHAs must adopt the same fiscal year so that the 
applicable periods for submission and review of the joint PHA Plan 
are the same. Notwithstanding any other regulation, PHAs proposing 
to form consortia may request and HUD may approve changes in PHA 
fiscal years to make this possible'') (emphasis added).
---------------------------------------------------------------------------

    Moreover, in this rule making the Department considered each 
individual Department regulation, and, as discussed further, decided to 
exempt certain regulations. The Department concluded that this final 
rule should apply to and amend its remaining regulations, because this 
final rule will enhance both (1) the fulfillment of the existing 
policies that led to those

[[Page 5704]]

regulations and (2) the Department's longstanding desire to comply with 
the RFA and periodically review its regulations. There is a need for 
widespread retrospective review, but it is nearly impossible to see how 
a satisfyingly comprehensive review could occur without a sunset 
mechanism. The Department recognizes that in many cases the Department 
had strong reasons for issuing its regulations. Examples of such 
motivations might include enhancing food safety,\107\ increasing access 
to health insurance,\108\ or increasing the incentive for Temporary 
Assistance for Needy Families recipients to work.\109\ These are all 
important policy goals that the Department wishes to achieve. This 
final rule is intended to further these goals, as well as the other 
goals motivating the Department's regulations. The literature and the 
Department's experience suggest that large numbers of regulations are 
having impacts that, over time, differ from what was estimated at the 
time the regulations were promulgated. Therefore, the Department needs 
to conduct periodic reviews of its regulations to determine whether the 
policy goals behind the regulations are in fact being effected (and if 
amending those regulations could more effectively further those goals). 
The Department concluded that the benefits of retrospective review, and 
need to more strongly incentivize it, justified this course of action. 
Forty years of experience since the RFA's enactment; the decades since 
relevant Executive Orders were enacted; and other Federal government 
efforts to spur the Department to conduct more retrospective reviews 
indicate that, absent this final rule's pushing mechanism, the 
Department will not conduct as many retrospective reviews as desired. 
In addition, the Department will consider each individual Section when 
conducting Assessments and (if needed) Reviews.
---------------------------------------------------------------------------

    \107\ E.g., 21 CFR part 112.
    \108\ E.g., 45 CFR part 147.
    \109\ 45 CFR part 261.
---------------------------------------------------------------------------

    The Department also notes the text of 5 U.S.C. 610 indicates 
Congress believed agencies had the authority to periodically review at 
least those regulations that have a significant economic impact upon a 
substantial number of small entities (and that the agency had the 
authority to assess which of its regulations have such an impact).
    The Department received comments on the statutory authority for the 
proposed rule. Below the Department summarizes these comments and 
responds to them.

IV. Provisions of Proposed Rule and Response to Public Comments \110\
---------------------------------------------------------------------------

    \110\ The Department proposed to add substantively identical 
provisions to Titles 21, 42, and 45. For concision, in this section 
the Department describes these provisions once, rather than 
repeating the same substantive provisions several times. The 
Department uses the phrase ``[XX]'' to refer to the fact that 
substantively identical provisions will be added to chapters in 
Titles 21, 42, and 45.
---------------------------------------------------------------------------

    On November 4, 2020, HHS published in the Federal Register the 
proposed rule.\111\ Part of the proposed rule had a 30-day public 
comment period, and part of it had a 60-day comment period to comply 
with 42 U.S.C. 1395hh(b). In response to the publication of that 
proposed rule, HHS received 486 comments from industry trade 
organizations, healthcare providers, businesses, legal/policy think 
tanks, non-profit public interest groups, and members of the U.S. 
Congress during the initial 30-day public comment period, and 532 
comments total throughout the 60-day comment period. Commenters 
generally opposed the proposed rule, although some commenters supported 
it. Roughly a quarter of commenters requested that the Department 
withdraw the proposed rule. Some commenters requested that the 
Department extend the public comment period.
---------------------------------------------------------------------------

    \111\ See 85 FR 70096.
---------------------------------------------------------------------------

    The Department also held a public hearing on the proposed rule on 
November 23, 2020. Twenty-one members of the public, all representing 
either unions, public-interest groups, or industry trade organizations, 
spoke. The speakers at the public hearing all either expressed concerns 
about the proposed rule, opposed it, or requested that the Department 
withdraw it. Both a transcript and recording of the public hearing are 
available at https://beta.regulations.gov/docket/HHS-OS-2020-0012/document.
    In the following sections, HHS includes a summary of the provisions 
of the proposed rule, the public comments received, HHS's responses to 
the comments, and any changes made to the regulatory text as a result.

General Purpose of the Proposal and General Comments

    5 U.S.C. 610 and Executive Orders 12866 and 13563 direct agencies 
to devise plans to periodically review certain of their regulations 
using certain criteria. By requiring the Department to periodically 
perform such reviews, this final rule implements Congress's and the 
President's desires for retrospective review of regulations. This final 
rule will lead to the amendment or rescission, where appropriate, of 
Department regulations that have a significant economic impact upon a 
substantial number of small entities. This final rule also furthers 
democratic values such as accountability, administrative 
simplification, transparency, and performance measurement and 
evaluation.
General Comments and Responses
    Comment: A few commenters stated that the retrospective review of 
regulations proposed by the rule is an important and necessary tool for 
improving agency regulation and minimizing unnecessary regulatory 
burdens. Commenters listed the many benefits of this approach, 
including the refining of regulations using real-world data and 
experience, improving government accountability, avoiding the natural 
tendency of agency officials charged with achieving public benefits to 
focus on pursuing those benefits and not on reducing the burdens of 
their regulation to the public, and preventing the continued 
enforcement of obsolete, outdated, and even unintentionally harmful 
regulations. Some commenters stated that it is axiomatic that periodic 
retrospective review is essential to the proper functioning of the 
executive branch.
    Response: The Department agrees, and believes this final rule will 
achieve these benefits.
    Comment: A few commenters stated that beyond simply cutting 
regulatory burdens, the scheduled assessments and, when necessary, 
reviews of existing HHS regulations afford HHS the opportunity to keep 
regulations up to date with modern trends. Commenters noted that not 
only will this rule establish an opportunity for the Department to 
terminate obsolete regulations that are no longer fit for purpose or 
that are judged to be ineffective, but it will also give HHS and the 
public a reliable framework and a set of tools to continually keep 
regulations up to date with evolving circumstances.
    Response: The Department agrees and emphasizes that the benefits of 
retrospective review--some of which are cited by these commenters--are 
substantial. As the proposed rule noted, Professor Cass Sunstein, who 
served as OIRA Administrator from 2009 to 2012, has observed that ``the 
requirement of retrospective analysis,'' if ``firmly 
institutionalized,'' ``would count as the most important structural 
change in regulatory policy since the original

[[Page 5705]]

requirement of prospective analysis during the Reagan Administration.'' 
\112\
---------------------------------------------------------------------------

    \112\ Cass R. Sunstein, The Regulatory Lookback, 94 B.U. L. Rev. 
579, 584 (2014).
---------------------------------------------------------------------------

    Comment: A large number of commenters stated that the proposed rule 
will cause an additional burden to the Department and a diversion of 
the Department's personnel resources. Some of these commenters 
suggested that the regulatory review process could adversely affect the 
Department's ability to focus on the administration of current 
programs, to issue new regulations, and to appropriately review current 
regulations needing modification. Commenters also raised specific 
concern about the initial review of regulations that are over ten years 
old within two years after the calendar year in which this rule is 
finalized. Those commenters expressed concern that HHS would be unable 
to Assess or Review all 12,400 regulations that the Department 
estimates will fall under this category because of the high volume of 
regulations. A number of commenters stated that two years is an 
arbitrary and inadequate timeline for all 12,400 regulations to be 
Assessed or Reviewed, and some regulations could expire simply because 
the Department did not have enough time to conduct an Assessment or 
Review. Several commenters also stated that they believe the 
Department's estimate that 12,400 of its regulations are over ten years 
old is lower than the actual number, although no commenter provided an 
independent count of HHS regulations to support this assertion. A few 
commenters pointed out that after an Assessment or Review occurs, there 
may be additional need for rulemaking or revision of regulations, which 
is an additional cost the Department does not contemplate in its 
estimate. A few commenters stated that it was unclear where HHS plans 
to obtain the funding and personnel resources needed to implement this 
regulatory review process.
    Response: The Department has considered the public comments, and 
decided that, for regulations that are more than ten years old on the 
effective date of this final rule, the Department shall have five 
years, rather two as proposed in the proposed rule, to complete the 
Assessments and (if needed) Reviews. This will spread out the initial 
burden and provide the opportunity for more robust Assessments and 
Reviews. The regulatory impact analysis in this final rule explains how 
HHS has the resources and personnel to perform the Assessments and 
Reviews called for by this final rule. Moreover, the Regulatory 
Flexibility Act already calls for the Department to assess which of its 
regulations have a significant economic impact upon a substantial 
number of small entities, and to review those regulations every ten 
years. Therefore, assuming full compliance with the RFA, this rule does 
not impose any additional burden on the Department beyond what was 
already called for in the RFA.
    To the extent there are additional burdens resulting from this 
regulation, HHS believes widespread retrospective review is a 
worthwhile enterprise. The literature and the Department's experience 
suggest that large numbers of regulations are having impacts that, over 
time, differ from what was estimated at the time of promulgation. The 
Department should conduct periodic reviews to determine whether the 
policy goals behind the regulations are in fact being effected (and if 
amending those regulations could more effectively further those goals). 
Thus, it is sensible to periodically review existing regulations, even 
if it takes some time away from issuing new regulations (many of which, 
the literature suggests, would have impacts that differ from their 
estimated impacts at the time of promulgation).
    HHS also notes that courts ``have no basis for reordering agency 
priorities. The agency is in a unique--and authoritative--position to 
view its projects as a whole, estimate the prospects for each, and 
allocate its resources in the optimal way.'' In re Barr Labs., Inc., 
930 F.2d 72, 76 (D.C. Cir. 1991). For the reasons discussed herein, the 
Department has done this, and determined that Reviews and Assessments 
should be a priority.
    Lastly, we note that the COVID-19 pandemic imposed a tremendous, 
unforeseen burden on the Department, yet there has been no material 
drop in the Department's ability to promulgate new regulations or 
enforce existing regulations. This suggests that after the pandemic, 
the Department will be resourceful enough to perform Assessments and 
Reviews, as well as promulgate new regulations that need to be 
promulgated and appropriately enforce existing regulations.
    Comment: A few commenters stated that the benefits of this final 
rule are difficult to fully anticipate, and there are a number of 
reasons to believe that the benefits of this rulemaking will vastly 
outweigh the costs. For example, if HHS were to find cost savings worth 
0.0025 percent of departmental spending or 0.0007 percent of national 
spending, the regulation would pay for itself and pass a cost-benefit 
test at the higher end of cost estimates.
    Response: The regulatory impact analysis for this final rule 
describes what the Department expects to be the primary impacts 
resulting from this final rule.
    Comment: A large number of commenters stated that, as proposed, 
this rule would divert resources from the Department's COVID-19 
pandemic response efforts. Many of these commenters stated that it is 
irresponsible for the Department to create a retrospective regulatory 
review process at a time when it should be devoting all of its 
resources to combatting COVID-19.
    Response: HHS respectfully disagrees with this comment. Due to the 
changes made from the proposed rule, under this final rule the first 
Assessments and Reviews need not be completed until the end of 2026. 
The Department believes the pandemic will be over by then.
    In fact, the COVID-19 pandemic has reinforced the need for this 
final rule. The Department's response to the pandemic has largely 
consisted of waiving regulatory requirements or exercising enforcement 
discretion to not enforce certain regulatory requirements during the 
pandemic. See, e.g., Coronavirus waivers and flexibilities, CMS.gov, 
https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers; Regulatory Relief 
to Support Economic Recovery; Request for Information (RFI), 85 FR 
75720 (Nov. 25, 2020) at Attachment A (non-exhaustive list of 
enforcement discretion announcements or changes to regulations, agency 
guidance materials, or compliance obligations made to respond to the 
COVID-19 pandemic and its impact on the healthcare industry). The 
Department should learn from the pandemic and consider whether to 
retain regulatory requirements that were waived or where flexibility 
was provided during the Nation's response to COVID-19, as well as 
consider the impact its regulations could have on the response to a 
future pandemic or other emergency.
    Comment: A large number of commenters viewed the 30-day comment 
period (which began on November 4, 2020, the day that the Federal 
Register published the proposed rule and the day after the rule went on 
public display) as too short. A large number of these commenters stated 
that the proposed rule should be withdrawn for various reasons, or in 
the alternative, requested a longer comment period if the proposed rule 
was not withdrawn. Commenters' reasons for asking for an extension 
included lack of

[[Page 5706]]

advanced notice of the proposed rule, the perceived magnitude of the 
rule, fewer resources available to commenters due to the COVID-19 
pandemic and the Thanksgiving holiday, and the number of topics on 
which the Department requested comment.
    A large number of commenters stated that the 30-day comment period 
violates the Administrative Procedure Act (``APA'') because it denies 
meaningful ``opportunity to participate in the rule making'' required 
by 5 U.S.C. 553(c).\113\ A few commenters specifically mentioned that 
while there is no established minimum comment period prescribed by the 
APA, Executive Order 12866 states that the public's opportunity to 
comment, ``in most cases should include a comment period of not less 
than 60 days,'' although shorter comment periods have been upheld in 
the face of exigent circumstances.\114\ Other commenters said the 
Department should not finalize the rule until the next Administration 
enters office.
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    \113\ See N.C. Growers' Ass'n, Inc. v. United Farm Workers, 702 
F.3d 755, 770 (4th Cir. 2012) (APA requires ``meaningful'' 
opportunity to comment); Petry v. Block, 737 F.2d 1193, 1201 (D.C. 
Cir. 1984) (relying on Administrative Conference of the United 
States' view that 30-day comment period is inadequate and 60-day 
comment period is the reasonable minimum time for comment).
    \114\ Exec. Order No. 12866 of Sept. 30, 1993, 58 FR 190 (Oct. 
4, 1993).
---------------------------------------------------------------------------

    Response: While HHS understands the commenters' desire for more 
time, the comment period was adequate. Neither the APA, nor any other 
statute requires a longer comment period for the proposed rule. 
Instead, the APA merely requires that ``[a]fter notice required by this 
section, the agency shall give interested persons an opportunity to 
participate in the rule making through submission of written data, 
views, or arguments with or without opportunity for oral 
presentation.'' 5 U.S.C. 553(c). This occurred here. The comment period 
provided ample time for the submission of 486 comments by a variety of 
interested parties, including extensive comments by a number of 
entities just by the end of the 30-day period. Those comments offer a 
broad array of perspectives on the proposed rule. The number and 
comprehensiveness of the comments received disprove commenters' claim 
that the 30-day comment period was insufficient time for commenters to 
provide meaningful comment. Accordingly, after reviewing the public 
comments and the requests for additional time, the Department does not 
believe that extending the comment period is or was necessary for the 
public to receive sufficient notice of, and opportunity to meaningfully 
comment on, the proposed rule. Nor is there anything that would have 
required additional outreach outside of the public notice and comment 
process and the comment period.
    Moreover, under this final rule, the public will have a robust 
opportunity to comment on each regulation during the Assessment or 
Review process.
    HHS respectfully disagrees that Executive Order 12866 requires a 
60-day comment period for this rule. Executive Order 12866 repeats the 
baseline requirement that ``each agency should afford the public a 
meaningful opportunity to comment on any proposed regulation,'' which 
``in most cases should include a comment period of not less than 60 
days.'' \115\ Neither Executive Order mandates a 60-day comment period. 
That is why many HHS, and other agency, regulations are issued with 
shorter comment periods. No commenter pointed to a court decision 
vacating a rule based on a failure to comply with an Executive Order's 
supposed 60-day comment period requirement. As explained above, the 
volume of comments received demonstrates that the public has been 
afforded a meaningful opportunity to comment.\116\
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    \115\ See also Exec. Order No. 13563 of Jan. 18, 2011, 76 FR 
3821 (Jan. 21, 2011) (``To the extent feasible and permitted by law, 
each agency shall afford the public a meaningful opportunity to 
comment through the internet on any proposed regulation, with a 
comment period that should generally be at least 60 days.'').
    \116\ A commenter pointed to 21 CFR 10.40(b)(2) as counseling in 
favor of a 60-day comment period. But that provision by its terms 
applies only to the FDA Commissioner. The proposed rule was issued 
by the Secretary.
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    Moreover, a portion of the proposed rule had a 60-day public 
comment period because 42 U.S.C. 1395hh(b) requires a 60-day comment 
period before issuing or amending certain Medicare regulations. The 
Department did not finalize this rule until after the 60-day comment 
period closed, and the Department has considered all comments, 
including those received throughout the 60-day comment period, before 
finalizing this rule. In all, the Department received 532 comments by 
the end of the 60-day comment period.
    Lastly, past practice has often been to finalize rules that are 
ready for finalization without waiting for the incoming Administration 
to take office.\117\
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    \117\ For example, fifty-six (56) new rules were finalized in 
the final two (2) full days of the previous Administration. See 
Federal Register, https://www.federalregister.gov/documents/search?conditions%5Bpublication_date%5D%5Bgte%5D=1%2F18%2F2017&conditions%5Bpublication_date%5D%5Blte%5D=1%2F20%2F2017&conditions%5Btype%5D%5B%5D=RULE.
---------------------------------------------------------------------------

    Comment: A few commenters viewed the 30-day comment period as 
insufficient because some of the regulations that will be amended by 
this final rule had a comment period that lasted more than 30 days when 
they were originally promulgated.
    Response: HHS respectfully disagrees with these commenters. Not 
only did the Department not finalize this rule until after the 60-day 
comment period closed, but the APA does not specify a required length 
for comment periods when issuing or amending regulations. The APA has 
already ``established the maximum procedural requirements which 
Congress was willing to have the courts impose upon agencies in 
conducting rulemaking procedures.'' Vt. Yankee Nuclear Power Corp. v. 
Natural Res. Def. Council, Inc., 435 U.S. 519, 524 (1978). Neither 
courts nor regulated entities may ``impose upon [an] agency its own 
notion of which procedures are `best' or most likely to further some 
vague, undefined public good.'' Id. at 549. The number and 
comprehensiveness of the comments received disprove commenters' claim 
that the comment period was insufficient. A portion of the proposed 
rule had a 60-day public comment period because 42 U.S.C. 1395hh(b) 
requires a 60-day comment period before issuing or amending certain 
Medicare regulations. But for many other Department regulations, 
Congress has enacted no requirement specifying a particular comment 
period.
    Comment: Several commenters stated that they found it unfair that 
the proposed rule had a 30-day comment period, but parties regulated by 
CMS have 60 days to comment on the portion of the proposed rule 
pertaining to certain CMS regulations. Commenters mentioned that they 
believed this could present a fundamental due process issue.
    Response: As stated in the proposed rule, Congress required a 60-
day public comment period before issuing or amending certain Medicare 
regulations. See 42 U.S.C. 1395hh(b); 85 FR at 70104 n.87. No similar 
statutory requirement applies to most other Department regulations.
    Comment: Several commenters stated that seven days' notice prior to 
the public hearing on the proposed rule was insufficient time to 
prepare remarks for the public hearing. The same commenters also stated 
that holding the public hearing 10 days before the close of the comment 
period on the rule was insufficient time for commenters to

[[Page 5707]]

meaningfully incorporate the testimony and learnings from the public 
hearing into their written comments.
    Response: HHS respectfully disagrees. While the specific date of 
the hearing (November 23, 2020) was published in the Federal Register 
on November 16, 2020, notice that a hearing would be held was provided 
in the proposed rule itself.\118\ Thus, commenters were on notice 19 
days (November 4, 2020, to November 23, 2020) prior to the hearing and 
had 19 days to prepare remarks for the hearing. And as these comments 
themselves show, choosing the date for the public hearing requires a 
balance between, first, giving the public sufficient time to review the 
proposed rule, and second, giving the public adequate time to review 
comments made at the hearing before submitting written comments. 
Scheduling the hearing on November 23, 2020 reflected an appropriate 
balance of these considerations.
---------------------------------------------------------------------------

    \118\ 85 FR at 70097.
---------------------------------------------------------------------------

    Comment: Several commenters were supportive of the rule and 
expressed that the provisions of the Regulatory Flexibility Act should 
be followed to increase transparency, public participation, and 
administrative accountability. These commenters appreciated the 
Department's efforts to ensure recurring attention to the impact of its 
rules on small and independent businesses, and minimize the regulatory 
burden it imposes on these entities. These commenters also stated that 
regulatory review is a laudable goal that administrative agencies 
should be aiming for.
    Several commenters emphasized the importance of periodically 
reviewing old regulations to determine whether they should be updated 
to adapt to changing circumstances. For instance, a few commenters 
stated that the COVID-19 pandemic drew attention to the fact that many 
of the Health Insurance Portability and Accountability Act (HIPAA) 
regulations are out-of-date. Some commenters also stated that the 
process for developing regulatory impact analyses could be improved if, 
after each regulation is fully implemented, public comments were 
solicited on the accuracy of the assumptions underlying the original 
impact analysis. These commenters appreciated the Department's efforts 
to consider and update its regulatory review process.
    Response: HHS agrees with these commenters that the final rule will 
implement the important goals of the Regulatory Flexibility Act, 
including transparency, public participation, administrative 
accountability, and a more streamlined regulatory structure. The 
process set out in the proposed rule that is now being finalized will 
create a structured plan to operationalize the Department's 
longstanding goals of reviewing and updating its regulations and--where 
needed--eliminating regulations that no longer serve their intended 
purpose(s) and unduly burden both small entities or the public at 
large. Requiring the solicitation of comments on the assumptions in 
regulatory impact analyses is beyond the scope of this final rule, but 
the public is welcome to submit such comments to the dockets of 
regulations being Assessed or Reviewed.
    Comment: A few commenters stated that the proposed rule does not 
provide sufficient examples of how this approach has worked in the 
past. A few commenters point out that the proposed rule cites an 
article that indicates that states have adopted and then abandoned 
similar approaches to adding automatic expirations dates. They also 
state that HHS dismisses this fact in the proposed rule without 
providing a compelling reason. Commenters stated that the examples 
where this approach has been used that the Department cites to in the 
proposed rule (U.S. states, the European Union, and the Republic of 
Korea) have no bearing or authority over federal rulemaking in the 
United States, where Congress through the APA has established 
procedures and standards for promulgating, updating, and rescinding 
regulations. They also stated that the executive actions reviewing 
regulations that are cited to in the proposed rule underscore that the 
Department does not need this rule to compel periodic regulatory 
review.
    Response: HHS respectfully disagrees. As explained in the proposed 
rule, 85 FR at 70102 & nn.66-69, to the extent that states abandoned 
automatic expiration dates, they did so for reasons that are 
inapplicable to this situation, namely, the provisions' failure to 
enhance legislative control. As explained in the regulatory impact 
analysis, at least one state that undid its sunset provision (North 
Carolina) subsequently reenacted a sunset process for regulations. The 
article that one commenter referenced \119\ did not cite any empirical 
support for the proposition that automatic expirations produce 
ineffective or inadequate retrospective reviews where sufficient 
resources and staff are provided (as is the Department's intent 
here).\120\
---------------------------------------------------------------------------

    \119\ Jason A. Schwartz, 52 Experiments with Regulatory Review: 
The Political and Economic Inputs into State Rulemakings, Inst. for 
Policy Integrity, Rep. No. 6, at 33 (Nov. 2010), https://policyintegrity.org/files/publications/52_Experiments_with_Regulatory_Review.pdf.
    \120\ See 85 FR at 70102 n.69.
---------------------------------------------------------------------------

    Second, the proposed rule referred to other jurisdictions' sunsets 
to illustrate that (1) adding sunset provisions does not wreak havoc or 
cause undue uncertainty and (2) experience shows sunset provisions can 
be effective in achieving the benefits from robust retrospective review 
of regulations. The legal framework of federal rulemaking under the APA 
may differ from other jurisdictions, but that does not detract from the 
point that other jurisdictions' experience shows that sunset provisions 
can be effective and do not lead to havoc or tremendous uncertainty. 
For the reasons explained in the proposed rule and this final rule, 
this final rule complies with the APA.
    The Department also disagrees with the commenters' suggestion that 
the existence of limited and sporadic instances of retrospective review 
demonstrate this rule is not necessary. As explained in the proposed 
rule, the Department has failed to engage in comprehensive 
retrospective review of its rules notwithstanding the RFA and long-
standing Executive Orders calling for such reviews. This history of 
limited compliance shows that the proposed rule being finalized is 
appropriate.
    Comment: Several commenters stated that the proposed rule was a 
political effort to cause difficulties for the incoming Biden 
Administration, which will be tasked with implementing this final rule.
    Response: HHS respectfully disagrees with these commenters because 
the purpose of this final rule is to require the Department to 
periodically review its regulations. The rule is not politically 
motivated, but is instead an effort to ensure the Department 
periodically reviews its regulations that have a significant economic 
impact upon a substantial number of small entities. In any event, based 
in part on comments received on the proposed rule, in this final rule 
the Department has extended the deadline to five calendar years to 
complete the Assessments and (if necessary) Reviews of regulations that 
are more than ten years old. Thus, the initial deadline will not occur 
in the next Presidential term.
    Comment: A few commenters stated that this rule is advancing the 
Trump Administration's conservative agenda at the expense of good 
regulations that regulate health and safety for patients and consumers. 
Many of these commenters also indicated that the rule would put the 
interests of Wall Street ahead of the individual Americans who

[[Page 5708]]

are affected by HHS regulations and benefit from the regulatory 
structures they create.
    Response: HHS respectfully disagrees. As emphasized in the proposed 
rule, (and this final rule) the Department intends to timely Assess and 
Review all covered regulations. Moreover, this final rule does not 
favor regulations of any particular ideological bent; it applies to all 
Department regulations, subject to the exceptions listed herein. 
Regulations that meet the RFA's criteria will not be modified or 
rescinded. The focus and anticipated result of the proposed rule is to 
eliminate or streamline unnecessary regulatory burdens on small 
entities. Retrospective review enjoys bipartisan support and benefits 
all Americans. Some regulations may bestow privileges upon narrow 
constituencies by creating barriers to entry in their industry. Such 
regulations may also disproportionately burden small businesses, 
because small businesses may be the new entrants such regulations are 
intended to keep out. If these regulations do not meet the RFA's 
criteria and are amended, small businesses and consumers may benefit 
from increased competition.
    Comment: A few commenters stated that regulations issued after this 
rule is finalized should include the date of promulgation to make it 
easy for the public to determine how old the regulation is and when it 
will be reviewed.
    Response: Rules already include their date of promulgation. To the 
extent the commenter requests that amendments to existing rules include 
the original date of promulgation, the Department may include this date 
in prospective rulemakings. Moreover, in conjunction with this final 
rule, the Department is placing at https://www.hhs.gov/regulations/federal-registry/index.html a list of Department rulemakings, the year 
they were initially promulgated, the last year the rules were amended, 
and the Federal Register citation from the time the rule was last 
amended. This list was generated with artificial intelligence and the 
Department believes it is accurate, but it is conceivable that some 
Department regulations are not included. This list includes all 
Department regulations, including those that may be exempt from this 
final rule. The Department believes it would be informative to the 
public to provide a list of all Department regulations, as well as 
their Federal Register citations and promulgation dates. The Department 
intends to update this list annually with newly-issued regulations.
    Comment: One commenter stated that instead of the Department's 
proposed schedule of regulatory review, each agency within HHS should 
include retrospective review compliance into its annual objectives and, 
perhaps, even into periodic Congressional reports.
    Response: The Department thanks the commenter for this suggestion, 
but experience suggests it would not be adequate to solve the problem. 
As noted in the proposed rule, the failure to adequately review 
existing significant regulations has already been well documented to 
Congress.\121\ It is also public knowledge.\122\ Nonetheless, such 
``public shaming,'' if that is what the commenter intends, has not 
resulted in the Department adequately conducting retrospective review.
---------------------------------------------------------------------------

    \121\ See, e.g., Curtis W. Copeland, Cong. Rsch. Serv., RL32801, 
Reexamining Rules: Section 610 of the Regulatory Flexibility Act 7-8 
(2008); U.S. Gov't Accountability Off., GAO/GGD-94-105, Regulatory 
Flexibility Act: Status of Agencies' Compliance 12 (1994) (quoting a 
1983 Small Business Administration report that stated that the 
Department's section 610 review plan was `` `very general,' and, as 
a result, `it is difficult to measure progress and to make 
recommendations with respect to future review' ''); see also 
Testimony of The Hon. Thomas M. Sullivan, Chief Counsel for 
Advocacy, U.S. SBA, U.S. House of Representatives Comm. on Small 
Bus. Subcomm. on Reg.'s, Health Care and Trade (July 30, 2008),
    \122\ See, e.g., Connor Raso, Assessing regulatory retrospective 
review under the Obama administration, Brookings Inst., (Jun. 15, 
2017), https://www.brookings.edu/research/assessing-regulatory-retrospective-review-under-the-obama-administration/.
---------------------------------------------------------------------------

    Comment: A large number of commenters stated that the proposed rule 
would be unnecessary and duplicative of the Department's existing 
efforts to review its regulations. These commenters stated that the 
Department already updates some of its rules annually, and has updated 
other non-annual rules in the past. Other commenters believe that HHS 
is already doing a fulsome review as required by the RFA. Several 
commenters stated that in 2011, the Department posted its final plan 
for retrospective review of existing regulations, and from 2012-2016 it 
provided semi-annual updates on its website listing the rules 
undergoing or scheduled for review. Some commenters suggested that 
previous executive orders that called for periodic review of existing 
regulations are a sufficient means of ensuring the Department is 
conducting these periodic reviews. Commenters suggested that the 
Department continue to conduct retrospective reviews using its already 
established process and provide regular updates to the public on its 
progress. Other commenters stated that the Department does not address 
why it failed to perform the required regulatory reviews in the past, 
nor how the process proposed in the proposed rule will make a 
difference.
    A few commenters noted that even though previous executive orders 
have prioritized regulatory reviews, most observers to date note that 
these kinds of reviews have failed to be institutionalized by agencies, 
including HHS. These commenters cited evidence suggesting that despite 
efforts to review regulations over the years and to reduce regulatory 
burdens, the total number of regulatory restrictions that have been 
issued by HHS continues to grow year after year, except for two brief 
periods around 1980 and during the mid-1990s (perhaps as part of 
deregulatory efforts).
    Response: The Department respectfully disagrees that this final 
rule is unnecessary and duplicative. While commenters are correct that 
HHS annually updates the annual Medicare payment rules, those rules and 
certain other rules that are updated annually are exempt from this 
final rule. This final rule also exempts the rules at 42 CFR part 73, 
since those are periodically reviewed. Regarding the 2011-2016 
retrospective review plan and reviews, that effort was helpful but 
sporadic, not sustained. As explained in the proposed rule, these 
efforts only resulted in review of a small fraction of rules. See 85 FR 
at 70099. The failure to institutionalize retrospective review further 
underscores the need for this final rule and the review process it is 
implementing. A few instances of the Department taking the initiative 
to review its regulations cannot reasonably be considered a sufficient 
regulatory review when thousands of regulations that have been 
promulgated over the decades have not been touched.\123\
---------------------------------------------------------------------------

    \123\ See, e.g., 85 FR at 70111 (explaining that as of 2019, 85% 
of Department regulations created before 1990 had not been edited, 
and the Department had nearly 300 broken citation references in the 
CFR).
---------------------------------------------------------------------------

    Comment: Many commenters questioned the Department's plan for 
personnel resources to conduct the Reviews prescribed by this final 
rule. These commenters believe that the Department underestimated the 
number of people who would be needed to conduct the Reviews, and stated 
that the personnel resources would be better utilized on other 
projects. For example, some commenters stated that the Department is 
already too slow in promulgating certain regulations, and should task 
its employees with carrying out the Department's existing duties.
    Response: The regulatory impact analysis for this final rule 
describes the personnel resources that the Department envisions being 
used to conduct Assessments and Reviews. The

[[Page 5709]]

sensitivity analysis therein addresses the possibility that costs could 
be lower than estimated in the proposed rule. Periodically reviewing 
regulations with a significant economic impact upon a substantial 
number of small entities is an existing Department duty. Moreover, as 
discussed elsewhere herein, retrospective review can yield tremendous 
benefits. The literature and the Department's experience suggest that 
large numbers of regulations are having impacts that, over time, differ 
from what was estimated at the time the regulations were promulgated. 
Therefore, the Department should prioritize conducting periodic reviews 
of its regulations to determine whether the policy goals behind the 
regulations are in fact being effected (and if amending those 
regulations could more effectively further those goals).
    Comment: A few commenters questioned whether the Department should 
have employees Assess or Review regulations if those employees are not 
responsible for implementing them. These commenters stated that if 
reviewers have not worked on matters connected with the regulations 
they are Reviewing, those reviewers may not have an adequate 
understanding of the regulations, which could lead to the expiration of 
regulations that are essential to the successful operation of the 
Department's programs.
    One commenter also disagreed with the premise of the Department's 
use of career civil servants to conduct regulatory reviews. This 
commenter stated that the proposed rule was logically inconsistent 
because it ``maligned'' career public servants at the Department for 
not reviewing the Department's regulations, but also proposes to task 
these same individuals with carrying out the proposed review process.
    Response: Which Department officials Assess or Review particular 
regulations will be decided on a case-by-case basis, but those 
conducting Assessments and Reviews will generally be employees who are 
familiar with those regulations, as well as technical experts, 
including economists. The Department strongly disagrees with the 
comment that the proposed rule ``maligned'' career civil servants. The 
proposed rule quoted a law professor who was suggesting several reasons 
why retrospective reviews do not occur as often as desired. The 
Department believes career civil servants can capably Assess and Review 
regulations, just as they capably conduct regulatory impact analyses 
and regulatory flexibility analyses.
    Comment: Several commenters stated that the two-year timeline for 
review of all regulations over ten years old was insufficient. A number 
of commenters suggested that the timeline be extended to five years.
    Response: The Department has considered these comments and has 
decided to revise the rule in light of them. Under this final rule, 
regulations issued more than ten years prior to the final rule's 
effective date will not expire if Assessed and (if necessary) Reviewed 
within five calendar years of the effective date of this final rule. 
Moreover, under this final rule, if the Secretary makes a written 
determination that the public interest requires continuation of the 
Section (as defined in the text of the final rule) in force beyond the 
date on which the Section otherwise would expire, the Secretary may 
continue the Section in force one time for a period stated in the 
determination, which period shall not to exceed one year.
    Comment: Several commenters stated that the proposed rule would 
cause significant regulatory uncertainty in the healthcare industry, 
which would not know which regulations may or may not expire. Some 
commenters stated that the proposed rule would cause uncertainty for 
states, which implement Federal programs and rely on Federal 
regulations and funding. Potential regulatory changes could create 
additional compliance and regulatory costs for healthcare providers 
which may be forced to adapt to a changing regulatory framework. 
Changes may also trigger regulated entities to forgo future investments 
because they lack regulatory clarity. For example, some commenters 
stated that the uncertainty created around the expiration of 
regulations, including those that guide eligibility for Medicaid, 
Medicare provider reimbursements, or certification of hospitals and 
clinics, could disrupt the efficient operation of critical safety-net 
programs, create regulatory gaps and inconsistent application of the 
law, and make accessing safety-net services for our most vulnerable 
populations even more complicated and difficult than it is today. Some 
commenters said the poor, people of color, and/or the LGBTQ community, 
would be particularly affected. Additionally, some commenters stated 
that the proposed rule would make it difficult for them to advise 
clients on how to comply with the Department's regulations. These 
commenters stated that if HHS determined that a regulation required 
modification, it should clearly publicize its intention to exercise 
enforcement discretion in not enforcing the then-current iteration of 
the regulation while the particular regulation is being modified.
    Other commenters stated that the regulatory review process set 
forth in this rule would ensure that HHS reviews regulations as 
required by the RFA, which means that if HHS were currently complying 
with the RFA in a satisfactory manner, there would be little additional 
uncertainty stemming from the proposed rule.
    Response: The Department notes that there is always a possibility 
that regulations could be amended or rescinded, even absent this rule. 
The Department does not believe uncertainty among the regulated 
community will add significantly to the costs of this rulemaking for 
the following reasons. The Department's sporadic use of periodic 
retrospective review--notwithstanding the RFA and Executive Orders--
itself leads to ``uncertainty'' about how robustly the Department 
implements directives that make for good policy.\124\ To the extent 
that the Department can maintain compliance with its obligations, this 
should build trust in the Department and reduce uncertainty (offsetting 
some or all of the uncertainty discussed by the commenters, if such 
uncertainty exists). Further, as noted above, the Department plans to 
release information about the 18,000 regulations under its authority 
and when they were adopted, such that any uncertainty surrounding the 
expiration dates of the Department's various rulemakings will be 
reduced substantially, if not entirely. Additional measures to mitigate 
private costs are discussed in the ``Operationalization of This Final 
Rule'' section of this final rule. Second, the Department notes that 
many states and foreign jurisdictions have sunset provisions that are a 
routine part of their regulatory processes. If the sunset reviews in 
these other jurisdictions do not create tremendous uncertainty, it 
stands to reason that neither will this final rule. The regulatory 
impact analysis for this final rule describes in more detail the sunset 
provisions from these other jurisdictions.
---------------------------------------------------------------------------

    \124\ To the extent this uncertainty has been lessened because 
the public has seen how the Department has implemented these 
directives over the course of many years, the same can be said for 
this final rule once it has been implemented for several years.
---------------------------------------------------------------------------

    Under this final rule, the regulated community has five years to 
adjust to the changes made by this final rule, so any reliance 
interests are significantly reduced as compared to the proposed rule. 
Where appropriate, the Department would announce the regulations for

[[Page 5710]]

which it is exercising enforcement discretion.
    Comment: A few commenters stated that the Department should allow 
reasonable reliance on a regulation while that regulation is under 
review, and for a reasonable time after a decision to amend, rescind or 
allow a regulation to expire. These commenters also stated that the 
final rule should allow the Department to extend a regulation for any 
period of time reasonably necessary for regulated entities relying the 
regulation to adjust their business practices.
    Response: HHS appreciates the commenters' concern regarding the 
reliance interests of regulated entities; however, HHS respectfully 
disagrees with the premises of these comments. First, HHS does not 
intend to allow a regulation to simply expire. And as explained in the 
proposed rule, the public will have the opportunity to provide comments 
identifying regulations that the public believes need to be Assessed 
and Reviewed, which mitigates the risk of inadvertent expiration.
    Second, with respect to Sections that, after Review, the Department 
determines should be amended or rescinded, such Sections will be 
amended or rescinded through a separate notice-and-comment rulemaking 
process. Considerations about the effective dates of such amendments or 
rescissions, including the need to allow adequate time for transition, 
will be taken into account in that separate rulemaking process. 
Finally, Review under this final rule expressly considers ``the 
continued need for the Section,'' so regulated entities' reliance 
interests will be taken into account during Reviews.
    Comment: Several commenters stated that the use of artificial 
intelligence and machine learning technology in regulatory review is a 
novel and innovative approach, and members of the public should have 
been afforded notice of the Deloitte research project and the 
opportunity to comment on the use of this technology. In particular, 
these commenters wanted to understand if and how the technology would 
be used by HHS to identify the regulations that will be reviewed. Some 
commenters asked HHS to provide additional information regarding the 
methodology used, and the underlying algorithm. A few commenters stated 
that all code should be posted on a publicly-accessible website, 
consistent with best practices among academic researchers in data 
science.
    Response: The Department agrees that the use of artificial 
intelligence machine learning technology in regulatory review is a 
novel and innovative approach. The technology discussed in the proposed 
rule was initially used to perform an internal assessment of Department 
regulations, which is why the Department did not previously notify the 
public about this research project. Artificial intelligence will not be 
used to perform Assessments and Reviews pursuant to this final rule. 
While artificial intelligence can determine if a regulation has been 
amended in the last thirty years, it cannot at this time easily 
determine if a regulation satisfies the criteria listed in 5 U.S.C. 
610. The artificial intelligence review was useful, because it 
suggested that large numbers of Department regulations would benefit 
from retrospective review. The technology identified that 85% of 
Department regulations created before 1990 have not been edited; the 
Department has nearly 300 broken citation references in the CFR; and 
there are more than 50 instances of HHS regulatory requirements to 
submit paper documents in triplicate or quadruplicate. This suggests 
humans performing a comprehensive review of Department regulations 
would find large numbers of requirements that would benefit from 
review, and possibly amendment or rescission.
    Regarding the technology used to perform the 2019 analysis, the 
analysis was performed using a tool called RegExplorer. RegExplorer is 
an ``augmented intelligence'' tool, meaning it is designed to use 
artificial intelligence in conjunction with subject matter experts. 
While RegExplorer is proprietary technology, some of the models 
deployed within RegExplorer include keyword technology (a structured 
and iterative approach to process, analyze, and return keyword search 
results); a clustering algorithm (a cluster is a machine-generated 
group of regulatory documents that have been algorithmically gathered 
together based on a set of similar characteristics, such as the 
relevant sub-agency, placement of text within the regulatory dataset, 
similarity of text content, and text format and structure); citation 
extraction and mapping; and similar section analysis.
    Comment: A few commenters asked why HHS chose to redact some of the 
``Regulatory Streamlining & Analysis'' published by Deloitte in March 
2019 that the Department cites in support of the proposed rule. These 
commenters pointed out that two of three bullet points in the 
``executive summary'' slide, and all but 25 of the document's 170 pages 
are redacted. These commenters asked why this information was not made 
available to the public, and why HHS did not have a public meeting to 
discuss the Deloitte findings and solicit feedback on its regulatory 
reform ideas back in 2019.
    Response: The Department was transparent by including the Deloitte 
analysis in the docket for this rulemaking. The redacted information is 
information protected by applicable privileges, is confidential 
information, trade secret information, or not relevant to this 
rulemaking. As can be seen from the Table of Contents for the analysis, 
the redacted information does not relate to the machine learning 
analysis that was conducted to enhance regulatory reform that was 
discussed in the proposed rule. In November 2020, the Department held a 
public hearing on the proposed rule, which referred to the Deloitte 
presentation. The public was able to opine on the analysis at that 
public hearing. The Department did not have a public meeting to discuss 
the Deloitte findings and solicit feedback in 2019, because the 
Department was at the time still undergoing its internal deliberative 
process.
    Comment: A few commenters stated that ideally the systematic 
evaluation of regulations should be a regular part of the rulemaking 
process, with the evaluation criteria and timeline embedded within each 
new rule so that the regulated community has an opportunity to opine on 
how and when each regulation will be reviewed. Commenters suggested 
that HHS identify up front what data it will use to track the progress 
of the regulation, and commit to continually collecting the same kinds 
of data over time. Such a process would make future evaluation of 
regulations and programs easier. It would also improve public 
accountability because the public would have a clearer sense of what 
the regulation is designed to achieve, and can monitor HHS's progress.
    Response: HHS agrees with the commenters' focus on the need to 
systematically evaluate the effectiveness of agency regulations--
indeed, the Department has proposed the instant rule in order to make 
such evaluations more frequent and comprehensive. The timeline for 
Review of a given Section is set forth in section [XX](c)(1), and the 
criteria for Review are set forth in [XX](d). As is current practice, 
the Department intends to explain in the preambles to future rules what 
goals the rules are intended to achieve. This will enable the public to 
know what goals each regulation is designed to achieve. However, the 
data necessary to evaluate a particular rule will differ from rule to 
rule, and the Department cannot

[[Page 5711]]

generally commit to such collection in advance and in the abstract, 
although it may be useful to do so in particular cases.
    Comment: One commenter suggested that HHS consider performing a 
cost-savings analysis for regulations receiving a Review under the 
proposed rule, or for that subset of Assessed regulations that are 
deemed significant or economically significant. Such analysis could 
include estimates of the costs, cost savings, and the net cost savings 
of the regulation.
    Response: For purposes of this final rule, the Department has 
decided to limit the Review criteria to the criteria listed in 5 U.S.C. 
610, plus whether the regulation complies with applicable law. These 
are the criteria that Congress directed the Department to use in its 
periodic reviews, plus a review for compliance with the law. 
Determining the regulation's costs, as well as cost savings from 
amendment or rescission, will often be subsumed in the five criteria 
listed in 5 U.S.C. 610.
    Comment: A large number of commenters stated that the proposed rule 
would negatively impact programs if review efforts are underfunded, or 
that the proposed rule was costly and unfunded.
    Response: The Department disagrees that regulatory review efforts 
would be underfunded. As explained in the regulatory impact analysis, 
this final rule will impose relatively low costs on the Department.
    Comment: Several commenters, including Tribal governments and 
representatives, affiliated groups of Indian Tribes, and the IHS Tribal 
Self-Governance Advisory Committee, stated that the Department should 
have consulted with Tribal governments on the rule and failed to notify 
Tribal leaders and representatives of the proposed rule in violation of 
HHS's duty as a federal agency to consult with Tribal nations under 
Exec. Order No. 13175 of Nov. 6, 2000, 65 FR 67249 (Nov. 9, 2000) (E.O. 
13175) and the Department's own Tribal consultation policy.
    Response: The Department and Indian Tribes share the goal to 
establish clear policies to further the government-to-government 
relationship between the Federal Government and Indian Tribes. True and 
effective consultation shall result in information exchange, mutual 
understanding, and informed decision-making on behalf of the Tribal 
governments involved and the Federal Government. The importance of 
consultation with Indian Tribes was affirmed through Presidential 
Memoranda in 1994, 2004 and 2009,\125\ and E.O. 13175. HHS believes 
that neither the proposed nor the final rule violate the Department's 
Tribal consultation policy or E.O. 13175. Subject to certain 
exceptions, the policy and E.O. 13175 require consultation before any 
action that will significantly affect Indian Tribes, or before 
promulgating any regulation that has Tribal implications. HHS believes 
that this final rule does not significantly affect Indian Tribes or 
have Tribal implications, as those terms are used in the policy and 
E.O. 13175. This final rule amends existing regulations to provide that 
the regulations will expire if not Assessed and (if necessary) Reviewed 
by certain dates. HHS intends that all rules will be Assessed and (if 
necessary) Reviewed timely. Therefore, this final rule would have no 
direct impact on Indian Tribes, beyond their costs of participation in 
the monitoring, Assessment, and Review processes. As explained in this 
final rule's regulatory impact analysis, the estimated total monitoring 
costs to the public over ten years is estimated to range from $52.2 
million to $156.7 million using a 7% discount rate, or $58.8 million to 
$176.3 million over ten years using a 3% discount rate (all figures 
using $2020). The U.S. Census estimates that in 2019, 1.7% of the U.S. 
population was all or partially American Indian or Alaska Native.\126\ 
1.7% of the estimated monitoring costs would be roughly $887,400 to 
$2.66 million over ten years using a 7% discount rate, or $999,600 to 
roughly $3 million over ten years using a 3% discount rate (and the 
cost to Tribes could be less since not every American Indian or Alaska 
Native is affiliated with a Tribe). Tribes will be able to comment on 
regulations during the Assessment and Review processes.
---------------------------------------------------------------------------

    \125\ Presidential Memoranda on Government-to-Government 
Relations With Native American Tribal Governments, 85 FR 22951 (May 
4, 1994), Presidential Memorandum, Government-to-Government 
Relationship with Tribal Governments, September 23, 2004, https://www.govinfo.gov/content/pkg/WCPD-2004-09-27/pdf/WCPD-2004-09-27-Pg2106.pdf, Presidential Memorandum on Tribal Consultation, 74 FR 
57879 (Nov. 9, 2009).
    \126\ ACS Demographic and Housing Estimates, U.S. Census Bureau, 
https://data.census.gov/cedsci/table?q=United%20States&g=0100000US&tid=ACSDP1Y2019.DP05&hidePreview=true.
---------------------------------------------------------------------------

    Comment: A commenter stated that the rule would allow for the 
sunset of regulations that merely implement statutory requirements, 
such as Indian preference. The commenter cited as examples 42 CFR 
136.41-43, 42 CFR 121, 42 CFR 136a.41-43, all of which, the commenter 
stated, are mandated by 25 U.S.C. 5117.
    Response: The Department respectfully disagrees. This final rule 
exempts from the Assessment and Review requirement ``Sections whose 
expiration pursuant to this section would violate any other Federal 
law.'' See Section [XX](g). In any event, the Department is not 
convinced the statutory provision cited by the commenter mandates the 
cited regulations. There is no obligation imposed on HHS in 25 U.S.C. 
5117 to prescribe any particular regulations on Indian preference. 
Rather, section 5117 provides that ``any employee entitled to Indian 
preference who is within a retention category established under 
regulations prescribed under such subsection to provide due effect to 
military preference shall be entitled to be retained in preference to 
other employees not entitled to Indian preference who are within such 
retention category.'' Neither 25 U.S.C. 5117 nor 25 U.S.C. 5116 (which 
is referenced in 25 U.S.C. 5117) are cited as statutory authorities for 
the regulations cited by the commenter.
    Comment: A few commenters stated that agencies (including HHS) have 
long ignored the retrospective review mandate of the RFA and have 
failed to perform such reviews. One reason for this, according to the 
commenters, is that the RFA does not create incentives for federal 
agencies to review their regulations. These commenters stated that this 
final rule would solve that problem by providing a clear incentive for 
agencies within HHS to review their regulations to prevent their 
automatic expiration. Commenters stated that without such a 
consequence, agencies will continue to fail to conduct retrospective 
reviews of their regulations.
    Response: The Department cannot speak for other federal agencies 
and would not state that the Department has completely ignored 
retrospective review. But the Department would agree that it has not 
performed reviews as often as Congress intended. The Department agrees 
that this final rule will address this problem by providing an 
incentive to perform retrospective reviews.
    Comment: A few commenters stated that the Department failed to 
analyze the potential costs of rescinding regulations, and only focuses 
on the costs of conducting voluntary Assessments and Reviews. A few 
commenters stated that HHS did not assess the potential forgone 
benefits of expired regulations.
    Response: This is addressed in the regulatory impact analysis for 
this final rule.

[[Page 5712]]

    Comment: A few commenters stated that the Department should 
consider doing a regulatory impact analysis when reviewing rulemakings 
that predate the Regulatory Flexibility Act and have a significant 
economic impact upon a substantial number of small entities 
(``SEISNOSE''). These commenters also noted that conducting additional 
regulatory impact analyses would impose an additional cost to the 
Department, which it should account for if it chooses to do additional 
analysis on Pre-RFA rulemakings.
    Response: As explained in the proposed rule, more resources will be 
required to review regulations that predate the RFA.\127\ The 
regulatory impact analysis for this final rule accounts for the 
additional resources required to conduct Reviews of rule makings that 
predate the RFA. But the criteria listed in 5 U.S.C. 610 are the 
criteria that Congress directed the Department to use when reviewing 
regulations that predate the RFA. Therefore, for rule makings that 
predate the RFA and have a SEISNOSE, this final rule requires that the 
Review consider the factors listed in 5 U.S.C. 610, as well as whether 
the component Sections within those rulemakings comply with applicable 
law.
---------------------------------------------------------------------------

    \127\ See 85 FR 70115 (``Of the 273 rulemakings subject to 
Reviews in the first two years, the Department estimates roughly 
16%, or 44, of those rulemakings were promulgated prior to the 
requirement for prospective regulatory flexibility analyses. As 
described further below, those 44 Reviews will require more 
Department resources than the estimated 229 Reviews of rulemakings 
promulgated after the prospective analysis requirement went into 
effect'').
---------------------------------------------------------------------------

    Comment: A few commenters asked for clarification on whether a 
regulation that is identified for amendment through the regulatory 
review process set forth in this final rule would be prioritized over 
new regulations the Department is promulgating.
    Response: In the scenario described by commenters, the Department 
would aim to amend the referenced regulation and also promulgate new 
regulations that the Department believes should be promulgated. 
Experience shows the Department is able to amend existing regulations 
and promulgate new ones at the same time.
    Comment: A few commenters asked if regulations that are sunset 
because they were not Assessed or Reviewed by the deadline would have 
to go through notice-and-comment rule making to be reissued if they 
were otherwise unchanged. These commenters also asked how these 
regulations would be prioritized by the Department.
    Response: As explained throughout the proposed rule (and this final 
rule), the Department is committed to dedicating adequate resources to 
timely Assess and Review its regulations. If a regulation did 
automatically expire, though, the Department would be required to 
undertake notice-and-comment rule making to reissue the regulation, 
unless one of the exceptions to notice-and-comment rule making in 5 
U.S.C. 553 applies.
    Furthermore, allowing for automatic reissuance of an expired 
regulation threatens to undermine the efficacy of this final rule. If 
there were no costs or obstacles to simply resurrecting an expired 
regulation in its original, pre-expiration form, then there would be no 
compelling incentive to timely Assess and Review Department 
regulations.
    It is impossible to say at this point how the Department might 
``prioritize'' re-issuance of expired regulations, without knowing 
which regulation is at issue and what other competing priorities the 
Department might have at the time. That said, the Department 
anticipates it will prioritize re-issuance of expired regulations in 
line with the public need for such regulation, balancing the same 
considerations it always does in allocating its policy-making 
resources. As noted above, the risk that important, ``priority'' 
regulations--those that meaningfully impact regulated entities--will 
expire is mitigated by the fact that interested members of the public 
can alert the Department to a needed Assessment or Review. Commenters 
have also flagged regulations to review during the public comment 
process on this rule.
    Comment: A few commenters stated that the Department should clarify 
how it will reconcile or update applicable guidance documents 
associated with rescinded regulations. If guidance documents remain in 
existence or are not updated to account for the regulatory changes 
resulting from the process established in this final rule, it could 
lead to confusion for regulated entities. A few commenters asked for 
clarification on whether the Department is considered to have Reviewed 
a regulation if the Department issues a guidance document on that 
particular regulation.
    Response: The Department may not issue any guidance document that 
establishes a legal obligation that is not reflected in a duly enacted 
statute or in a regulation lawfully promulgated under a statute. The 
Department may not use any guidance document for purposes of requiring 
a person or entity outside the Department to take any action, or 
refrain from taking any action, beyond what is required by the terms of 
an applicable statute or regulation.\128\ Therefore, any guidance 
document based on an expired regulation has no effect. If a guidance 
document addresses expired regulations as well as regulations still in 
effect, the Department would seek to expeditiously revise the guidance 
document.
---------------------------------------------------------------------------

    \128\ Department of Health and Human Services Good Guidance 
Practices, 85 FR 78785 (Dec. 7, 2020).
---------------------------------------------------------------------------

    The Department is not considered to have Reviewed a Section simply 
because the Department issues a guidance document concerning that 
particular Section. The Department is only considered to have Reviewed 
a Section if, with respect to the Section, the Department has followed 
the procedures specified in section [XX](f) of this final rule. The 
Department must publish the results of the Review, including the full 
underlying analyses and data used to support the results (subject to 
any applicable privilege, protections for confidential business 
information, or explicit legal prohibition on disclosure), in the 
Federal Register.
    Comment: A few commenters asked how other enforcement agencies, 
such as the Office of the Inspector General or the Department of 
Justice, and federal healthcare program contractors, would be affected 
by the proposed rule. Commenters stated that a lack of coordination 
between agencies and other entities with equities in an expired 
regulation could lead to different and possibly contrary conclusions 
about how to proceed. These commenters also stated that this could lead 
to conflicting requirements, resulting in different rules in different 
jurisdictions. Commenters asked the Department to clarify how corporate 
compliance programs should advise their organizations if a regulation 
expires.
    Response: This final rule applies to the HHS Office of Inspector 
General (OIG), which is a component of HHS, although certain 
regulations for which OIG has enforcement responsibility are exempt, 
such as 42 CFR 1001.952. For regulations that were issued in 
coordination with another Agency, that function in concert with another 
Agency's regulations, or that have a specific, direct impact on 
regulations issued by another Federal agency, the Department shall 
consult with that other Agency when undertaking the Assessment or 
Review, and consider the other Agency's views when considering the 
factors described in section [XX](d). In addition, when Assessing or 
Reviewing regulations that require review and approval by the Attorney 
General under Exec. Order No. 12250 of

[[Page 5713]]

Nov. 2, 1980, 45 FR 72995 (Nov. 4, 1980), the Department will consult 
with the Department of Justice (DOJ) and provide a draft of the 
findings to DOJ well in advance of the Assessment or Review deadline so 
DOJ can review and approve prior to the publication of the findings. If 
an HHS regulation is amended, rescinded, or expires, no other 
governmental body may take a different view of the regulation's legal 
effect.
    Regarding how corporate compliance programs should advise their 
organizations if a regulation expires, an HHS regulation that expires 
no longer has legal effect and cannot be enforced by any governmental 
body against a regulated entity.
    Comment: One commenter stated that HHS observes that the proposed 
rule's review requirements ``do not impose new burdens . . . if 
incomplete compliance [with the Regulatory Flexibility Act] is not 
accounted for in the regulatory baseline.'' \129\ But HHS's entire 
rationale for the proposed pule, according to the commenter, is that 
incomplete compliance with existing review requirements is and will 
continue to be a problem under the regulatory baseline (i.e., absent 
the proposed rule).
---------------------------------------------------------------------------

    \129\ 85 FR 70112.
---------------------------------------------------------------------------

    Response: HHS maintains that the proposed rule, as well as this 
final rule, does not impose new burdens if incomplete compliance with 
the RFA is not accounted for in the regulatory baseline. HHS recognizes 
that, after implementation of this final rule, the Department's 
Assessments and Reviews will likely result in an additional resource 
expenditure beyond what would occur absent promulgation of this final 
rule. This was analyzed in the Regulatory Impact Analysis of the 
proposed rule and in more detail (largely due to comments received) in 
the Regulatory Impact Analysis of this final rule. It is worth noting, 
though, that the burdens resulting from this final rule are burdens 
that Congress already intended for the Department to bear.
    Comment: A few commenters stated that the Department does not cite 
any reason why a regulatory review should be triggered by the age of a 
regulation or why ten years should be the trigger. Some commenters 
stated that a regulatory review could also be based on the subject 
matter of the regulation, its economic impact, or the number of people 
it affects. Other commenters pointed out that the Department also could 
have used a different time period other than ten years to conduct its 
reviews. Commenters point to the Department's citation to a number of 
foreign and sub-national entities that mandate the reviews of 
regulations after five or seven years. These commenters stated that 
since there are other options for the frequency of regulatory review, 
the proposal to have such rules automatically expire after ten years is 
arbitrary and capricious.
    Response: HHS respectfully disagrees. The proposed rule explained 
why the Department chose ten years:

    The Department proposes to perform the Assessment and (if 
required) the Review on each Regulation every ten years. Some states 
provide that, unless readopted or re-reviewed, their regulations 
expire in seven years,\130\ while at least one state uses a ten-year 
time period.\131\ The Department proposes to perform the Assessment 
and (if required) the Review every ten years, because ten years is 
the period listed in 5 U.S.C. 610. The Department has many 
Regulations, some of which are complex, so having to perform the 
Assessment and Review more than once every ten years could unduly 
burden the Department and increase the likelihood that a Regulation 
inadvertently expires because it is not Assessed or Reviewed.\132\
---------------------------------------------------------------------------

    \130\ See, e.g., N.J. Admin. Code Sec.  1:30-6.4 (2020) 
(regulations expire every seven years unless readopted, subject to 
certain exceptions); Ind. Code 4-22-2.5-2 (imposing seven-year 
expiration date on regulations unless readopted).
    \131\ N.C. Gen. Stat. 150B-21.3A.
    \132\ 85 FR at 70106.

    This rationale still holds. In this final rule, the Department 
decides to Review rules that have a SEISNOSE, because those are the 
rules that the RFA directed HHS to review.
    Comment: A few commenters stated that the proposed rule interferes 
with the RFA's procedure for regulatory review. 5 U.S.C. 610-611. These 
commenters note that those sections require agencies to publish plans 
for regulatory review, provide a schedule for revision that varies by 
agency, give agency heads the right to delay review for one-year 
periods, up to a maximum of five years, identify multiple factors that 
must be considered in reviewing each rule, prescribe the terms of 
public notice via the Federal Register, and specify judicial appeal 
procedures and criteria, including standing rights and remedies. These 
commenters also stated that the Department's proposed rule would scrap 
that process and replace it with a default of across-the-board 
regulatory repeal in case of inaction, without recourse, using a 
completely different system of judicial review premised on the 
underlying APA, rather than the RFA. Commenters stated that this would 
be a usurpation of Congress's role, and would raise constitutional 
questions involving balance of power between the branches. According to 
commenters, the Department must address this issue or else promulgating 
this final rule would be arbitrary and capricious.
    Response: HHS respectfully disagrees. This final rule is consistent 
with the RFA's requirement to publish a plan for periodic review--it is 
such a plan, and the RFA does not prohibit the Department from 
including expiration dates in its regulations. The Review process 
considers the five factors enumerated in the RFA. See 5 U.S.C. 610(b). 
This final rule requires publication in the Federal Register of the 
results of Assessments and Reviews under section [XX](f). This final 
rule does not supplant or purport to foreclose any available judicial 
review under 5 U.S.C. 611. And with respect to section 610 compliance, 
the RFA's judicial-review provisions expressly cross-reference the 
broader APA judicial-review provisions. See 5 U.S.C. 611(a)(1) (``For 
any rule subject to this chapter, a small entity that is adversely 
affected or aggrieved by final agency action is entitled to judicial 
review of agency compliance with the requirements of sections 601, 604, 
605(b), 608(b), and 610 in accordance with chapter 7.'') (emphasis 
added). Because this rule is consistent with the RFA, it does not usurp 
Congress's role or raise constitutional separation-of-power concerns. 
To the contrary, it implements Congressional intent for periodic review 
of regulations. Section II.F of this final rule further addresses the 
commenters' concerns in discussing how the Department will 
operationalize this final rule.
    Comment: Several commenters stated that the proposed rule violates 
the RFA's intent as expressed by Congress. In passing the RFA, Congress 
expressly made the following finding: ``the practice of treating all 
regulated businesses, organizations, and governmental jurisdictions as 
equivalent may lead to inefficient use of regulatory agency resources, 
enforcement problems and, in some cases, to actions inconsistent with 
the legislative intent of health, safety, environmental and economic 
welfare legislation.'' \133\ These commenters stated that the proposed 
rule departs from the Congressional intent in passing the RFA because 
the proposed rule would subject every regulation to mandatory review as 
well as repeal by default. In this way, the proposed rule ``treats all 
regulated businesses, organizations, and governmental jurisdictions as 
equivalent'' by terminating all

[[Page 5714]]

regulations, without considering the unique set of stakeholders 
affected by each regulation.
---------------------------------------------------------------------------

    \133\ Public Law 96-354, 94 Stat. 1164, 1164 (1980) (as amended 
1996).
---------------------------------------------------------------------------

    Response: HHS respectfully disagrees with these comments because 
these commenters fundamentally misunderstand the operation of this 
final rule, as well as the Congressional finding they quote. This final 
rule does not repeal regulations by default. As explained in this final 
rule, the Department intends to timely complete the necessary 
Assessments and Reviews and has built in safeguards to mitigate the 
risk of inadvertent expiration. Under this final rule, the Department 
must Assess which of its rule makings have a significant economic 
impact upon a substantial number of small entities, and then perform 
the more robust Reviews on those rule makings. Therefore, the 
Department is paying special attention to those regulations which have 
a significant economic impact upon a substantial number of small 
entities. As explained in the proposed rule, the Department cannot know 
which regulations currently have a SEISNOSE without Assessing its 
regulations.\134\ This process is consistent with the RFA, which 
instructs agencies to review ``the rules issued by the agency which 
have or will have a significant economic impact upon a substantial 
number of small entities.''
---------------------------------------------------------------------------

    \134\ See 85 FR 70107.
---------------------------------------------------------------------------

    Reviews consider the five factors expressly included within the 
RFA, as well as an additional factor that is indisputably beneficial 
and appropriate: ``Whether the rulemaking complies with applicable 
law.'' See Section [XX](d). Subjecting regulations with a SEISNOSE to 
Review does not ``treat all regulated businesses, organizations, and 
governmental jurisdictions as equivalent'' because the findings of the 
Review will be tailored to the regulation.\135\
---------------------------------------------------------------------------

    \135\ Under the commenters' argument, the fact that the RFA sets 
forth five factors to be considered (see 5 U.S.C. 610(b)) would also 
supposedly be inconsistent with Congressional intent.
---------------------------------------------------------------------------

    The commenters also quote the language from the Congressional 
findings and declaration of purpose out of context. Congress was 
clearly focused on agencies ignoring the distinction between ``large 
scale entities'' and small entities.\136\ Given that this rule closely 
tracks the RFA's goal of minimizing undue burden on small entities, it 
aligns with the Congressional intent behind the RFA.
---------------------------------------------------------------------------

    \136\ See Public Law 96-354, 94 Stat. 1164, 1164 (1980) (as 
amended 1996), Sec. 2(a)(2) (``laws and regulations designed for 
application to large scale entities have been applied uniformly to 
small businesses, small organizations, and small governmental 
jurisdictions even though the problems that gave rise to government 
action may not have been caused by those smaller entities''); Sec. 
2(b) (``It is the purpose of this Act to establish as a principle of 
regulatory issuance that agencies shall endeavor, consistent with 
the objectives of the rule and of applicable statutes, to fit 
regulatory and informational requirements to the scale of the 
businesses, organizations, and governmental jurisdictions subject to 
regulation.'').
---------------------------------------------------------------------------

    Comment: A commenter stated that automatic expiration of Department 
regulations could frustrate the RFA's purpose by inappropriately 
sunsetting rules that increase economic benefits for small entities. 
This commenter stated that the proposed rule does not sufficiently 
address this concern. This commenter also stated that the proposed rule 
undermines congressional intent because the proposed rule does not 
consider that the Department may be impeding its ability to conduct 
reviews under the RFA by instituting added procedural requirements and 
broadly applicable regulatory sunsets. This commenter further stated 
that expiration dates are particularly contrary to effectuating RFA 
compliance because the Department will need to prioritize assessing 
rules without any impact on small entities simply due to their imminent 
expiration, rather than using Department resources efficiently to focus 
on rules requiring the Department's review under the RFA.
    Response: The Department respectfully disagrees. The RFA calls on 
the Department to periodically review regulations that have a 
significant economic impact upon a substantial number of small 
entities. This final rule intends to increase the number of such 
reviews that occur, and directs the Department to review using the 
criteria specified in 5 U.S.C. 610(b) (plus whether the rule making 
complies with applicable law). As for Assessing regulations not 
previously determined to have a SEISNOSE, implicit in 5 U.S.C. 610 is 
the requirement to determine which regulations have a SEISNOSE.\137\ 
Without performing the Assessment, the Department may not know which 
regulations have or will have a significant economic impact upon a 
substantial number of small entities. Due to changed circumstances, a 
regulation that did not have such an impact at the time it was 
promulgated may now have such an impact.\138\ The Department does not 
intend for any regulations to inadvertently sunset, and it is unlikely 
that any regulations with significant benefits would slip through the 
cracks. The regulatory impact analysis addresses this in more detail.
---------------------------------------------------------------------------

    \137\ 85 FR 70112.
    \138\ 85 FR 70107.
---------------------------------------------------------------------------

    Comment: A few commenters stated that beyond simply cutting 
regulatory burdens, the scheduled regulatory review of existing HHS 
regulations will afford HHS the opportunity to keep regulations up to 
date with modern trends. These commenters noted that not only will this 
rule establish an opportunity for the Department to terminate obsolete 
regulations that are no longer fit for purpose or that are judged to be 
ineffective, but it will also give HHS and the public a reliable 
framework and a set of tools to continually keep regulations up to date 
with evolving circumstances.
    Response: The Department agrees with these comments and emphasizes 
that the benefits of retrospective review--some of which are cited by 
these commenters--are substantial. As the proposed rule noted, 
Professor Cass Sunstein, who served as OIRA Administrator from 2009 to 
2012, has observed that ``the requirement of retrospective analysis,'' 
if ``firmly institutionalized,'' ``would count as the most important 
structural change in regulatory policy since the original requirement 
of prospective analysis during the Reagan Administration.'' \139\
---------------------------------------------------------------------------

    \139\ Cass R. Sunstein, The Regulatory Lookback, 94 B.U. L. Rev. 
579, 584 (2014).
---------------------------------------------------------------------------

    Comment: A few commenters stated that regulatory review does not 
create as much benefit to regulated entities as the proposed rule 
suggests, because many of the costs of regulatory compliance have 
already been factored into the cost of doing business, and are 
essentially evanescent over time.
    Response: While some costs of regulatory compliance may have been 
factored into the cost of doing business, this comment overlooks many 
of the benefits of retrospective review. For example, economic, 
technological, or legal changes can make a regulation obsolete over 
time. Retrospective review is widely acknowledged to be beneficial by 
scholars across the ideological spectrum, many of whom are cited in the 
proposed and this final rule.
    Comment: A commenter asked for greater detail on the Assessment and 
Review process, especially planning of what is to be included and 
excluded in the retrospective review process. The commenter also asked 
for greater explanation of how the Department will provide notification 
of what rules have been Assessed. The commenter also asked what would 
happen if a part of a rule was reviewed but not other parts of it.

[[Page 5715]]

    Response: Section II.F of this final rule's preamble provides 
greater detail on the Assessment and Review process and the 
Department's planning for Assessments and Reviews. Examples of Section 
610 reviews conducted by the EPA are instructive on how the Department 
anticipates the five factors set forth in 5 U.S.C. 610(b) will be 
analyzed.\140\ The results of all Assessments and Reviews conducted in 
a calendar year will be published in a single document in the Federal 
Register during that calendar year. The Department also intends to 
place the results of an Assessment or Review in the docket for the rule 
on Regulations.gov. Lastly, this final rule defines ``Assess'' as a 
determination as to whether the ``Sections issued as part of the same 
rulemaking (and any amendments or additions that may have been added 
thereafter)'' currently have a significant economic impact upon a 
substantial number of small entities. This final rule defines 
``Review'' as a process the purpose of which is to determine whether 
``Sections that were issued as part of the same rulemaking (and any 
amendments or additions that may have been issued thereafter)'' should 
be continued without change, amended, or rescinded. Thus, while 
Sections are what expire if they are not timely Assessed or Reviewed, 
the Department should be Assessing or Reviewing all Sections that were 
part of the same rulemaking (and any amendments or additions that may 
have been issued thereafter), not just some of them.
---------------------------------------------------------------------------

    \140\ See Results of EPA's Section 610 Review of the Final Rule 
for Control of Emissions of Air Pollution from Nonroad Diesel 
Engines and Fuel, EPA Off. of Transp. & Quality (Sept. 2014), 
https://www.regulations.gov/document?D=EPA-HQ-OAR-2013-0642-0003; 
Regulatory Flexibility Act Section 610 Review of the National 
Pollutant Discharge Elimination System (NPDES) Permit Regulation and 
Effluent Limitation Guidelines and Standards for Concentrated Animal 
Feeding Operations (CAFOs), EPA Off. of Water (June 3, 2014), 
https://www.regulations.gov/document?D=EPA-HQ-OW-2012-0813-0216; 
Results of EPA's Section 610 Review of the Final Rule for Lead; 
Renovation, Repair, and Painting Program, EPA Off. of Pollution 
Prevention and Toxics (Apr. (April 2018), https://www.regulations.gov/document?D=EPA-HQ-OPPT-2016-0126-0019.
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    Comment: One commenter stated that it previously advocated for the 
review and modernization of some of the Department's regulations 
covering Medicare health and safety standards. For example, according 
to the commenter, the Medicare Conditions of Participation regulations 
for psychiatric hospitals do not align their requirements with modern 
psychiatric care. However, the commenter stated that no substantive 
revisions to the provisions have occurred since the requirements for 
psychiatric hospitals were first implemented, meaning that a 
comprehensive review of these regulations has not occurred for at least 
40 years, when psychiatric care was delivered much differently. This 
commenter stated that this is a clear example of why regular regulatory 
reviews are necessary.
    Response: The Department thanks the commenter for identifying these 
regulations. The Department intends to timely Assess and (if necessary) 
Review these regulations. If the Assessments and Reviews suggest these 
regulations should be amended or rescinded, the Department will 
commence rulemaking to amend or rescind them.
    Comment: A few commenters applauded the Department for continuing 
the bipartisan work on regulatory review to ensure federal agencies are 
continually held accountable to taxpayers and that regulations remain 
relevant and updated to innovation and changes in market conditions. 
The commenters also asked when the planning and drafting of the 
proposed rule began, any recent regulatory actions that would 
demonstrate the effects that regulatory reviews, suspensions, or 
updates can have on the health care industry, or the economy more 
broadly, and a list of Department regulations suspended during the 
pandemic.
    Response: The Department thanks the commenters for the first part 
of this comment. Second, for a non-exhaustive list of 382 enforcement 
discretion announcements, waivers or changes to regulations, agency 
guidance materials, or compliance obligations made to respond to the 
COVID-19 pandemic and its impact on the healthcare industry, see 
Regulatory Relief to Support Economic Recovery; Request for Information 
(RFI), 85 FR 75720 (Nov. 25, 2020) at Attachment A. The planning and 
drafting of the proposed rule is subject to the deliberative process 
privilege, but evolved out of the 2019 regulatory streamlining analysis 
discussed in the proposed rule.
Technical Legal Comments
    Comment: A large number of commenters stated that the proposed rule 
would violate the Administrative Procedure Act (APA), because it would 
allow the Department to revise or rescind thousands of regulations at 
one time instead of conducting notice and comment rulemaking on each 
existing individual rule it chooses to repeal. Some of these commenters 
also mentioned that the APA requires agencies to use substantially the 
same process to repeal a rule as they used to promulgate a rule, so a 
process that allows for automatic expiration of a rule would not meet 
this statutory requirement. A commenter stated that ``Revocation 
constitutes a reversal of the agency's former views as to the proper 
course'' and ``[w]hile the agency is entitled to change its view on [a 
matter], it is obligated to explain its reasons for doing so. . . . 
[A]n agency changing its course by rescinding a rule is obligated to 
supply a reasoned analysis for the change'' and ``[g]enerally, one 
aspect of that explanation would be a justification for rescinding the 
regulation . . .'' (quoting Motor Vehicles Mfrs. Ass'n of U.S., Inc. v. 
State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 41, 42, 52, 56 (1983)). 
Commenters stated that this rule would be arbitrary and capricious on 
these grounds. One commenter stated that if the Department does not 
perform an affirmative action to prevent expiration of a regulation, 
the Department would fail to articulate a satisfactory explanation for 
its expiration, making the agency action arbitrary and capricious.
    Response: This final rule complies with the APA. The APA generally 
requires, with certain exceptions, notice and comment prior to 
finalizing a ``rule making,'' 5 U.S.C. 553, which is defined as 
``formulating, amending, or repealing a rule.'' 551(5). See Motor 
Vehicles Mfrs. Ass'n of U.S. v. State Farm Mut. Auto. Ins. Co., 463 
U.S. 29, 41 (1983) (``We believe that the recession or modification of 
an [agency rule] is subject to the same test.''). The APA has already 
``established the maximum procedural requirements which Congress was 
willing to have the courts impose upon agencies in conducting 
rulemaking procedures.'' Vt. Yankee Nuclear Power Corp. v. Nat. Res. 
Def. Council, Inc., 435 U.S. 519, 524 (1978). Neither courts nor 
regulated entities may ``impose upon [an] agency its own notion of 
which procedures are `best' or most likely to further some vague, 
undefined public good.'' Id. at 549.
    The Department agrees with commenters who stated the APA generally 
requires agencies to use substantially the same process to amend or 
repeal a rule as they used to promulgate a rule. The Department is 
complying with this requirement. See Clean Air Council v. Pruitt, 862 
F.3d 1, 9 (2017) (an agency can amend or revoke a legislative rule 
through notice-and-comment rulemaking). In this rule making, the 
Department has gone through notice-and-comment rule making to amend its 
regulations by establishing conditions under which the regulations will 
either be Assessed and/

[[Page 5716]]

or Reviewed or expire. This is permissible. The Department is going 
through notice-and-comment rule making to amend its regulations to 
apply expiration dates unless certain conditions are satisfied. 
Agencies already promulgate regulations that expire upon the 
satisfaction of a future event or non-event.\141\ Nothing in the APA 
forecloses agencies from including conditional expirations dates in 
regulations. It would call into question many rules--and be extremely 
disruptive--if courts held that conditional expiration dates violate 
the APA.
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    \141\ See, e.g., Control of Communicable Diseases; Foreign 
Quarantine 85 FR 7874, 7874 (Feb. 12, 2020) (providing that, unless 
extended, interim final rule ``will cease to be in effect on the 
earlier of (1) the date that is two incubation periods after the 
last known case of 2019-nCoV, or (2) when the Secretary determines 
there is no longer a need for this interim final rule''); Medicare 
and Medicaid Programs, Clinical Laboratory Improvement Amendments 
(CLIA), and Patient Protection and Affordable Care Act; Additional 
Policy and Regulatory Revisions in Response to the COVID-19 Public 
Health Emergency, 85 FR 54820, 54820 (Sept. 2, 2020) (providing that 
an interim final rule applies ``for the duration of the [public 
health emergency] for COVID-19''); U.S. Dep't of Transp., Final 
Regulatory Impact Analysis: Amendment to Federal Motor Vehicle 
Safety Standard 208 Passenger Car Front Seat Occupant Protection, at 
XII-35 (July 11, 1984), http://www-nrd.nhtsa.dot.gov/Pubs/806572.pdf 
(explaining that ``[i]f mandatory use laws are passed that will 
cover 67 percent of the population effective September 1, 1989, the 
rule will be rescinded'').
---------------------------------------------------------------------------

    The Department also rejects the argument that it cannot revise many 
regulations in one rule making, but instead must conduct notice-and-
comment rule making on each individual regulation it seeks to amend or 
rescind. The APA does not include such a requirement. When 5 U.S.C. 
551(5) defines ``rule making'' as an ``agency process for formulating, 
amending, or repealing a rule'' (emphasis added), that includes 
formulating, amending, or repealing ``rules.'' See 1 U.S.C. 1 (``In 
determining the meaning of any Act of Congress, unless the context 
indicates otherwise--words importing the singular include and apply to 
several persons, parties, or things''). Agencies can--and often do--
issue one rule that applies to many other agency rules, rather than 
amending or rescinding each affected regulation individually. To take 
one example, in 2008 the Department revised the definition of 
``entity'' at 42 CFR 411.351. See 73 FR 48434, 48751 (Aug. 19, 2008). 
The revised definition had the effect of changing the meaning of 
``entity'' each time it was used in 42 CFR part 411, subpart J. It 
would be burdensome to specify the meaning of ``entity'' each time it 
appears in subpart J, so the Department issued one definition that 
broadly applied to all sections of subpart J. There are many other 
examples where an Agency issues a regulation that applies to, amends, 
rescinds, or supersedes many other regulations.\142\ This avoids an 
unnecessarily cumbersome process. A court ruling that Agencies must 
amend each individual regulation would call into question large numbers 
of Agency regulations and impose substantial burdens on agencies (and 
the Office of the Federal Register, which would be required to print 
the same text over and over) when promulgating future regulations. In 
addition, the Department will consider each individual regulation when 
conducting Assessments and (if needed) Reviews.
---------------------------------------------------------------------------

    \142\ See, e.g., 21 CFR 1.1(b) (``the definitions and 
interpretations of terms contained in sections 201 and 900 of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321 and 387) shall 
be applicable also to such terms when used in regulations 
promulgated under that act'').''); 7 CFR 786.113 (``Notwithstanding 
any other regulation, interest will be due from the date of the 
disbursement to the producer or other recipient of the funds''); 40 
CFR 455.21 (``Notwithstanding any other regulation, process 
wastewater flow for the purposes of this subpart does not include 
wastewaters from the production of intermediate chemicals''); 7 CFR 
3430.1 (``In cases where regulations of this part conflict with 
existing regulations of NIFA in Title 7 (i.e., 7 CFR parts 3400 
through 3499) of the Code of Federal Regulations, regulations of 
this part shall supersede''); 45 CFR 611.12 (``All regulations . . . 
heretofore issued by any officer of the Foundation which impose 
requirements designed to prohibit any discrimination against 
individuals on the ground of race, color, or national origin under 
any program to which this part applies, and which authorize the 
suspension or termination of or refusal to grant or to continue 
Federal financial assistance to any applicant for or recipient of 
such assistance for failure to comply with such requirements, are 
hereby superseded to the extent that such discrimination is 
prohibited by this part,'' with certain exceptions).
    .
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    Moreover, in this rule making the Department considered each 
individual Department regulation, and, as discussed further, decided to 
exempt certain regulations from this final rule. The Department 
concluded that the benefits of retrospective review, and need to more 
strongly incentivize it, justified applying this final rule to the 
Department's remaining regulations. In this rule making, the Department 
is considering the important factors. It issues this final rule 
because, for the reasons described herein, the Department believes the 
benefits of retrospective review, and the need to strongly incentivize 
it, are so great that the risk of a regulation inadvertently expiring 
is justified by the benefit of institutionalizing retrospective review 
in this manner. Forty years of experience since the RFA's enactment; 
the decades since relevant Executive Orders were enacted; and other 
Federal government efforts to spur the Department to conduct more 
retrospective reviews indicate that, absent such a pushing mechanism, 
the Department will not conduct as many retrospective reviews as 
desired. Indeed, this final rule, rather than being a revocation of 
prior regulations, will enhance the fulfillment of the existing 
policies that led to the Department's regulations subject to this final 
rule.
    Comment: Many commenters stated that the proposed rule could create 
legal uncertainty regarding the validity and enforceability of 
regulations that the Department, after conducting a Review, determines 
should be amended or rescinded. Commenters stated this could have 
negative effects on the HHS programs, the healthcare industry, and 
states which administer Medicaid and CHIP. Some of these commenters 
stated that HHS admits that enforcing a Regulation deemed to require 
amendment or rescission in some cases could raise concerns about 
whether such enforcement is arbitrary and capricious. Continuing to 
enforce the regulation (or portions thereof) could arguably run counter 
to the evidence before the agency. However, these commenters stated 
that, HHS provides no insight or explanation on how it would address 
this conundrum.
    Response: The Department respectfully disagrees. The commenters' 
concerns only apply where the Department has announced, after Review, 
that a regulation should be amended or rescinded. Where that is the 
case, the announced results will suggest what portions of the 
regulation may need revision and the Department anticipates that 
commenters will generally be able to participate in subsequent rule 
making regarding amending or rescinding the regulation. The basis for 
amendment or rescission will suggest the extent to which continued 
enforcement in the interim is appropriate. That is why the proposed 
rule states the Department would exercise enforcement discretion ``on a 
case-by-case basis as appropriate.'' \143\ Consistent with Department 
practice, the Department would announce if it is exercising enforcement 
discretion to not enforce a regulation.
---------------------------------------------------------------------------

    \143\ 85 FR 70108.
---------------------------------------------------------------------------

    Comment: Several commenters stated that if Congress's intent was to 
effectuate results similar to those in the proposed rule, it could have 
included sunset provisions in its statutes. By not including sunsets in 
its statutes, Congress must not have perceived a need for 
Congressionally-directed

[[Page 5717]]

rulemaking to expire in the foreseeable future, or at least not 
automatically.
    Response: HHS disagrees that Congress's choice to not include 
automatic sunset provisions in its statutes undercuts or forecloses the 
proposed rule. The RFA requires the Department to develop ``a plan for 
the periodic review of the rules issued by the agency which have or 
will have a'' SEISNOSE, but leaves the details of said plan to the 
Department. 5 U.S.C. 610(a). The RFA demonstrates Congress's intent 
that agencies conduct retrospective review, and the Department has 
determined, for the reasons explained in the proposed rule, that sunset 
provisions are a practical and effective way to ensure that 
Congressional intent is honored. The commenters' position suggests it 
is improper to take steps to effectuate Congressional intent if 
Congress itself has not expressly legislated such steps--but, of 
course, agencies frequently fill in the details of a statutory regime 
implemented by Congress.
    Comment: One commenter stated that the proposed rule is misleading, 
which thwarts public comment and violates the APA. This commenter 
stated that it was misleading and irrational for HHS to suggest that it 
is hypothetical whether any regulation would sunset under the rule, 
because every regulation would sunset unless a timely Assessment or 
Review occurs. This commenter suggested that the rule's description is 
inadequate to meet the notice standard required by the APA. This 
commenter reasoned that the Department's explanation of the proposed 
rule and its reasoning did not provide the public with a meaningful 
opportunity to participate in rulemaking through the submission of 
comments, which violates the notice and comment requirement of the APA. 
5 U.S.C. 553.
    Response: HHS respectfully disagrees. ``The APA requires that the 
notice of proposed rulemaking contain `reference to the legal authority 
under which the rule is proposed' and `either the terms or substance of 
the proposed rule or a description of the subjects and issues 
involved.' '' Little Sisters of the Poor Saints Peter and Paul Home v. 
Pa., 140 S. Ct. 2367, 2384 (2020) (quoting 5 U.S.C. 553(b)(2)-(3)). The 
notice of proposed rulemaking, which spanned 29 pages of the Federal 
Register, did just that. The adequacy of the notice is demonstrated by 
the fact that the agency received 532 comments--both critical and in 
support of the proposed rule--that raised general issues as well as 
commented on specific provisions of the proposed rule. The volume of 
comments also demonstrates that the public had ample, meaningful 
opportunity to participate in this rulemaking. There is nothing 
misleading in the Department's statement that it intends to timely 
Assess and (where required) Review its Sections. The proposed rule and 
this final rule adequately explain the basis for this final rule.
    Comment: One commenter stated that the proposed rule is arbitrary 
and capricious because the stated rationale of incentivizing 
retrospective regulatory review is implausible. This commenter stated 
that it is wrong to think that the Department is incentivized to Assess 
or Review its regulations, because the Department may want its 
regulations to expire. The commenter said that the penalty for failure 
to review regulations actually falls on the regulated industry, not the 
Department. The commenter stated that HHS unlawfully ignored the 
predictable effects of the proposed rule on third parties.
    Response: HHS respectfully disagrees. The proposed rule amply 
explained the benefits of retrospective review. It also explained why 
sunset deadlines were necessary to incentivize retrospective review 
(including, for example, the Department's experience with under-
utilization of retrospective review). This rationale is not implausible 
because of the speculative possibility that the Department will 
intentionally forego Assessments and Reviews. If the Department wanted 
its regulations to expire, it would have conducted rulemakings to 
rescind its regulations. The proposed rule and this final rule 
demonstrate the Department's commitment to timely Assess and (where 
necessary) Review its regulations. For example, the proposed rule and 
final rule include (among other things) a clear-eyed analysis of the 
resources and staff time required to conduct Assessments and Reviews, 
and provide a mechanism for the public to request the Department to 
conduct Assessments and Reviews on certain regulations.
    Comment: A few commenters stated that the proposed regulatory 
review process is arbitrary and capricious, because it elevates the 
need to undertake RFA reviews above any other purpose served by the 
Department's regulations, which commenters state is disproportionate to 
the problem at hand. These commenters state that since HHS estimates 
that only 11% of its regulations have a SEISNOSE and would be subject 
to the RFA, it is arbitrary and capricious to subject the other 89% of 
regulations to possible rescission.
    Response: HHS respectfully disagrees. As explained in the proposed 
rule and this final rule's preamble, there is a need for widespread 
retrospective regulatory review. It is nearly impossible to see how a 
satisfyingly comprehensive review could occur without a sunset 
mechanism. The Department recognizes that in many cases the Department 
had strong reasons for issuing its regulations. Those regulations were 
motivated by important policy goals that the Department wishes to 
achieve. This final rule will further these goals. The literature and 
the Department's experience suggest that large numbers of regulations 
are having impacts that, over time, differ from what was estimated at 
the time the regulations were promulgated. Therefore, the Department 
needs to conduct periodic reviews of its regulations to determine 
whether the policy goals behind the regulations are in fact being 
effected (and if amending those regulations could more effectively 
further those goals). Therefore, this final rule is in fact an effort 
to enhance both (1) the fulfillment of the existing policies that led 
to the Department's regulations and (2) the Department's longstanding 
desire to comply with the RFA and periodically review its regulations.
    As for conducting Assessments on many regulations, and not just 
Reviewing those regulations previously determined to have a SEISNOSE, 
the proposed rule explained that ``[w]ithout performing the Assessment, 
the Department may not know which regulations have or will have a 
significant economic impact upon a substantial number of small 
entities. Due to changed circumstances, a regulation that did not have 
such an impact at the time it was promulgated may now have such an 
impact.'' \144\
---------------------------------------------------------------------------

    \144\ 85 FR 70107.
---------------------------------------------------------------------------

    Comment: One commenter stated that the Department may not finalize 
the proposed rule without conducting a review under the National 
Environmental Policy Act (NEPA) or considering how the proposed rule is 
consistent with Executive Orders 13045 or 12898.
    This commenter stated that HHS violated its obligations under NEPA 
because commenters believe the rule is a major federal action. 
According to the commenter, the proposed rule stated that it ``will not 
have a significant impact on the environment'' without providing 
additional explanation.\145\ The commenter stated that the FDA's own 
NEPA regulations require it to conduct at least an environmental 
assessment before promulgating certain

[[Page 5718]]

regulations, and FDA cannot rescind those regulations without 
conducting NEPA review. See 21 CFR 25.20.
---------------------------------------------------------------------------

    \145\ 85 FR 70118.
---------------------------------------------------------------------------

    This commenter also stated that the proposed rule does not 
adequately consider Executive Orders 13045 or 12898. Executive Order 
13045 imposes requirements on agencies to protect children from 
environmental health risks and safety risks.\146\ The commenter stated 
that because the Department did not mention Executive Order 13045 in 
its proposed rule, it must have failed to consider it. Executive Order 
12898 directs federal agencies to make environmental justice part of 
their mission, and to identify and address the disproportionate 
environmental and health effects of their activities.\147\ This 
commenter expressed that HHS did not consider whether the proposed 
sunset rule will cause ``disproportionately high and adverse human 
health or environmental effects . . . on minority populations and low-
income populations'' \148\ even though the commenter believes there is 
every reason to think that the sunset rule will cause such adverse 
effects.
---------------------------------------------------------------------------

    \146\ Exec. Order No. 13045 of Apr. 21, 1997, 62 FR 19885 (Apr. 
23, 1997) (E.O. 13045).
    \147\ Exec. Order No. 12898 of Feb. 11, 1994, 59 FR 7629 (Feb. 
16, 1994) (E.O. 12898).
    \148\ Id.
---------------------------------------------------------------------------

    Response: HHS respectfully disagrees that further analysis under 
NEPA, E.O. 12898 (``Federal Actions To Address Environmental Justice in 
Minority Populations and Low-Income Populations''), and/or E.O. 13045 
(``Protection of Children From Environmental Health Risks and Safety 
Risks''), is required. The commenter's position is based on a 
fundamental misunderstanding of how the final rule functions. As 
explained in the notice of proposed rulemaking, this rule does not in 
and of itself rescind any regulations; it provides that certain 
regulations will expire if not Assessed and (if required) Reviewed by 
certain dates.
    Thus, there is no basis to say that this final rule itself 
``significantly affect[s] the quality of the human environment,'' 42 
U.S.C. 4332(C); may cause ``disproportionately high and adverse human 
health or environmental effects . . . on minority populations and low-
income populations,'' E.O. 12898, Sec. 1-101; or ``concern[s] an 
environmental health risk or safety risk that an agency has reason to 
believe may disproportionately affect children,'' E.O. 13045 Sec. 2-
202(b).\149\
---------------------------------------------------------------------------

    \149\ See also 85 FR 70118 (``HHS has determined that the 
proposed rule will not have a significant impact on the 
environment.'').
---------------------------------------------------------------------------

    The commenter says an environmental assessment may be necessary, 
including consideration of alternatives as required by section 
102(2)(E) of NEPA, 40 CFR 1501.5(c)(2), if it is unclear whether the 
rule will significantly affect the environment. But it is clear that 
this rule alone does not have a significant environmental impact. Any 
rescissions or amendments pursuant to Assessments and Reviews will be 
effected through notice-and-comment rulemaking independent of this rule 
and include any required environmental (and other) analyses. In any 
event, the Department adequately explained the alternatives it 
considered in its proposed rule,\150\ as well as in the regulatory 
impact analysis for this final rule.
---------------------------------------------------------------------------

    \150\ See 85 FR 70116-17.
---------------------------------------------------------------------------

    Comment: A few commenters stated that HHS mistakenly exempts the 
proposed rule from the regulatory review process it creates. The 
proposed rule states that it ``cannot, absent other actions, directly 
impose on the public costs that exceed benefits . . . [o]nly the 
failure to perform an Assessment or Review in the future could 
theoretically impose on the public costs that exceed benefits.'' \151\ 
These commenters stated that it was a mistake for HHS to assume that 
the proposed rule will not ``directly impose on the public costs that 
exceed benefits'' because costs would be imposed on the public unless 
Assessment or Review of Regulations take place. These commenters took 
the position that the Department's regulations would expire by default, 
and that expiration would impose a cost that would exceed benefits.
---------------------------------------------------------------------------

    \151\ 85 FR 70109.
---------------------------------------------------------------------------

    Response: HHS respectfully disagrees. This final rule would not 
become obsolete due to economic, technological, or legal changes the 
way that many other rules can. For the reasons discussed herein, the 
Department believes the process set forth in this final rule will 
enable the Department to Assess and (where required) Review its 
regulations. It is a mistake, and bereft of evidence, to assume that 
the Department's regulations would expire by default.
    Comment: Several commenters stated that the Department did not 
adequately explain its reasoning for the proposed rule. Some of these 
commenters stated that HHS did not acknowledge the facts and 
circumstances that motivated the initial promulgation of its 
regulations, nor did HHS discuss in the proposed rule the serious 
reliance interests that have been created by some of these regulations. 
Commenters asserted that the Department claims that it ``is considering 
the important factors''--without articulating what those factors are--
and asserts that it ``believes the benefits of retrospective review, 
and the need to strongly incentivize it, are so great that the risk of 
a Regulation inadvertently expiring is outweighed by the benefit of 
institutionalizing retrospective review in this manner.'' \152\ A few 
commenters asked HHS to identify the regulations that are vulnerable to 
rescission under the rule, and to describe the nature and magnitude of 
the harm that might result from their expiration.
---------------------------------------------------------------------------

    \152\ 85 FR 70106.
---------------------------------------------------------------------------

    Response: The Department believes the proposed rule adequately 
explained the facts and circumstances that motivated issuing the 
proposed rule, and adequately showed that the Department considered the 
relevant factors. The same is true for the preamble to this final rule, 
which provides additional explanation for why the Department is issuing 
this final rule and the factors it considered. The Department 
recognizes that in many cases the Department had strong reasons for 
issuing its regulations. Examples of such motivations might include 
enhancing food safety,\153\ increasing access to health insurance,\154\ 
or increasing the incentive for Temporary Assistance for Needy Families 
recipients to work.\155\ These are all important policy goals that the 
Department wishes to achieve. This final rule is intended to further 
these goals, as well as the other goals motivating the Department's 
regulations. The literature and the Department's experience suggest 
that large numbers of regulations are having impacts that, over time, 
differ from what was estimated at the time the regulations were 
promulgated. Therefore, the Department needs to conduct periodic 
reviews of its regulations to determine whether the policy goals behind 
the regulations are in fact being effected (and if amending those 
regulations could more effectively further those goals). Outside of the 
exempted regulations, no particular regulations are more ``vulnerable 
to rescission'' than others under this final rule. This final rule is 
agnostic as to all Department regulations. They must all be Assessed 
and, if they have a SEISNOSE, Reviewed using the criteria specified in 
section [XX](d).
---------------------------------------------------------------------------

    \153\ E.g., 21 CFR part 112.
    \154\ E.g., 45 CFR part 147.
    \155\ 45 CFR part 261.

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[[Page 5719]]

Comments on the Statutory Authority for This Final Rule
    Comment: Several commenters stated that the Department does not 
have the authority to propose automatic expiration of its regulations. 
Some commenters stated that HHS fails to explain how Congress's grants 
of authority to the Department to ``promulgate,'' 21 U.S.C. 371(a), to 
``make and publish,'' 42 U.S.C. 1302(a), or to ``prescribe,'' 42 U.S.C. 
1395hh(a), regulations also give it the authority to rescind those 
regulations, with that rescission subject to future reversal at the 
Department's discretion. Other commenters stated that the proposed rule 
not only falls outside these grants of rulemaking authority, but 
squarely contradicts Congress's instructions that HHS ``shall'' 
promulgate certain regulations. E.g., 21 U.S.C. 371, 42 U.S.C. 
1395hh(a). Some commenters cited to section 1102 of the Social Security 
Act, which directs the Secretary of HHS to issue regulations ``not 
inconsistent with this Act'' to implement the Medicaid and CHIP 
programs but does not provide specific statutory authority for the 
Secretary to write automatic expiration dates into regulations.
    Response: The Department respectfully disagrees. As explained in 
the proposed rule, the statutory authorities supporting this rule 
making are the statutory authorities for the Department's existing 
regulations.\156\ Moreover, the Department believes that the relevant 
portions of the proposed rule, as finalized herein, are fully 
consistent with 42 U.S.C. 1302(a). Indeed, it specifically cited this 
provision as one source of statutory authority for promulgating the 
proposed rule (85 FR at 70103), and does so in this final rule. The 
commenters' position is incorrect for multiple reasons. First, the 
commenters' assertion seems to suggest that any action by the 
Department to repeal or amend Medicaid or CHIP regulations, by the mere 
act of amendment or rescission, is ``inconsistent'' with those 
programs. That position is untenable.\157\ In fact, this final rule is 
the promulgation of a regulation that will contribute to ``the 
efficient administration of '' the Department's functions under the 
Social Security Act, because the Reviews called for by this final rule 
will take into account both the continued need for particular 
regulations, as well as whether the burden of those regulations on 
small entities can be minimized (among several other factors that will 
enhance efficiency, such as the complexity of the Regulation or whether 
it is duplicative). For the same reasons, this final rule is the 
promulgation of a regulation for ``the efficient enforcement'' of the 
Federal Food Drug, and Cosmetic Act and necessary to carry out the 
administration of the Medicare program. See 21 U.S.C. 371(a); 42 U.S.C. 
1395hh(a)(1). This final rule will enhance the fulfillment of the 
policies that motivated the regulations issued pursuant to 42 U.S.C. 
1302, 42 U.S.C. 1395hh, and 21 U.S.C. 371.
---------------------------------------------------------------------------

    \156\ 85 FR 70103.
    \157\ See, e.g., Medicare and Medicaid Programs; Regulatory 
Provisions To Promote Program Efficiency, Transparency, and Burden 
Reduction; Part II, 79 FR 27106, 27153 (May 12, 2014) (citing 42 
U.S.C. 1302 as statutory authority for the removal of certain 
regulatory text); Medicare Program; Amendment to Payment Policies 
Under the Physician Fee Schedule and Other Revisions to Part B for 
CY 2011 76 FR 1366, 1367 (Jan. 10, 2011) (relying on 42 U.S.C. 1302 
and 42 U.S.C. 1395hh, among other statutory provisions, to amend or 
remove regulatory text); Color Additives; D&C Green No. 6; Uniform 
Specifications, 51 FR 37908, 37909 (Oct. 27, 1986) (citing 21 U.S.C. 
371 as statutory authority for amending and removing regulatory 
text).
---------------------------------------------------------------------------

    Comment: Several commenters stated that the proposed rule exceeds 
the statutory authority of the RFA, because the RFA only affects 
regulations that ``have a significant economic impact upon a 
substantial number of small entities.'' 5 U.S.C. 602, 604, 605. 
However, according to the commenters, the proposed rule does not limit 
its reach to those regulations covered by the RFA because it adds 
expiration dates to all HHS regulations, not just those that ``have a 
significant economic impact upon a substantial number of small 
entities.'' \158\ These commenters added that the RFA also does not 
mandate the automatic expiration of regulations that have not undergone 
agency review.
---------------------------------------------------------------------------

    \158\ See 85 FR 70123; id. at 70104-05 (defining ``Regulations'' 
as ``a section of the Code of Federal Regulations'').
---------------------------------------------------------------------------

    Response: The primary statutory authorities for this final rule are 
the statutory authorities for the Department's existing regulations. 
The Department also notes, though, that the text of 5 U.S.C. 610 
indicates Congress believed agencies have the authority to periodically 
review at least those regulations that have a significant economic 
impact upon a substantial number of small entities (and that agencies 
have the authority to assess which of their regulations have such an 
impact). See 5 U.S.C. 610(a)-(b). The commenters are correct that the 
RFA does not mandate the automatic expiration of rules; however, the 
RFA also does not foreclose this final rule's approach. As explained 
throughout the proposed rule and in this final rule, decades of 
experience, empirical evidence, and scholarly commentary all support 
the Department's view that this final rule will enhance compliance with 
the RFA's directive to periodically review regulations with a SEISNOSE.
    Comment: A few commenters stated that the proposed rule does not 
cite the RFA (5 U.S.C. 610) as a source of its statutory authority. 
These commenters stated that they believe the Department omitted the 
RFA it its list of statutory authority because the rule is contrary to 
the statute.
    Response: The proposed rule cited 5 U.S.C. 610 as one of the 
statutory bases for the proposed rule.\159\ The statutory bases for 
this rulemaking also include the existing statutory authorities for the 
Department's regulations. This final rule is consistent with the RFA, 
because it sets forth a plan for the periodic review of the regulations 
issued by the Department which have or will have a significant economic 
impact upon a substantial number of small entities. See 5 U.S.C. 
610(a). Moreover, this final rule requires such review to consider the 
factors set forth in 5 U.S.C. 610(b). The text of 5 U.S.C. 610 
indicates Congress believed agencies have the authority to periodically 
review at least those regulations that have a significant economic 
impact upon a substantial number of small entities (and that agencies 
have the authority to assess which of their regulations have such an 
impact). See 5 U.S.C. 610(a)-(b).
---------------------------------------------------------------------------

    \159\ See 85 FR 70119, 70120, 70121, 70123.
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Specific Provisions of the Proposed Rule and Final Rule
Section [XX](a)
    In the proposed rule, HHS proposed to add Section [XX](a), which 
provided that the proposed rule would apply to and amend all 
Regulations issued by the Secretary or his delegates or sub-delegates 
in this title. HHS received no comments specific to Section [XX](a). 
However, in this final rule HHS replaces ``this title'' with ``this 
chapter,'' and amends the relevant chapters of Titles 21, 42, and 45, 
rather than amending all regulations that were issued by the Secretary 
(or his delegates or sub-delegates) in the titles. HHS makes this 
change to increase clarity and precision. For example, certain chapters 
in Title 21 contain Drug Enforcement Administration, not HHS or FDA 
regulations. Although the proposed rule's use of the language 
``Regulations issued by the Secretary or his delegates or sub-delegates 
in this title'' addressed this by limiting the scope of the

[[Page 5720]]

proposed rule to regulations issued by the HHS Secretary or his 
delegates or sub-delegates, HHS in this final rule amends the chapters 
belonging to HHS, rather than the entirety of the titles. This is not a 
substantive change and does not cause the application of the final rule 
or the rights and obligations it creates to differ from the proposed 
rule.\160\
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    \160\ In addition, whereas the proposed rule added certain 
regulatory text to Title 45, Part 6, this final rule adds the text 
to Title 45, Part 8. This is not a substantive change. Since the 
Department anticipates that, for good governance and streamlining 
reasons, Part 6 soon may soon be subsumed into Part 5, the 
Department in this final rule adds the relevant text to Part 8.
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    Similarly, HHS clarifies that it is amending its other regulations 
through the provisions in this final rule by generally applying an 
expiration date to those regulations, if certain conditions are not 
met, rather than asking the Office of the Federal Register to literally 
amend each other regulation, which would be unnecessarily burdensome 
and resource intensive. Accordingly, this final rule states that it 
applies to and ``shall be deemed to amend'' all regulations issued by 
the Secretary or his delegates or sub-delegates in the applicable 
chapters. This is not a substantive change and does not affect the 
application of the final rule or the rights and obligations it creates.
    HHS received no comments specific to section [XX](a) of the 
proposed rule.
    Accordingly, HHS finalizes section [XX](a) to read, ``[t]his 
section applies to and shall be deemed to amend all regulations issued 
by the Secretary or his delegates or sub-delegates in this chapter.''
Section [XX](b)
    HHS proposed to add section [XX](b), which defined several terms 
used in the proposed rule.
i. Section [XX](b)(1)
    HHS proposed to define ``Assess'' as ``a determination by the 
Department, in consultation with other Federal agencies as appropriate, 
as to whether the Regulations issued as part of the same rulemaking 
(and any amendments or additions that may have been added thereafter) 
currently have a significant economic impact upon a substantial number 
of small entities.''
    5 U.S.C. 610 directs agencies to have plans to periodically review 
those regulations that have or will have a significant economic impact 
upon a substantial number of small entities. Accordingly, in order to 
determine which regulations to periodically review using 5 U.S.C. 610's 
criteria, the Department must first determine which rules have a 
significant economic impact upon a substantial number of small 
entities. When promulgating regulations, the Department is required to 
determine whether a rule will have a significant economic impact on a 
substantial number of small entities. See 5 U.S.C. 605(b).\161\ The 
Assessment refers to an essentially identical determination. In making 
the Assessment, the Department can look to the determination of the 
regulation's impact on small entities made at the time of promulgation, 
as well as experience since promulgation.
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    \161\ 5 U.S.C. 605(b) refers to rules that have a ``significant 
economic impact on a substantial number of small entities,'' whereas 
5 U.S.C. 610 refers to rules that have ``significant economic impact 
upon a substantial number of small entities.'' This does not appear 
to be a material difference.
---------------------------------------------------------------------------

Comments on Section [XX](b)(1)
    HHS received the following comment on the proposed definition of 
``Assess.''
    Comment: A few commenters stated that HHS should clarify that 
periodic Assessments must look to the determination of the regulation's 
impact on small entities made at the time of promulgations, as well as 
experience since promulgation.\162\ These commenters stated that HHS 
should clarify that any Assessment that only contemplates the former 
and ignores the latter will be deficient.
---------------------------------------------------------------------------

    \162\ See A Guide for Government Agencies: How To Comply With 
The Regulatory Flexibility Act, U.S. SBA Off. of Advoc., at 80-81 
(2017), https://cdn.advocacy.sba.gov/wp-content/uploads/2019/06/21110349/How-to-Comply-with-the-RFA.pdf, (``If Congress meant to 
limit periodic reviews, it would have simply required agencies to 
review rules that originally had a significant impact, rather than 
rules that now have a significant impact.'').
---------------------------------------------------------------------------

    Response: Assessments must analyze the regulation's impact on small 
entities at the time the regulation is being Assessed. The Department 
believes this is clear from the text of the proposed rule, which 
defined ``Assess'' as ``a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Regulations issued as part of the same rulemaking (and any 
amendments or additions that may have been added thereafter) currently 
have a significant economic impact upon a substantial number of small 
entities'' (emphasis added). Accordingly, the Department adopts in this 
final rule the definition of ``Assess'' from the proposed rule, except 
that the term ``Regulations'' in the proposed rule is changed to 
``Sections'' in this final rule. The determination made at the time of 
promulgation about whether a rulemaking had a SEISNOSE may be a useful 
data point in assessing the regulation's current impact on small 
entities.
    Accordingly, HHS is finalizing the definition of ``Assess'' as 
proposed, with the technical amendment just mentioned.
ii. Section [XX](b)(2)
    HHS proposed to define ``Review'' as a process conducted by the 
Department, in consultation with other Federal agencies as appropriate, 
the purpose of which shall be to determine whether the Regulations that 
were issued as part of the same rulemaking (and any amendments or 
additions that may have been issued thereafter) should be continued 
without change, or should be amended or rescinded, consistent with the 
stated objectives of applicable statutes, to minimize any significant 
economic impact of the Regulations upon a substantial number of small 
entities.
    HHS received no comments specific to the proposed definition of 
``Review.''
    Accordingly, HHS is finalizing the definition of ``Review'' as 
proposed, except that it replaces the term ``Regulations'' with 
``Sections,'' to conform this provision to the rest of this final rule.
iii. Section [XX](b)(3)
    HHS proposed to define ``Regulation'' as ``a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Regulation, and 42 
CFR 2.14 is another Regulation.'' This definition was proposed to make 
clear that a section of the CFR, as opposed to a part, subpart, or 
paragraph within a section, is the unit that must be Assessed and (if 
required) Reviewed, or will otherwise expire. Defining ``Regulation'' 
in this objective way makes it easier for the Department and the public 
to know what exactly has to be Assessed or Reviewed by the dates listed 
in the proposed rule. Had the Department used the Administrative 
Procedure Act's (APA's) definition of ``rule,'' \163\ it could be 
unclear in certain circumstances what precisely needed to be reviewed.
---------------------------------------------------------------------------

    \163\ 5 U.S.C. 551(4) (providing that `` `rule' means the whole 
or a part of an agency statement of general or particular 
applicability and future effect designed to implement, interpret, or 
prescribe law or policy or describing the organization, procedure, 
or practice requirements of an agency and includes the approval or 
prescription for the future of rates, wages, corporate or financial 
structures or reorganizations thereof, prices, facilities, 
appliances, services or allowances therefor or of valuations, costs, 
or accounting, or practices bearing on any of the foregoing'').
---------------------------------------------------------------------------

    In the final rule, HHS changes the term ``Regulation'' to 
``Section'' for the reasons previously discussed.

[[Page 5721]]

Comments on Section [XX](b)(3)
    HHS received the following comments on the proposed definition of 
``Regulation.''
    Comment: A few commenters stated that HHS arbitrarily chose to 
reject the APA's definition of ``Regulation'' and adopted its own 
definition of ``Regulation'' for the purposes of this rule, defining 
regulation as ``a section of the Code of Federal Regulations.'' Some 
commenters stated that using a different definition in this rule from 
the definition in the APA (and incorporated in Executive Order 12866 
and Executive Order 13771) is confusing. Commenters stated that the 
Department's explanation that it used a special definition of 
``Regulation'' to avoid confusion that could be created by using the 
APA's definition was insufficient and lacked statutory basis.
    Response: To avoid any confusion, HHS uses ``Section,'' rather than 
``Regulation,'' in this final rule to refer to a section of the Code of 
Federal Regulations. It is crucial to the proper function of this final 
rule that the Department and public clearly understand the scope and 
timing of the Assessment and Review process. Such understanding is made 
easier with a bright-line definition of the agency issuances that are 
subject to Assessment and Review. The Department's use of ``Section'' 
endeavors to provide such clarity by using a readily available and 
well-established system of organization, the Code of Federal 
Regulations. It is clear when a section of the Code of Federal 
Regulations was first promulgated.
    The use of ``Section,'' rather than ``Regulation,'' in this final 
rule is not a substantive change from the proposed rule. Rather, it is 
an attempt to bring additional clarity by using ``Section'' to refer to 
a section of the Code of Federal Regulations, rather than using the 
term ``Regulation.''
    Comment: One commenter expressed concern over the proposed rule's 
definition of ``Regulation,'' stating that the definition is too 
narrow. This commenter stated that under the proposed rule, each 
Regulation would be Assessed or Reviewed without the context of the 
preamble language that was included in the rulemaking.
    Response: HHS respectfully disagrees. ``Assessment'' and ``Review'' 
are defined in this final rule as determinations with respect to 
``Sections that were issued as part of the same rulemaking (and any 
amendments or additions that may have been issued thereafter).'' In the 
proposed rule, ``Regulation'' was defined as a section of the Code of 
Federal Regulations so the Department and public can know what units 
would expire absent Assessment or (if needed) Review. But the text of 
the final rule makes clear that a single Assessment or Review should be 
performed on all Sections that were issued as part of the same 
rulemaking (and any amendments or additions that may have been issued 
thereafter). The Department disagrees with the commenters who stated 
that, under the proposed rule, each Regulation would be Assessed or 
Reviewed without the context of the preamble language that was included 
in the rulemaking. Under this final rule, the Department may consider 
this information when conducting Assessments and Reviews.
    Accordingly, HHS is finalizing the definition proposed, except that 
it defines the term ``Section'' rather than ``Regulation.''
iv. Section [XX](b)(4)
    HHS proposed to define ``Year of the Regulation's Promulgation'' to 
mean the calendar year the Regulation first became effective, 
irrespective of whether it was subsequently amended. The purpose of 
this proposed definition was to provide clarity to the Department and 
the public. If a regulation were amended, questions could arise whether 
the clock for re-reviewing the rule making in which the regulation was 
first promulgated begins on the date the rule making was first 
promulgated; the date it was last amended; or whether the clock for 
reviewing the amended portion begins on a different date than the 
portion that was initially enacted. The proposed definition is more 
clear for the Department and the public, because this definition, in 
conjunction with section [XX](c) of the proposed rule, makes clear that 
the clock starts for the retrospective review of a regulation on the 
date that the rule making from which the regulation originates was 
first promulgated, even if it is subsequently amended.
    If, for example, the Department issues a regulation as a part of a 
rule making and amends it nine years later, the Department may wish to 
conduct the regulatory review of the entire rule making at the time of 
amendment of a specific regulation initially promulgated in that rule 
making, particularly since the Department is presumably already 
performing a regulatory impact analysis with regard to the amendment. 
Since the Department is already conducting a regulatory impact 
analysis, performing the regulatory review at that time may save 
Department resources and spare the Department from having to perform 
the Review on the regulation the next year. In fact, any time the 
Department amends a regulation, it could perform the regulatory review 
at that time, thereby conserving Department resources.
    HHS received no comments specific to the proposed definition of 
``Year of the Regulation's Promulgation.''
    Accordingly, HHS is finalizing the definition of ``Year of the 
Regulation's Promulgation'' as proposed, except that it changes the 
term ``Regulation'' to ``Section.''
v. Section [XX](b)(5)
    HHS proposed to define ``[s]ignificant economic impact upon a 
substantial number of small entities'' as having the meaning ascribed 
to that term in the Regulatory Flexibility Act, Public Law 96-354, 94 
Stat. 1164 (Sept. 19, 1980) (as amended 1996).
    HHS received the following comments on the proposed definition of 
``Significant economic impact upon a substantial number of small 
entities.''
    Comment: A few commenters stated that neither the proposed rule, 
nor the RFA gives a clear definition of ``significant impact'' or of 
``small entity,'' and asked that HHS clarify the definition of these 
terms in the final rule.
    Response: HHS declines to add definitions of these terms within 
this final rule. ``Significant economic impact'' and ``small entity'' 
are terms within the RFA, which has been in existence for over forty 
years. These terms have been applied by the Department and other 
agencies since the RFA's enactment. Definitions pertinent to ``small 
entity'' appear at 5 U.S.C. 601. As explained in the proposed rule, the 
Department has considered a rule to have a significant impact on a 
substantial number of small entities if it has at least a three percent 
impact on revenue on at least five percent of small entities.\164\
---------------------------------------------------------------------------

    \164\ See 85 FR at 70117.
---------------------------------------------------------------------------

    Comment: One commenter stated that the citation in the definition 
of ``Significant economic impact upon a substantial number of small 
entities'' found at 21 CFR 6.1(b)(5), 42 CFR 1.1(b)(5), 42 CFR 
404.1(b)(5), and 45 CFR 6.1(b)(5) was incorrect. The proposed rule 
cited the Regulatory Flexibility Act, Public Law 96-354, 94 Stat. 1164 
(Sept. 19, 1980) (as amended 1996). This commenter stated that because 
the definition in the RFA appears in section 610 of title 5 of the U.S. 
Code, the correct citation is to the code. This commenter also stated 
that the definition of ``Significant economic impact upon a substantial 
number of

[[Page 5722]]

small entities'' shall be defined to have the meaning ``of'' that term 
in 5 U.S.C. 610, rather than the meaning ``ascribed to'' that term in 5 
U.S.C. 610.
    Response: HHS appreciates the comments and agrees that citation to 
the Code is proper. This final rule incorporates this suggestion, and 
replaces the citation in the proposed rule with ``5 U.S.C. 610.'' It 
also incorporates the comment to use ``of'' instead of ``ascribed to.'' 
This revised definition may provide increased clarity.
    Accordingly, in this final rule HHS is finalizing the definition of 
``[s]ignificant economic impact upon a substantial number of small 
entities'' to provide that this term shall have the meaning of that 
term in section 610 of title 5 of the United States Code.
Section [XX](c)
i. Section [XX](c)(1)-(2)
    In the proposed rule, HHS proposed that unless a Regulation 
contains an earlier expiration date or is rescinded earlier, all 
Regulations issued by the Secretary or his delegates or sub-delegates 
in this title shall expire at the end of either (1) two calendar years 
after the year that this rule first becomes effective, (2) ten calendar 
years after the Year of the Regulation's Promulgation, or (3) ten 
calendar years after the last year in which the Department Assessed and 
(if Review of the Regulation is required pursuant to paragraph (d)) 
Reviewed the Regulation, whichever is latest. The last year in which 
the Department Assessed and (if Review of the Regulation is required) 
Reviewed the Regulation shall be the year during which the findings of 
the Assessment and, if required, the Review of the Regulation are 
published in the Federal Register pursuant to paragraph (f) of this 
section.
    In other words, under the proposed rule the Department must Review 
all its regulations (subject to the exceptions listed below) that have 
a significant economic impact upon a substantial number of small 
entities every ten years, or such regulations shall expire. To 
determine which regulations have a significant economic impact upon a 
substantial number of small entities, the proposed rule stated that the 
Department must Assess all its regulations (subject to the exceptions 
listed below) every ten years, or such regulations shall expire if not 
Assessed. The Department believes all of its regulations (subject to 
the exceptions) should be Assessed and, if they have a significant 
economic impact upon a substantial number of small entities, Reviewed. 
The proposed rule stated that Assessments and Reviews should not be 
performed only on those regulations issued after the proposed rule goes 
into effect. After all, it is likely that some regulations promulgated 
decades ago may have become outdated.\165\
---------------------------------------------------------------------------

    \165\ See, e.g., Office of Mgmt. & Budget, Validating Regulatory 
Analysis: 2005 Report to Congress on the Costs and Benefits of 
Federal Regulations and Unfunded Mandates on State, Local, and 
Tribal Entities, at 46-47 (2005), http://perma.cc/R8LX-BQMJ; Cynthia 
Morgan & Nathalie B. Simon, National primary drinking water 
regulation for arsenic: A retrospective assessment of costs, 5 J. 
Benefit Cost Anal. no. 2, 2014, at 259-84, https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A7B29CE98E650B424E92FF292A8FFC89/S2194588800000774a.pdf/national_primary_drinking_water_regulation_for_arsenic_a_retrospective_assessment_of_costs.pdf.
---------------------------------------------------------------------------

    Section [XX](c) of the proposed rule made clear that Department 
regulations (subject to the exceptions listed below) shall expire if 
their Assessment and (if required) Review are not timely performed. 
Both 5 U.S.C. 610 and executive orders by multiple presidents over 
several decades direct the Department to devise plans to periodically 
review many of its regulations.\166\ Although the Department 
retrospectively reviewed a very limited number of its regulations, 
observers have over the decades noted that the Department has not 
always performed retrospective review to a satisfactory extent, and 
many of its regulations have not been reviewed. Therefore, the 
Department concluded in the proposed rule that it was appropriate to 
impose on itself a stronger incentive to ensure it complies with the 
purposes animating the RFA and the executive orders, as well as to 
ensure its regulations are not unduly burdening the public. As a CRS 
report put it, ``[w]ithout some type of enforcement of the review 
requirement, agencies are unlikely to conduct many more reviews than 
have occurred pursuant to Section 610.'' \167\ This is one reason why 
analyses have found that sunset provisions are an effective way to 
improve governance and reduce undue regulatory burdens.\168\ States 
have imposed similar expiration dates for many of their regulations 
unless they are reviewed or readopted.
---------------------------------------------------------------------------

    \166\ The RFA and the Executive Orders direct agencies to review 
overlapping, but not identical, sets of regulations. The RFA directs 
agencies to have plans to review regulations that have a 
``significant economic impact upon a substantial number of small 
entities.'' 5 U.S.C. 610. By contrast, Executive Order 12866 
directed agencies to submit to OIRA programs to periodically review 
``significant regulations.'' Exec. Order 12866, Sec. 5(a). 
``Significant regulations'' are not necessarily those that have a 
``significant economic impact upon a substantial number of small 
entities.'' Id. at Sec. 3(f) (defining ``significant regulatory 
action'' as any regulatory action that is likely to result in a rule 
that may: (1) Have an annual effect on the economy of $100 million 
or more or adversely affect in a material way the economy, a sector 
of the economy, productivity, competition, jobs, the environment, 
public health or safety, or State, local, or tribal governments or 
communities; (2) Create a serious inconsistency or otherwise 
interfere with an action taken or planned by another agency; (3) 
Materially alter the budgetary impact of entitlements, grants, user 
fees, or loan programs or the rights and obligations of recipients 
thereof; or (4) Raise novel legal or policy issues arising out of 
legal mandates, the President's priorities, or the principles set 
forth in this Executive order.''). Executive Order 13563 also 
directed agencies to review ``significant regulations.'' Exec. Order 
13563, Sec. 6. The Department has proposed to Review those 
regulations that satisfy the RFA criteria, since those are the 
regulations that Congress directed agencies to have plans to review. 
The Department requested comment on whether additional regulations, 
such as significant regulations, should also be Reviewed.
    \167\ Curtis W. Copeland, Cong. Rsch. Serv., RL32801, 
Reexamining Rules: Section 610 of the Regulatory Flexibility Act 11 
(2008); see also Yoon-Ho Alex Lee, An Options Approach to Agency 
Rulemaking, 65 Admin. L. Rev. 881, 895-96 (2013) (setting forth 
possible reasons why agencies, even when they have adequate 
resources, may be reluctant to perform retrospective reviews).
    \168\ Russell S. Sobel & John A. Dove, State Regulatory Review: 
A 50 State Analysis of Effectiveness 36 (Mercatus Ctr., Working 
Paper No. 12-18, 2012), https://www.mercatus.org/system/files/State-Regulatory-Review-50-State-Analysis-Effectiveness.pdf;); 
Occupational Licensing: A Framework for Policymakers, The White 
House, at 48-50 (July 2015), https://obamawhitehouse.archives.gov/sites/default/files/docs/licensing_report_final_nonembargo.pdf.
---------------------------------------------------------------------------

    It complies with the APA to amend regulations to specify dates by 
which regulations expire unless the Assessment and/or Review is timely 
performed. An agency can, through notice-and-comment rulemaking, amend 
its regulations to provide that they expire at a future date.\169\ An 
agency can also provide that its regulations expire upon the occurrence 
of a condition.\170\ That is what the Department proposed

[[Page 5723]]

in the proposed rule. To be sure, an agency generally must ``articulate 
a satisfactory explanation'' for its action, ``including a rational 
connection between the facts found and the choice made,'' and cannot 
``entirely fail[] to consider an important aspect of the problem.'' 
\171\ The Department anticipates that if a regulation expires because 
the Department does not timely complete its regulatory review, a 
litigant might object to the expiration on the grounds that the 
Department by definition did not ``articulate a satisfactory 
explanation'' or ``failed to consider an important factor,'' because in 
not performing an Assessment or Review, the Department failed to 
consider any factors. The Department rejects such arguments. In this 
rulemaking, the Department is considering the important factors. For 
the reasons described in the proposed rule and in this final rule, the 
Department believes the benefits of retrospective review, and the need 
to strongly incentivize it, are so great that the risk of a regulation 
inadvertently expiring is justified by the benefit of 
institutionalizing retrospective review in this manner. Forty years of 
experience since the RFA's enactment; the decades since relevant 
Executive Orders were enacted; and other Federal government efforts to 
spur the Department to conduct more retrospective reviews indicate 
that, absent such a forcing mechanism, the Department will not conduct 
as many retrospective reviews as desired.
---------------------------------------------------------------------------

    \169\ See, e.g., Amendment to the Interim Final Regulation for 
Mental Health Parity, 70 FR 42276, 42277 (July 22, 2005) (amending 
interim final rule, to provide that ``the requirements of the MHPA 
interim final regulation apply to group health plans and health 
insurance issuers offering health insurance coverage in connection 
with a group health plan during the period commencing August 22, 
2005 through December 31, 2005. Under the extended sunset date, MHPA 
requirements do not apply to benefits for services furnished after 
December 31, 2005.''); see generally Clean Air Council, 862 F.3d at 
9 (an agency can amend or revoke a legislative rule through notice-
and-comment rulemaking).
    \170\ See, e.g., Control of Communicable Diseases; Foreign 
Quarantine 85 FR 7874, 7874 (Feb. 12, 2020 (providing that, unless 
extended, interim final rule ``will cease to be in effect on the 
earlier of (1) the date that is two incubation periods after the 
last known case of 2019-nCoV, or (2) when the Secretary determines 
there is no longer a need for this interim final rule''); Medicare 
and Medicaid Programs, Clinical Laboratory Improvement Amendments 
(CLIA), and Patient Protection and Affordable Care Act; Additional 
Policy and Regulatory Revisions in Response to the COVID-19 Public 
Health Emergency, 85 FR 54820, 54820 (Sept. 2, 2020) (providing that 
an interim final rule applies ``for the duration of the [public 
health emergency] for COVID-19'').
    \171\ Little Sisters of the Poor Saints Peter and Paul Home v. 
Pa., 140 S. Ct. 2367, 2383-84 (2020) (quoting Motor Vehicle Mfrs. 
Assn. of U.S., Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 
43 (1983)).
---------------------------------------------------------------------------

    The Department will mitigate this risk by setting up two web pages 
on the Department's website by the date this final rule is published; 
one that lists the dates of promulgation of all of its rulemakings, and 
a second that lists the rulemakings that contain regulations (called 
``Sections'' in this final rule) that the Department has decided to 
Assess or Review. The Department will regularly update the web page 
listing the rulemakings containing Sections that it has decided to 
Assess or Review with all additional rulemakings containing Sections 
that it begins to Assess or Review. The Department will also create a 
docket on Regulations.gov, to which the public may direct any comments 
requesting that the Department begin the Assessment or Review of 
regulations. This requirement is described in more detail in the 
discussion of section [XX](h).
    Therefore, in this rulemaking process, which amends Department 
regulations through the notice-and-comment process, the Department is 
considering the important factors. In addition, the Department intends 
to create on its website a dashboard that shows its progress on its 
Assessments and Reviews, including when it commenced those Assessments 
and Reviews, its progress, and when it expects them to be completed. 
The Department also intends to create a dashboard showing its progress 
on conducting Assessments and Reviews. See Section II.F. for more 
detail on the dashboard.
    The Department proposed to perform the Assessment and (if required) 
the Review on each regulation every ten years. Some states provide 
that, unless readopted or re-reviewed, their regulations expire in 
seven years,\172\ while at least one state uses a ten-year time 
period.\173\ The Department proposed to perform the Assessment and (if 
required) the Review every ten years, because ten years is the period 
listed in 5 U.S.C. 610.
---------------------------------------------------------------------------

    \172\ See, e.g., N.J. Admin. Code Sec.  1:30-6.4 (2020) 
(regulations expire every seven years unless readopted, subject to 
certain exceptions); Ind. Code 4-22-2.5-2 (2020) (imposing seven-
year expiration date on regulations unless readopted).
    \173\ N.C. Gen. Stat. 150B-21.3A (2020).
---------------------------------------------------------------------------

    The proposed rule provided that regulations promulgated more than 
ten years ago will expire at the end of two calendar years from the 
date the proposed rule, if finalized, became effective, unless an 
Assessment and (if required) the Review is performed on them. In the 
proposed rule, the Department requested public comment on whether two 
years is an appropriate time period to Assess and (if required) Review 
Regulations promulgated more than ten years ago.
    The Department has decided that all of its regulations (subject to 
the exceptions listed below) should be periodically Assessed to 
determine whether they have a significant economic impact upon a 
substantial number of small entities. Without performing the 
Assessment, the Department may not know which regulations have or will 
have a significant economic impact upon a substantial number of small 
entities. Due to changed circumstances, a regulation that did not have 
such an impact at the time it was promulgated may now have such an 
impact. The Department is also aware of literature suggesting that 
agencies have not been consistent in deciding which rules have a 
significant economic impact on a substantial number of small entities, 
or have avoided such a finding in order to avoid complying with the 
RFA's requirements.\174\ By Assessing all of its regulations (subject 
to the exceptions described herein) and publishing the results of the 
Assessments, the Department can avoid concern that the Department is 
failing to Assess or Review regulations that have a significant 
economic impact upon a substantial number of small entities.
---------------------------------------------------------------------------

    \174\ See, e.g., Connor Raso, Agency Avoidance of Rulemaking 
Procedures, 67 Admin. L. Rev. 65, 93-95, 99-101 (2015); Michael R. 
See, Willful Blindness: Federal Agencies' Failure to Comply with the 
Regulatory Flexibility Act's Periodic Review Requirement--And 
Current Proposals to Reinvigorate the Act, 33 Fordham Urb. L. J. 
1199, 1222-25 (2006).
---------------------------------------------------------------------------

    The Department should in many cases perform a single Assessment 
(and, where required, a single Review) that considers all regulations 
issued as part of the same rulemaking. That would generally make sense 
from an economic perspective, for the same reasons that the Department 
in many cases does a single regulatory impact analysis on all 
regulations that are issued as part of the same rulemaking. That is why 
the proposed rule and this final rule define ``Assess'' and ``Review'' 
as determinations regarding ``Regulations issued as part of the same 
rulemaking (and any amendments or additions that may have been added 
thereafter)'' (except that the term ``Regulations'' is replaced with 
``Sections'' in this final rule). Indeed, 5 U.S.C. 605(c) provides that 
``[i]n order to avoid duplicative action, an agency may consider a 
series of closely related rules as one rule for the purposes of 
sections 602, 603, 604 and 610 of this title.'' Thus, if a series of 
regulations were issued as part of the same rulemaking and one of those 
regulations was subsequently amended, the Department would in many 
cases take the view that the series of regulations could be Assessed or 
Reviewed together for purposes of this final rule.
    The same is true for the converse. Consider, for example, the 2015 
rulemaking Preventive Controls for Human Food that established 21 CFR 
part 117 and also amended or revised individual regulations in Parts 1, 
106, 110, 114, 120, 123, 129, 179, and 211 that were originally issued 
before 2015.\175\ If the Department so chose, when the deadline 
approaches for Assessing and (if required) Reviewing the amended 
regulations in 21 CFR part

[[Page 5724]]

106, the Department could, as part of the same Assessment or Review, 
also assess or review the other regulations that were amended in this 
rulemaking.
---------------------------------------------------------------------------

    \175\ Current Good Manufacturing Practice, Hazard Analysis, and 
Risk-Based Preventive Controls for Human Food, 80 FR 55,907 (Sept. 
17, 2015). https://www.federalregister.gov/documents/2015/09/17/2015-21920/current-good-manufacturing-practice-hazard-analysis-and-risk-based-preventive-controls-for-human.
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    For regulations that were issued in coordination with another 
Agency, that function in concert with another Agency's regulations, or 
that have a specific, direct impact on regulations issued by another 
Federal agency, the proposed rule proposed that the Department would 
consult with that other Agency when undertaking the Assessment or 
Review, and consider the other Agency's views when considering the 
factors described in section [XX](d). An example of regulations that 
have a specific, direct impact on regulations issued by another Federal 
agency are the Department's ACA regulations concerning the operation of 
Exchanges that affect eligibility for the advance premium tax credit. 
Such regulations have a specific, direct impact on Department of the 
Treasury regulations.\176\
---------------------------------------------------------------------------

    \176\ See, e.g., 45 CFR 155.340 (regarding administration of 
advance payments of the premium tax credit and cost-sharing 
reductions and requiring the Exchange to comply with Treasury 
regulations).
---------------------------------------------------------------------------

    The Department's understanding is that the decisions based upon 
Reviews, including the amendment, repeal, or continuance of regulations 
without change, will constitute final agency action. First, the 
decisions will mark the consummation of the agency's decisionmaking 
process with respect to whether a regulation satisfies the criteria 
described in section [XX](d). Second, the decisions constitute action 
by which rights or obligations have been determined, or from which 
legal consequences will flow. This is because if the Review is not 
performed, the regulation would expire.\177\ Therefore, because the 
decisions based upon Reviews constitute final agency action, they must 
be performed in such a manner that they would withstand judicial review 
under the arbitrary and capricious standard.\178\
---------------------------------------------------------------------------

    \177\ See U.S. Army Corps of Engineers v. Hawkes Co., Inc., 136 
S. Ct. 1807, 1813 (2016) (to have final agency action, ``First, the 
action must mark the consummation of the agency's decisionmaking 
process--it must not be of a merely tentative or interlocutory 
nature. And second, the action must be one by which rights or 
obligations have been determined, or from which legal consequences 
will flow'' (quoting Bennett v. Spear, 520 U.S. 154, 177-78 (1997)).
    \178\ See 5 U.S.C. 704 (final agency action is reviewable); 5 
U.S.C. 706 (a reviewing court shall hold unlawful and set aside 
agency action, findings, and conclusions found to be arbitrary, 
capricious, an abuse of discretion, or otherwise not in accordance 
with law).
---------------------------------------------------------------------------

    Similarly, if an Assessment concludes that a regulation does not 
have a significant economic impact upon a substantial number of small 
entities, that would mark the consummation of the Department's 
decisionmaking process with respect to whether a Review must be 
performed on the regulation. Such an Assessment's findings would also 
constitute action by which rights or obligations have been determined, 
or from which legal consequences will flow, because if the Assessment 
is not performed, the regulation would expire. Therefore, Assessments 
must also be performed in such a manner that they would withstand 
judicial review under the arbitrary and capricious standard.
    The Department proposed to perform the Assessment and (if required) 
the Review on each Regulation every ten years. Some states provide 
that, unless readopted or re-reviewed, their regulations expire in 
seven years,\179\ while at least one state uses a ten-year time 
period.\180\ The Department proposed to perform the Assessment and (if 
required) the Review every ten years, because ten years is the period 
listed in 5 U.S.C. 610. The Department has many regulations, some of 
which are complex, so having to perform the Assessment and Review more 
than once every ten years could unduly burden the Department and 
increase the likelihood that a Regulation inadvertently expires because 
it is not Assessed or Reviewed.
---------------------------------------------------------------------------

    \179\ 85 FR 70,105.
    \180\ Id.
---------------------------------------------------------------------------

Comments and Responses Regarding Section [XX](c)
    HHS received the following comments on Section [XX](c) of the 
proposed rule.
    Comment: Several commenters asked the Department to extend, from 
two years to five years, the timeframe for Assessment or Review of 
regulations that are over ten years old.
    Response: The Department considered this comment, and has decided 
to make this change. Under this final rule, regulations that are more 
than ten years old when this final rule becomes effective shall expire 
if not Assessed and (if needed) Reviewed within five calendar years of 
the year that this final rule becomes effective. This will spread out 
the initial burden on the Department and provide the opportunity for 
more robust Assessments and Reviews. It also reduces any harm to 
reliance interests, since the public will now be on notice further in 
advance of the initial Assessment and Review deadlines.
    Comment: Several commenters stated that the final rule should 
provide the Secretary with the authority to make one-time, case-by-case 
exceptions to the automatic expiration of a rule.
    Response: HHS appreciates this comment and has decided to include 
within this final rule a provision that allows the Secretary--on a non-
delegable basis--to extend on a one-time, case-by-case basis the 
automatic expiration date of a Section by one year. The Department 
shall promptly publish in the Federal Register any such determination 
by the Secretary to extend the expiration date.
    Comment: A large number of commenters stated that the process 
established in the proposed rule could result in important regulations 
slipping through the cracks and expiring, which could have implications 
for other rules. These commenters stated that the Assessment and Review 
process established in the proposed rule would be complicated and time-
consuming to put into practice, which could result in the automatic 
expiration of some regulations. A large number of commenters 
specifically mentioned regulations at 42 CFR 435.603, on which multiple 
insurance affordability programs, including Medicaid and CHIP, rely to 
determine financial eligibility using Modified Adjusted Gross Income 
(MAGI) methodologies. According to the commenters, the expiration of 
that regulation would allow programs to redefine MAGI household and 
income counting rules, with no standards, consistency, or 
accountability, which commenters fear could wreak havoc in HHS 
programs. Another commenter stated that if some critical regulations, 
such as the Medicare health and safety standards which provide a 
baseline for patient safety sunset, this could threaten patient safety. 
A large number of commenters suggested that safeguards be put in place 
to ensure that regulations that are critical to the operation of safety 
net providers do not simply expire because an Assessment or Review was 
not completed in time.
    Response: HHS appreciates the theoretical possibility raised by 
these commenters that important regulations (such as MAGI methodologies 
or Medicare health and safety standards) could expire inadvertently. 
But as explained throughout the proposed rule and in this final rule, 
the Department intends to timely complete the required Assessments and 
Reviews. As noted in the proposed rule, as an additional safeguard, in 
the unlikely event it appears HHS has overlooked an impending deadline, 
interested members of the public can raise the need to Assess or Review 
specific regulation through public comment. As

[[Page 5725]]

an additional safeguard, the Department adds in this final rule that 
if, prior to the expiration of a Section, the Secretary makes a written 
determination that the public interest requires continuation of the 
Section in force beyond the date on which the Section would otherwise 
expire under this final rule, the Secretary may continue the Section in 
force one time for a period stated in the determination, which period 
shall not exceed one year.
    Comment: Several commenters expressed concern about the precedent 
created by an automatic expiration date, which they believe could allow 
future administrations to reject regulations by simply letting them 
lapse. These commenters stated that this scenario would allow the 
Department to bypass the regulatory process and deprive the American 
people of the opportunity for comment and input.
    Response: HHS respectfully disagrees that this is a significant 
enough risk to outweigh the tremendous benefits from retrospective 
review. The commenters' concerns assume a lack of good faith by future 
administrations. There would also likely be a tremendous public outcry 
if many beneficial regulations were permitted to expire.
    This final rule does not bypass the regulatory process or deprive 
the American people of the opportunity for comment and input. In this 
rulemaking, the Department is going through the APA's ordinary notice-
and-comment process. This final rule reflects that the Department 
accepted and considered over 500 public comments on the proposed rule. 
The Department also held a public hearing on the proposed rule and 
considered the comments made there in promulgating this final rule. In 
addition, this final rule institutionalizes an ongoing opportunity for 
public comment during this regulatory review process.
    Comment: Several commenters stated that public harm could result 
from removing regulations that protect the public health and consumers. 
A few commenters suggested that the Assessments and Reviews conducted 
by the Department should specifically consider consumer protection.
    Response: For the reasons explained in the preamble and regulatory 
impact analysis for this final rule, this final rule implements a 
process by which the Department will Assess and Review its regulations. 
HHS intends to undertake a careful Assessment, and (if necessary) 
Review of each regulation subject to this final rule to determine if 
the regulation should be continued without change, amended, or 
rescinded. HHS has no intention to rescind regulations that 
appropriately protect the public health or consumers. Reviews will 
consider the factors described in 5 U.S.C. 610(b) (as well as whether 
the regulation complies with applicable law). These are the factors 
that Congress directed the Department to consider when periodically 
reviewing regulations that have a SEISNOSE. Considerations with respect 
to consumer protection will often be subsumed in this analysis.
    Comment: A few commenters suggested that instead of the proposed 
timeframe for review, the Department should instead Review regulations 
on a rolling basis but not less than 10 years from the date of first 
promulgation or substantial amendment.
    Response: HHS respectfully disagrees. Clear and specific deadlines 
are needed to ensure the efficacy of this rule and to secure robust 
retrospective review of agency regulations. Moreover, the commenters' 
suggestion that review occur no less than 10 years from the date of 
promulgation or substantial amendment is, in the Department's view, an 
undue time lapse. It threatens to leave long outdated and burdensome 
regulations in place for too long.
    Comment: One commenter stated that the proposed timeline for 
reviewing regulations is inconsistent with the proposed rule's goal of 
reviewing regulations based on the likelihood of their obsolescence. 
This commenter stated that the proposed rule assumes that the passage 
of time increases the likelihood of regulatory obsolescence, but the 
proposed rule defines a Regulation's age based on the date on which it 
was originally promulgated, regardless of subsequent amendments. 
Therefore, some regulations that have been subsequently amended could 
reach their time for review earlier than regulations that were 
promulgated and never amended. For example, a Medicaid regulation first 
adopted in 1968 but revised repeatedly and as recently as 2020 would 
need to be Assessed, possibly Reviewed, and possibly revised again even 
though it was just amended.
    This commenter said this timing is also incongruent with specific 
provisions in the RFA. The RFA defines a ``rule'' to include ``any rule 
for which the agency publishes a general notice of proposed rulemaking 
pursuant to section 553(b),'' which explicitly includes regulatory 
amendments. See 5 U.S.C. 553(b) and 551(5). The commenter stated that 
this statutory provision requires the proposed rule's ``clock'' for 10-
year review to be reset based on the most recent regulatory amendment 
that went through APA notice and comment procedures.
    Response: HHS respectfully disagrees. As an initial matter, 5 
U.S.C. 610 refers to review ``within'' ten years; it does not foreclose 
reviewing regulations sooner. Second, this rule seeks to balance the 
desire to review older regulations first, while also specifying clear, 
easily-ascertainable deadlines for Assessments and Reviews. It would be 
harder for the Department and the public to determine the Assessment 
and Review deadlines if the deadlines changed each time a regulation 
were amended. Providing that the ``clock'' begins to run from the year 
a Section was first promulgated is a reasonable way to balance these 
considerations. Tying deadlines to the amendments of Sections threatens 
to make the rule completely unwieldy--leaving an open question of when 
certain parts of a rule are up for Assessment and Review.
    Also, as explained in the proposed rule, if the Department is 
amending a regulation close in time to its ten-year Assessment or 
Review date, then the Department can conduct Assessment and Review 
alongside the amendment, thereby restarting the ten-year clock if it 
publishes the findings in the Federal Register in the manner specified 
in this final rule.\181\
---------------------------------------------------------------------------

    \181\ 85 FR 70105.
---------------------------------------------------------------------------

Amendments to Section [XX](c)
    After considering the public comments on the two year time period 
to Assess and (if required) Review regulations that are more than ten 
years old, the Department has decided to extend this time period to 
five calendar years after the year that this section first becomes 
effective. Furthermore, in this final rule the Department amends 
section [XX](c) to read ``this chapter,'' rather than ``this title,'' 
as was used in the proposed rule. The Department makes this change to 
conform to the fact that this final rule amends certain chapters, 
rather than entire titles. The Department finalizes sections [XX] 
(c)(1)-(2) as amended.
ii. Section [XX](c)(3)
    After considering the public comments received on the proposed 
rule, the Department decided to add a new Section [XX](c)(3) to this 
final rule.
    Section [XX](c)(3) states that if, prior to the expiration of a 
Section under paragraph (c)(1) of this section, the Secretary makes a 
written determination that the public interest requires continuation of 
the Section in force beyond the date on which the Section would 
otherwise expire under paragraph (c)(1), the Secretary may continue the 
Section in force one time

[[Page 5726]]

for a period stated in the determination, which shall not exceed one 
calendar year. This final rule requires the Department to promptly 
publish any such written determination in the Federal Register. The 
authority of the Secretary to make this written determination is not 
delegable and may be exercised only by the Secretary or, when the 
office of the Secretary is vacant or the Secretary has become unable to 
perform the functions and duties of the office of the Secretary, by the 
individual acting as Secretary in accordance with the law. This 
provision, like other provisions of this final rule, is severable.
    The Department adds this provision so that, if a pandemic, 
emergency, or other development arises that prevents the Department 
from timely Assessing or Reviewing certain Sections and the public 
interest requires their continuation, the Department can have 
additional time to Assess and (if needed) Review those Sections.
A. Section [XX](d)
    HHS proposed in Section [XX](d) of the proposed rule that the 
Department would be required to Review those Regulations that the 
Department Assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing Regulations to 
minimize any significant economic impact of the Regulation on a 
substantial number of small entities in a manner consistent with the 
stated objectives of applicable statutes, the proposed rule stated that 
the Department's Review shall consider (1) the continued need for the 
Regulation, consideration of which shall include but not be limited to 
the extent to which the Regulation defines terms or sets standards used 
in or otherwise applicable to other Federal rules; (2) the nature of 
complaints or comments received concerning the Regulation from the 
public; (3) the complexity of the Regulation; (4) the extent to which 
the Regulation overlaps, duplicates or conflicts with other Federal 
rules, and, to the extent feasible, with State and local governmental 
rules; (5) the degree to which technology, economic conditions, or 
other factors have changed in the area affected by the regulation since 
the Regulation was promulgated or the last time the Regulation was 
Reviewed by the Department; (6) whether the Regulation complies with 
applicable law; and (7) other considerations as required by relevant 
executive orders and laws.
    This largely mirrors the review described in 5 U.S.C. 610. It is 
also consistent with ACUS' recommendation that agencies ``consider 
whether the [existing] regulations are accomplishing their intended 
purpose or whether they might, to the extent permitted by law, be 
modified, strengthened or eliminated in order to achieve statutory 
goals more faithfully, minimize compliance burdens on regulated 
entities, or more effectively confer regulatory benefits.'' \182\ Prior 
to finalization, OIRA may review Reviews, including to coordinate 
inter-agency participation in the Review process where there are 
significant inter-agency equities or as otherwise appropriate.\183\ For 
example, when Assessing or Reviewing regulations that require Executive 
Order 12250 review and approval by the Attorney General, the Department 
will consult with the Department of Justice (DOJ) and provide a draft 
of the findings to DOJ well in advance of the Assessment or Review 
deadline, so that DOJ can review and approve prior to the publication 
of the findings. It may be appropriate for OIRA to coordinate this 
process.
---------------------------------------------------------------------------

    \182\ Administrative Conference of the United States, 
Recommendation 2014-5, 79 Fed. App'x--Recommendations of the 
Administrative Conference of the United States, 79 FR 75114, 75117 
(Dec. 17, 2014).
    \183\ OIRA may also coordinate inter-agency participation in the 
Assessment process where there are significant inter-agency equities 
or as otherwise appropriate.
---------------------------------------------------------------------------

    Proposed section [XX](d) of the proposed rule provided that the 
Department shall consider the continued need for the Regulation, 
``consideration of which shall include but not be limited to the extent 
to which the Regulation defines terms or sets standards used in or 
otherwise applicable to other Federal rules.'' The quoted phrase is not 
found in 5 U.S.C. 610, but the Department included it in the proposed 
rule to clarify that determining the continued need for a regulation 
includes determining the extent to which it defines terms or sets 
standards used in or otherwise applicable to other Federal rules. 
However, this was not meant to be the only factor the Department should 
consider when determining the continued need for a regulation. Under 
the proposed rule, the Department shall consider any factors that, for 
a particular regulation, are relevant to determining whether there is a 
continued need for the regulation.
    In addition to this phrase, two factors listed in section [XX](d) 
of the proposed rule were not found in 5 U.S.C. 610. The first is that 
section [XX](d) of the proposed rule stated that the Review should take 
into account ``whether the Regulation complies with applicable law.'' 
Since applicable law may have changed since a regulation was 
promulgated, the Department wants to ensure that its regulations are 
regularly reviewed to ensure that they comply with applicable law.
    Second, section [XX](d) of the proposed rule stated that the Review 
should take into account ``other considerations as required by relevant 
executive orders and laws.'' The proposed rule stated that to the 
extent Executive Orders or laws enacted since the RFA require the 
Department to consider additional factors when performing retrospective 
review of particular regulations, the Department wishes to comply with 
those Executive Orders and laws. A recent Department of Transportation 
rule similarly required that agency, when periodically reviewing its 
regulations, to consider ``[o]ther considerations as required by 
relevant executive orders and laws.'' See 49 CFR 5.13(d)(2)(vi). Upon 
further consideration, the Department has decided not to finalize this 
seventh factor. First, this factor is not included in the RFA.\184\ 
Second, this factor is potentially unclear and could be open to 
multiple interpretations. Third, this final rule already requires the 
Department to consider whether the rulemaking complies with applicable 
law. Thus, the seventh factor is not only susceptible to multiple 
interpretations, but seems largely (if not entirely) subsumed by other 
factors in this final rule.
---------------------------------------------------------------------------

    \184\ The RFA also does not include ``whether the Regulation 
complies with applicable law'' as a factor. But it seems 
uncontroversial to require the Department to consider whether its 
regulations comply with applicable law, and this phrase has a clear 
meaning.
---------------------------------------------------------------------------

    The Department anticipates that the Reviews would be similar to the 
section 610 analyses currently performed by agencies. The Reviews would 
benefit from real-world data and information gathered since the 
regulations were promulgated to potentially discern the impact of the 
regulation on small entities and on society more generally.
    Section [XX](d) of the proposed rule requires that only regulations 
that have a significant economic impact upon a substantial number of 
small entities be Reviewed, because those are the regulations that 5 
U.S.C. 610 requires agencies have a plan to periodically review.
Comments on Section [XX](d)
    HHS received the following comments on Section [XX](d) of the 
proposed rule.
    Comment: Several commenters suggested that HHS consult with trade

[[Page 5727]]

groups and other specialty societies to consider the policy 
recommendations of providers and others in the healthcare industry to 
understand the implications of modifying or rescinding existing 
regulations. Some of these commenters brought up certain regulations 
for which they care deeply and would like to see rescinded or 
maintained.
    Response: HHS appreciates these comments and wishes for the public 
to have the opportunity to provide meaningful feedback on regulatory 
changes that the Department may consider as it conducts its Assessments 
and Reviews. To achieve that goal, the proposed rule, as finalized, 
includes a process of soliciting robust public comments and feedback, 
which HHS will consider and incorporate into its Assessment and Review 
decisions. As stated in [XX](d)(2), ``[t]he nature of complaints or 
comments received concerning the Regulation from the public'' is one of 
the factors that the Department is required to consider under this rule 
when it conducts its Assessments and Reviews. HHS is committed to 
ensuring that the public has ample opportunity to opine on its 
regulations, and looks forward to thoughtfully considering public 
comments during the regulatory review process resulting from this final 
rule.
    Comment: A few commenters stated that the Department's process for 
reviewing regulations that have a SEISNOSE was unclear from the 
proposed rule. These commenters asked that the Department provide at 
least one example of how factors would be considered and how HHS would 
conduct its decision-making process.
    Response: Based in part on these comments, in this final rule the 
Department removes the final factor specified in the proposed rule 
(``other considerations as required by relevant executive orders and 
laws''). The Department does so because this factor's meaning could be 
unclear, it is not in the RFA, and it adds little beyond what is 
already more clearly stated in other factors, such as whether the 
rulemaking complies with applicable law. Beyond removing this factor, 
HHS respectfully declines to provide additional clarity within this 
final rule as to the exact contours of the Review process. As explained 
in the proposed rule, the Review takes into account factors that 
already exist under 5 U.S.C. 610(b), along with a consideration of 
whether the rulemaking complies with applicable law, a factor whose 
meaning is clear and uncontroversial. It is anticipated that the Review 
process will track the Department's and other agencies' past practice 
with respect to Section 610 analyses. In particular, examples of 
Section 610 reviews conducted by the EPA are instructive on how the 
Department anticipates the five factors set forth in 5 U.S.C. 610(b) 
will be analyzed.\185\ The Review decision-making process will be 
implemented in a manner appropriate for the regulation in question, 
including but not limited to input from subject-matter experts within 
the Department and the public.
---------------------------------------------------------------------------

    \185\ See Results of EPA's Section 610 Review of the Final Rule 
for Control of Emissions of Air Pollution from Nonroad Diesel 
Engines and Fuel, EPA Off. of Transp. & Quality (Sept. 2014), 
https://www.regulations.gov/document?D=EPA-HQ-OAR-2013-0642-0003; 
Regulatory Flexibility Act Section 610 Review of the National 
Pollutant Discharge Elimination System (NPDES) Permit Regulation and 
Effluent Limitation Guidelines and Standards for Concentrated Animal 
Feeding Operations (CAFOs), EPA Off. of Water (June 3, 2014), 
https://www.regulations.gov/document?D=EPA-HQ-OW-2012-0813-0216; 
Results of EPA's Section 610 Review of the Final Rule for Lead; 
Renovation, Repair, and Painting Program, EPA Off. of Pollution 
Prevention and Toxics (Apr. (April 2018), https://www.regulations.gov/document?D=EPA-HQ-OPPT-2016-0126-0019.
---------------------------------------------------------------------------

    Comment: A few commenters asked for clarification regarding the 
Department's decision-making process as to whether a regulation would 
be identified as requiring a rescission or amendment based on the 
factors provided. For example, if HHS were to identify overlap or 
duplication between a regulation under Review and other Federal 
regulations, how would HHS assess the factors to make a decision to 
rescind or amend? These commenters also asked for clarification on how 
the Department would determine that a regulation is duplicative.
    Response: The factors specified in the final rule will be balanced, 
and a determination as to whether to amend or rescind a Section will be 
made on a case-by-case basis. No one factor by itself is dispositive 
(unless the Section does not comply with applicable law). The balancing 
of a series of considerations, sometimes complex and wide-ranging, is 
inherent in the Department's policy-making functions, even beyond the 
context of the Review process set out in this final rule. In the prior 
comment, the Department provided examples of how the Reviews will 
consider the relevant factors. The concept of regulatory duplication, 
which has been in the RFA, 5 U.S.C. 610(b)(4) for over forty years, is 
largely self-explanatory. A regulation may be considered duplicative, 
if, for instance, it serves the same function or overlaps with another 
regulation.\186\ Amending or rescinding duplicative regulations can 
reduce complexity and regulatory burden.
---------------------------------------------------------------------------

    \186\ Duplicative, Black's Law Dictionary (11th ed. 2019) 
(defining ``duplicative'' as ``Having or characterized by having 
overlapping content, intentions, or effect'').
---------------------------------------------------------------------------

    Comment: Some commenters asked HHS to clarify how it would consider 
public comments about a regulation, and whether there would be 
numerical or content benchmarks that HHS would use to guide its 
decision-making regarding the public feedback it receives.
    Response: The Department will create dockets on Regulations.gov for 
its Assessments and Reviews, and the public may submit comments to 
those dockets in the same manner as it can submit comments on notices 
of proposed rulemaking. The Department's Reviews will be holistic and 
consider the five factors specified in 5 U.S.C. 610(b), as well as 
compliance with applicable law. No one factor by itself is dispositive 
(unless the Section does not comply with applicable law). The weight 
that the Department gives to comments will be a case-by-case 
determination. For example, fifty complaints about a major rule that 
also had 500 supportive comments might not counsel in favor of amending 
or rescinding the rule. But fifty complaints about a rule that had no 
comments supporting it might weigh in favor of amendment or rescission, 
particularly if the other section 610 factors do not counsel strongly 
in favor of continuing the regulation without change. The public-
comment process, and how much weight to give to various comments, is 
familiar to the Department and the public from the many instances of 
public comment on Department policymaking actions. A similar standard 
will be applied here.
    Accordingly, the Department finalizes section [XX](d) of the 
proposed rule as proposed, except that it removes (d)(7), which 
proposed that Reviews consider ``[o]ther considerations as required by 
relevant executive orders and laws.'' Moreover, in the finalized 
section [XX](d), the Department replaces the term ``Regulation'' with 
``rulemaking.'' This is in response to comments previously discussed 
expressing concerning about potential ambiguity caused by the use of 
the term ``Regulation.'' This change is also made to conform section 
[XX](d) to the fact that ``Reviews'' are defined as determinations as 
to ``whether Sections \187\ that were issued as part of the same 
rulemaking (and any amendments or additions that may have been issued 
thereafter)'' should be continued without change, amended, or 
rescinded. Reviews are therefore not of individuals sections but of the 
sections

[[Page 5728]]

issued as part of the same rulemaking. Thus, this revision to section 
[XX](d) is made for clarity but is not a substantive change from the 
proposed rule.
---------------------------------------------------------------------------

    \187\ ``Regulations'' in the proposed rule.
---------------------------------------------------------------------------

Section [XX](e)
    In the proposed rule, HHS proposed that if the Review concludes 
that a Regulation should be amended or rescinded, the Department shall 
have two years from the date that the findings of the Review are 
published in the Federal Register pursuant to paragraph (f) to amend or 
rescind the Regulation. The proposed rule further stated that if the 
Secretary determines that completion of the amendment or rescission is 
not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time for a total of not more than five 
years.
    The Department included this provision in the proposed rule 
because, if the Review concludes that a Regulation should be amended or 
rescinded, the Regulation should in fact be amended or rescinded. The 
Department believes that two years will generally be an adequate amount 
of time to amend or rescind a Regulation, since the Department will 
have already conducted a Review of the Regulation. In circumstances 
where amendment is not feasible within that time period, the proposed 
rule stated that the Secretary could so certify in a statement 
published in the Federal Register and extend the completion date by one 
year at a time for a total of not more than five years.
    As stated in the proposed rule, when the Review determines that a 
regulation should be amended or rescinded, the Department would, on a 
case-by-case basis as appropriate, use enforcement discretion to not 
enforce the regulation or a portion of the regulation until it is 
amended or rescinded. This is because in many cases the Department 
would not want to enforce regulations (or portions of regulations) that 
it determines should be amended or rescinded. The Department noted that 
enforcing a regulation deemed to require amendment or rescission in 
some cases raises concerns about whether such enforcement is arbitrary 
and capricious. Continuing to enforce the regulation (or portions 
thereof) would arguably ``run[ ] counter to the evidence before the 
agency.'' \188\
---------------------------------------------------------------------------

    \188\ Motor Vehicle Mfrs. Ass'n of U.S., Inc. v. State Farm Mut. 
Auto. Ins. Co., 463 U.S. 29, 43 (1983).
---------------------------------------------------------------------------

Comments on Section [XX](e)
    HHS received the following comments on Section [XX](e) of the 
proposed rule.
    Comment: Some commenters stated that the Department should limit 
the length of time for amending or rescinding a Regulation from two 
years with three one-year extensions for a total of not more than five 
years to two years with the possibility to extend for one year (for a 
total of not more than three years). One commenter also stated that the 
current text is ambiguous as to whether it is a maximum of five years 
(two years plus three one-year extensions) or a maximum of seven years 
(two years plus five one-year extensions).
    Response: HHS appreciates these comments and, in this final rule, 
modifies the rule's text to clarify that, if a Review concludes that a 
Section should be amended or rescinded, the maximum time for amending 
or rescinding the Section (including all possible extensions) is five 
years. That is, there is a two-year period to amend or rescind, which 
can be extended no more than three times for one year each time.
    The Department believes the two-year default period is appropriate 
and declines to further limit the number of possible extensions. If the 
Department concludes that a regulation should be amended or rescinded, 
it does not want to unduly delay doing so. The Department believes that 
two years will generally be an adequate amount of time to amend or 
rescind such regulations, since the Department has already Reviewed 
them. However, given the complexity of some Department regulations and 
competing priorities, in some circumstances it may not be feasible to 
amend or rescind a regulation within two years. In circumstances where 
amendment or rescission is not feasible within that time period, the 
Secretary can so certify in a statement published in the Federal 
Register and extend the completion date by one year at a time no more 
than three times, for a total of not more than five years (inclusive of 
the initial two-year period).
    Accordingly, after considering the public comments, the Department 
chose to clarify the language in section [XX](e) of the proposed rule 
with respect to the time period for extension of the completion of an 
amendment or rescission. Where the proposed rule stated that the 
Secretary ``may extend the completion date by one year at a time for a 
total of not more than five years,'' the final rule clarifies that the 
Secretary ``may extend the completion date by one year at a time, no 
more than three times, for a total of not more than five years 
(inclusive of the initial two-year period)'' (emphasis added). This 
change does not alter the time period for extending the completion date 
of an amendment or rescission, but HHS believes that this language 
clarifies the length of time that the completion may be extended. The 
Department finalizes Section [XX](e) of the proposed rule, with this 
clarifying language.
Section [XX](f)
    Section [XX](f) of the proposed rule provided that the results of 
all Assessments and Reviews conducted in a calendar year, including the 
full underlying analyses and data used to support the results (subject 
to any applicable privilege, protections for confidential business 
information, or explicit legal prohibition on disclosure), shall be 
published in a single document in the Federal Register during that 
calendar year. The proposed rule stated that the document shall be 
organized in a manner that enables both the Department and the public 
to readily determine which Assessments and Reviews were conducted 
during that calendar year. It further proposed that the document shall 
also specify the year by which the next Assessment (and, if required, 
the next Review) of the Regulation shall be completed.
    The Department included this requirement in the proposed rule so 
that both the Department and the public could readily know which 
Regulations were Assessed and Reviewed each year. If Assessments and 
Reviews were published in disparate places throughout the year, it 
could become extraordinarily difficult for both the Department and the 
public to know which Regulations were Assessed and Reviewed each year. 
Section [XX](f) was proposed to enable both the Department and the 
public to look in one place to know which Assessments and Reviews were 
conducted each calendar year, and know the findings of those 
Assessments and Reviews.
    The proposed rule stated that when publishing the findings of an 
Assessment or Review, the Department should include the full underlying 
analyses and data used to support the results, subject to any 
applicable privilege, protections for confidential business 
information, or explicit prohibition on disclosure. This will increase 
transparency and permit the public to see how the Department reached 
its conclusion. By requiring publication of the Reviews and the 
underlying analyses and data, the Department also incorporated ACUS'

[[Page 5729]]

suggestion that ``[a]gencies should disclose relevant data concerning 
their retrospective analyses'' so as to ``allow private parties to 
recreate the agency's work and to run additional analyses concerning 
existing rules' effectiveness.'' \189\ The Department does not believe 
that the deliberative process privilege would generally bar disclosing 
the final underlying analyses and data referred to in section 
[XX](f).\190\
---------------------------------------------------------------------------

    \189\ 79 FR 75114, 75117 (Dec. 17, 2014); see also Exec. Order 
13563, Sec. 6(a) (Jan. 18, 2011) (``retrospective analyses, 
including supporting data, should be released online whenever 
possible''). Although this final rule incorporates several ACUS' 
recommendations, it does not incorporate all of them. This final 
rule does not set forth a prioritization scheme, although the 
Department intends to subsequently set forth a schedule for 
conducting Assessments and Reviews.
    \190\ See, e.g., Coastal States Gas Corp. v. Dep't of Energy, 
617 F.2d 854, 866 (D.C. Cir. 1980) (``[E]ven if the document is 
predecisional at the time it is prepared, it can lose that status if 
it is adopted, formally or informally, as the agency position on an 
issue or is used by the agency in its dealings with the public.'').
---------------------------------------------------------------------------

    Section [XX](f) of the proposed rule also provides that the 
document published in the Federal Register shall specify the year by 
which the next Assessment (and, if required, the next Review) of the 
Regulation shall be completed. This can be particularly helpful if the 
Department conducts an Assessment or Review of a Regulation prior to 
the deadline year.
Comments on Section [XX](f)
    HHS received the following comments on Section [XX](f) of the 
proposed rule.
    Comment: A few commenters suggested that the results of each 
Assessment and Review should be published separately in the Federal 
Register as they are completed, with a title clearly identifying the 
affected regulation and the Department's responses to the public 
comments received.
    Response: HHS respectfully disagrees that the results should be 
published on a rolling basis. Announcing the results of all Assessments 
and Reviews within a single document makes it easier for the public 
(and the Department) to determine (1) which Sections were Assessed and 
Reviewed, (2) the dates by which they were Assessed and Reviewed, and 
(3) when they next need to be Assessed and (if needed) Reviewed. 
Interested parties need only refer to a single source of information 
for a given year. Publishing all Assessments and Reviews for a given 
year in a single document also reduces the risk that a Section will 
inadvertently expire.
    The commenters' concerns about the Reviews including the 
Department's responses to public comments was already addressed in the 
proposed rule. Section [XX](d) of the proposed rule directed the agency 
to consider, as part of Reviews, ``the nature of complaints or comments 
received concerning the Regulation from the public.'' And the document 
published in the Federal Register shall include the ``full underlying 
analyses and data used to support the results (subject to any 
applicable privilege, protections for confidential business 
information, or explicit legal prohibition on disclosure.'' Section 
[XX](d)'s requirement to consider the nature of complaints or comments 
only applies to Reviews, not Assessments. Assessments are preliminary 
determinations that only focus on whether a rule making has a SEISNOSE, 
and do not require as extensive an analysis as Reviews. If the 
Department receives comments during the Assessment process, it would 
endeavor to take them into account in determining whether a rule making 
has a SEISNOSE. Moreover, as the proposed rule proposed,\191\ the 
document published in the Federal Register will be organized in a 
manner that enables both the Department and the public to readily 
determine which Assessments and Reviews were conducted during each 
calendar year.
---------------------------------------------------------------------------

    \191\ See, e.g., 85 FR 70121.
---------------------------------------------------------------------------

    Comment: Some commenters stated that the Department should commit 
to publishing results of Reviews as they are completed, or on no less 
than a monthly basis, so that the interested public can truly 
contemplate each regulation now in question.
    Response: The Department intends to publish the results of the 
Assessments and Reviews in the dockets for the applicable regulations. 
However, as compared to publishing Assessments and Reviews in the 
Federal Register on a rolling basis, announcing the results of all 
Assessments and Reviews within a single document makes it easier for 
the public (and the Department) to determine (1) which Sections were 
Assessed and Reviewed, (2) the dates by which they were Assessed and 
Reviewed, and (3) when they next need to be Assessed and (if needed) 
Reviewed. Interested parties need only refer to a single source of 
information for a given year. Publishing all Assessments and Reviews 
for a given year in a single document also reduces the risk that a 
Section will inadvertently expire. The Department will announce on a 
periodic basis when it has commenced the process of performing an 
Assessment or Review.
    Comment: A few commenters asked what role the Office of Information 
and Regulatory Affairs (OIRA) within the Office of Management and 
Budget (OMB) would have in reviewing the reports, and any proposed 
revisions to standing regulations.
    Response: As noted in the proposed rule, ``Prior to finalization, 
OIRA may review Reviews, including to coordinate inter-agency 
participation in the Review process where there are significant inter-
agency equities or as otherwise appropriate.'' \192\
---------------------------------------------------------------------------

    \192\ 85 FR 70108.
---------------------------------------------------------------------------

    Accordingly, after considering the public comments, HHS finalizes 
section [XX](f) as proposed.
Section [XX](g)
    HHS proposed in Section [XX](g) of the proposed rule that paragraph 
(c) of the proposed rule would not apply to Regulations that are 
prescribed by Federal law, such that the Department exercises no 
discretion as to whether to promulgate the Regulation and as to what is 
prescribed by the Regulation. For such Regulations that are adopted 
after the effective date of this section, the proposed rule stated that 
the Federal law described shall be cited in the notice of adoption. 
Section [XX](g) of the proposed rule also provided that paragraph (c) 
of the proposed rule would not apply to (1) Regulations whose 
expiration pursuant to this section would violate any other Federal 
law; (2) this section; (3) Regulations that involve a military or 
foreign affairs function of the United States; (4) Regulations 
addressed solely to internal agency management or personnel matters; 
(5) Regulations related solely to Federal Government procurement; and 
(6) Regulations that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    Section[XX](g)(1) of the proposed rule excepted Regulations that 
are prescribed by Federal law, such that the Department exercises no 
discretion as to whether to promulgate the Regulation and as to what is 
prescribed by the Regulation. This is only the case in rare 
circumstances. Because the Department lacks discretion over what is 
contained in these Regulations and cannot rescind them, they are 
exempted from section [XX](c). For such Regulations that are 
promulgated after the effective date of this final rule, the Department 
shall describe in the Regulation's notice of adoption the Federal law 
that results in

[[Page 5730]]

the Department having no discretion as to whether to promulgate the 
Regulation and what is prescribed by the Regulation. The proposed rule 
included this requirement so the public has notice that such 
Regulations are exempt from section [XX](c).
    Section [XX](g) of the proposed rule likewise also exempted from 
section [XX](c) any Regulation whose expiration pursuant to this 
section would violate any other Federal law. The exceptions listed in 
sections [XX](g)(1) and [XX](g)(2) of the proposed rule are not 
satisfied simply because the statutory authority for the regulation 
provides that the Secretary ``shall'' prescribe regulations. For 
example, section 804(b) of the Federal Food Drug & Cosmetic Act, 21 
U.S.C. 384(b), provides that the ``Secretary, after consultation with 
the United States Trade Representative and the Commissioner of U.S. 
Customs and Border Protection, shall promulgate regulations permitting 
pharmacists and wholesalers to import prescription drugs from Canada 
into the United States'' (emphasis added). However, although the 
statute was enacted in 2003, as of January 1, 2020 the Department had 
not issued any regulations implementing it, indicating the Department's 
view that section 804(b) did not require the Department to issue 
regulations. Similarly, Section 1102 of the Social Security Act, 42 
U.S.C. 1302, provides that the Secretary ``shall make and publish such 
rules and regulations, not inconsistent with this Act, as may be 
necessary to the efficient administration of the functions with which 
[he] is charged under this Act'' (emphasis added). But the Department 
does not believe every regulation promulgated pursuant to section 1102 
is required to have been issued, or that it would violate Federal law 
to rescind such regulations.
    Section [XX](g) of the proposed rule also exempted the proposed 
rule from section [XX](c). Assuming that no rules expire due to lack of 
Assessment or Review, the proposed rule stated that this rule cannot, 
absent other actions, directly impose on the public costs that exceed 
benefits, since the proposed rule merely would require the Department 
to periodically Assess and, in some cases, Review its Regulations. Only 
the failure to perform an Assessment or Review in the future could 
theoretically impose on the public costs that exceed benefits (assuming 
expired Regulations were on balance benefiting the public). The 
proposed rule stated that it would improve the Department's regulations 
by requiring the Department to evaluate the impact of its regulations 
and amend or rescind those regulations with a significant economic 
impact upon a substantial number of small entities that the Department 
determines should be amended or rescinded. Therefore, the rationale for 
periodic review would not apply to the proposed rule to the extent it 
applies to other Department regulations. The Department realizes that 
certain members of the regulated community might rely on particular 
regulations, but the Department proposed that it would take that into 
account when performing Assessments and Reviews. The Department 
proposed that it would only determine that a regulation should be 
amended or rescinded if the regulation's burdens outweigh these 
reliance interests and the other benefits of the regulation or if other 
factors, such as a change in law, might compel amendment or rescission. 
The Department stated in the proposed rule that it does not intend to 
avoid Assessing or, if required, Reviewing any regulation and does not 
anticipate that an important regulation would expire due to failure to 
Assess or Review it. Accordingly, the Department proposed to exempt the 
proposed rule from Section [XX](c).
    The Department also proposed in Section [XX](g) of the proposed 
rule to exempt Regulations that involve a military or foreign affairs 
function of the United States. For purposes of the proposed rule (as 
well as in this final rule), ``a military or foreign affairs function 
of the United States'' has the same meaning as that phrase has under 5 
U.S.C. 553(a). Regulations that involve a military or foreign affairs 
function of the United States were exempted from the proposed rule for 
the same reasons that Congress exempted them from the requirements of 5 
U.S.C. 553.
    Section [XX](g) of the proposed rule also exempted Regulations 
addressed solely to internal agency management or personnel matters and 
Regulations related solely to Federal Government procurement. Because 
such Regulations do not directly impact the public, the rationale for 
retrospective review is weaker with respect to these Regulations.
    The portion of the proposed rule applying to Title 42 also exempted 
42 CFR 1001.952 from expiration. 42 CFR 1001.952 provides a safe harbor 
for various payment and business practices that, although they 
potentially implicate the Federal anti-kickback statute, are not 
treated as offenses under the statute. The Department proposed to 
exempt this regulation because it was concerned that certain otherwise 
permissible behavior could become criminal simply because the 
Department did not Review this Regulation. The portion of the proposed 
rule applying to Title 42 also exempted 42 CFR part 73. 42 U.S.C. 262a 
provides that, with respect to Part 73, the ``Secretary shall review 
and republish [a list of certain biological agents and toxins] 
biennially, or more often as needed, and shall by regulation revise the 
list as necessary in accordance with such paragraph.'' Since those 
regulations are already being reviewed biennially, there was no need 
for the proposed rule to apply to 42 CFR part 73. Similarly, the 
portion of the proposed rule applying to Title 42 also exempted the 
annual Medicare Part A and Part B payment methodology update rules. 
Since these rules are amended annually, it does not make sense to 
Review them every ten years. Lastly, the portion of the proposed 
applying to Title 42 also exempted 42 CFR 100.3, since the statutory 
basis for this regulation provides that it cannot be amended unless (1) 
a proposed regulation is provided to the Advisory Committee on 
Childhood Vaccines (ACCV) and the ACCV is provided at least 90 days to 
make recommendations and comments, and (2) there is subsequently a 180-
day public comment period. See 42 U.S.C. 300aa-14(c). For these 
reasons, these regulations are also exempted from this final rule.
    Section [XX](g) of the proposed rule also exempted any Regulations 
that were issued jointly with other Federal agencies, or that were 
issued in consultation with other agencies because of a legal 
requirement to consult with that other agency. This is because the 
Department cannot on its own rescind or amend a Regulation issued 
jointly with another Federal agency. An example of regulations issued 
with other agencies because of a legal requirement to consult with 
those other agencies are the regulations issued jointly by the 
Department and the Departments of Labor and the Treasury in accordance 
with section 104 of the Health Insurance Portability and Accountability 
Act (HIPAA). This provision directs the Secretaries of HHS, Labor and 
the Treasury to ensure that regulations issued pursuant to provisions 
where the Secretaries share interpretive jurisdiction (which includes 
many of the provisions in Title XXVII of the Public Health Service 
(PHS) Act) are administered to have the same effect at all times.\193\ 
An example of jointly-issued regulations are regulations governing 
State innovation waivers under section 1332 of the

[[Page 5731]]

Patient Protection and the Affordable Care Act.\194\
---------------------------------------------------------------------------

    \193\ See Health Insurance Portability and Accountability Act of 
1996, Public Law 104-191, 110 Stat. 1936 (1996).
    \194\ See, e.g., 77 FR 11700 (Feb. 27, 2012).
---------------------------------------------------------------------------

    The Department retains these exemptions for the reasons discussed 
in the proposed rule. For the reasons discussed below, this final rule 
also exempts certain other regulations from this final rule.
Comments on Section [XX](g)
    HHS received the following comments on Section [XX](g) of the 
proposed rule.
    Comment: Several commenters asked for further clarity on the 
proposed exemptions from the proposed rule. These commenters stated 
that it is unclear how the public would know which regulations are 
eligible for an exemption under the proposed rule. They suggested that 
the Department may be interpreting ``Regulations that are prescribed by 
Federal law, such that the Department exercises no discretion as to 
whether to promulgate the Regulation and as to what is prescribed in 
the Regulation'' very narrowly, because the proposed rule stated that 
it is ``rare'' that the Department has ``no discretion as to whether to 
promulgate [a] regulation and what is prescribed by the regulation.'' 
\195\ These commenters stated that the examples given in the proposed 
rule were insufficient and open to interpretation, and members of the 
public should not be expected to be able to conduct their own statutory 
analysis. Some commenters specifically asked for at least one example 
of a regulation that would be exempted under this rule. Commenters also 
asked for examples of regulations that ``were issued in consultation 
with other agencies because of a legal requirement to consult with that 
other agency.''
---------------------------------------------------------------------------

    \195\ 85 FR 70109.
---------------------------------------------------------------------------

    Response: The Department thanks these commenters for their 
comments. Regulations that ``involve a military or foreign affairs 
function of the United States'' are regulations that would satisfy that 
standard under 5 U.S.C. 553(a)(1). ``Regulations addressed solely to 
internal agency management or personnel matters'' refers to regulations 
that would satisfy the ``matter relating to agency management or 
personnel'' standard under 5 U.S.C. 553(a)(2).\196\
---------------------------------------------------------------------------

    \196\ See, e.g., regulations amended in Update of Organizational 
References, 50 FR 8993 (Mar. 6, 1985) (``Because these amendments 
related to internal agency management and personnel and because the 
amendments are not substantive, the rule is exempt from the notice 
and comment and delayed effective date requirements of section 
553(b) and (d)(3) of the Administrative Procedure Act'').
---------------------------------------------------------------------------

    An example of regulations issued with other agencies because of a 
legal requirement to consult with those other agencies are the 
regulations issued jointly by the Department and the Departments of 
Labor and the Treasury in accordance with section 104 of HIPAA. This 
provision directs the Secretaries of HHS, Labor and the Treasury to 
ensure that regulations issued pursuant to provisions where the 
Secretaries share interpretive jurisdiction (which includes many of the 
provisions in Title XXVII of the PHS Act) are administered to have the 
same effect at all times.\197\ Such regulations constitute a small 
percentage of the Department's overall number of regulations (although 
they may have an outsize impact), and the Department is not aware of 
many regulations outside those promulgated pursuant to the relevant 
HIPAA provisions that would satisfy this exception. Regulations that 
are prescribed by Federal law, such that the Department exercises no 
discretion as to whether to promulgate the regulation and as to what is 
prescribed in the regulation is also a very small category.
---------------------------------------------------------------------------

    \197\ See Health Insurance Portability and Accountability Act of 
1996, Public Law 104-191, 110 Stat. 1936 (1996). See also 85 FR 
70110.
---------------------------------------------------------------------------

    Comment: A few commenters stated that it was disingenuous for HHS 
to specifically decide to exempt this rule from the assessment and 
review process. These commenters stated that this decision is at best 
disingenuous or at worst an attempt to permanently impose a rigid 
review structure.
    Response: HHS respectfully disagrees. This final rule does not 
permanently impose a rigid review structure, because this rule can be 
amended or rescinded under the APA. As explained in the notice of 
proposed rulemaking, the nature of this rule means that ``the rationale 
for periodic review does not apply to this proposed rule to the extent 
it applies to other Department regulations.'' \198\ This final rule 
would not become obsolete due to economic, technological, or legal 
changes the way that many other rules can.
---------------------------------------------------------------------------

    \198\ 85 FR at 70109.
---------------------------------------------------------------------------

    Comment: Several commenters stated that they do not want the annual 
Notice of Benefits and Payment Parameters (NBPP) rule to be subject to 
this rule.
    Response: The Department agrees and has decided to exempt the 
annual Notice of Benefit and Payment Parameters update rules. Just as 
the proposed rule exempted the annual Medicare payment rules, this 
final rule need not apply to NBPP rules that are already reviewed and 
updated annually. The 2021 NBPP annual rules can be found at 85 FR 
29164 (May 14, 2020). These and the equivalents for other years are 
exempt from this final rule.
Final Section [XX](g)
    Based in part on comments, the Department has decided in the 
portion of the final rule applying to Title 21, Chapter I to also 
exempt the following provisions from this final rule:
     21 CFR parts 131, 133, 135-137, 139, 145, 146, 150, 152, 
155, 156, 158, 160, 161, 163-166, 168, 169.
     21 CFR parts 331-333, 335-336, 338, 340-341, 343-344, 346-
350, 352, 355, 357, 358.
     21 CFR parts 862, 864, 866, 868, 870, 872, 874, 876, 878, 
880, 882, 884, 886, 888, 890, 892, 895, 898.
    Based in part on comments, the Department decided in the portion of 
the file rule applying to Title 45, Subchapter A, to also exempt the 
annual Notice of Benefit and Payment Parameters update rules.
    The first three bullets encompass FDA's food standard, device-
specific, and over-the-counter drug regulations that specify 
characteristics of certain foods, devices, and over-the-counter drugs. 
These are regulations that specify the characteristics of particular 
foods, devices, and over-the-counter drugs. Many of the device 
regulations are already required to be reviewed in some way every five 
years.\199\ Similarly, FDA is already undergoing a process to establish 
a set of general principles for food standards for FDA to use when 
considering whether to establish, revise, or eliminate a food 
standard.\200\ Thus, there is less need to review these regulations 
every ten years, since these are being reviewed, or new processes for 
reviewing these regulations are being established. In addition, the 
exempt food standard, device, and OTC drug regulations simply create 
product identities.
---------------------------------------------------------------------------

    \199\ See, e.g., 21 U.S.C. 360(l) (providing that ``at least 
once every 5 years thereafter, as the Secretary determines 
appropriate, the Secretary shall identify, through publication in 
the Federal Register, any type of class I device that the Secretary 
determines no longer requires a report under subsection (k) to 
provide reasonable assurance of safety and effectiveness''; 21 
U.S.C.(m) (providing that the Secretary, ``at least once every 5 
years thereafter, as the Secretary determines appropriate [ ] 
publish in the Federal Register a notice that contains a list of 
each type of class II device that the Secretary determines no longer 
requires a report under subsection (k) to provide reasonable 
assurance of safety and effectiveness'').
    \200\ See https://www.federalregister.gov/documents/2020/04/20/2020-08182/food-standards-general-principles-and-food-standards-modernization-extension-of-comment-period.
---------------------------------------------------------------------------

    As explained supra, the annual Notice of Benefit and Payment 
Parameters update rules are also now being exempt because those are 
already updated

[[Page 5732]]

annually. Thus, there is no need to Assess or Review them every ten 
years.
    In addition, whereas the proposed rule exempted in Title 42 the 
``annual Medicare Part A and Part B payment methodology update rules,'' 
this final rule exempts the ``annual Medicare payment update rules.'' 
All annual Medicare payment update rules are revised annually, so there 
is no need to require Assessment or Review of them every ten years.
    Other than adding or revising these exemptions and changing the 
term ``Regulation'' to ``Section,'' the Department finalizes Section 
[XX](g) as proposed.
Section [XX](h)
    HHS proposed in Section [XX](h) of the proposed rule that when the 
Department commences the process of performing an Assessment or Review, 
it shall state on a Department-managed website the Regulation(s) whose 
Assessment or Review it is commencing. As proposed, the public would be 
able to submit comments regarding these Regulation(s) in the manner 
specified on this website. HHS proposed that members of the public 
could also submit comments in the manner specified on the website 
requesting that the Department begin the Assessment or Review of a 
Regulation, particularly if they are concerned that the deadline is 
nearing and the Department has not stated that it has commenced the 
Assessment or Review.
    The Department included this provision in the proposed rule so 
that, when the Department is Assessing or Reviewing a regulation, the 
public can submit comments for the Department's consideration. The 
Department stated in the proposed rule that it believes this will 
maximize transparency, public participation, and the Department's 
knowledge of the real-world impacts of its regulations.
    The Department also proposed in this provision to allow the public 
to submit comments on the Department website requesting that the 
Department begin the Assessment or Review of a regulation. The 
Department stated that it considered the risk that a regulation could 
expire because the Department inadvertently did not Assess or Review 
it. The Department proposed to mitigate this risk by allowing members 
of the public to submit comments requesting that the Department 
commence the Assessment or Review of a regulation. If a person is 
concerned that the Department has not announced the Assessment or 
Review of a Regulation and the deadline is nearing, the person can 
request that the Department to conduct the Assessment or Review.
    The Department stated in the proposed rule that it intends to 
timely Assess and, where required, Review all its regulations. The 
Department noted, however, that if it has not announced that it is 
Assessing or Reviewing a Regulation, and the deadline is nearing, those 
who rely on the regulation are on notice that it might expire, just as 
the public is on notice that a regulation might be rescinded when an 
agency issues a notice of proposed rulemaking to rescind the 
Regulation.
Comments on Section [XX](h)
    HHS received the following comments on section [XX](h) of the 
proposed rule.
    Comment: Several commenters questioned the adequacy of the proposed 
process for soliciting comments on the regulations that are reaching 
their time for Assessment or Review. Some of these commenters stated 
that the public should be given ample notice of upcoming Assessments 
and Reviews, and a clear and adequate timeframe for providing comments. 
Other commenters expressed concern about the process of posting 
information regarding Assessments and Reviews to a Department-managed 
website. Some commenters stated that instead of providing notice of 
Assessments and Reviews and instructions on how to submit public 
comments exclusively on a Department-managed website, the Department 
should also put this information on the Federal Register.
    Several commenters stated that members of the public should not be 
responsible for monitoring an HHS website to see if Assessment or 
Review of a particular regulation is commencing. Some commenters cited 
the added expense on the regulated industry that would be created if an 
additional review process is created by this rule, which would 
disproportionately fall on small businesses. One commenter even 
suggested this was a purposeful decision by the Department to create a 
system that favors well-funded special interests that can afford 
lawyers and lobbyists to advocate for their favored policies. 
Commenters stated that although HHS proposes to create a website to 
enable the public to comment and request a review when the deadline for 
assessing a rule is approaching, this website would not be governed by 
APA rules and the Department would not be required to meaningfully 
respond to those comments. Commenters stated that, as a result, rules 
that govern the administration of Medicaid and CHIP and affect access 
to care for millions of beneficiaries could automatically expire 
without public comment.
    A potential solution suggested by one commenter is that the 
Department could include in the final rule a requirement that it 
include a notice of all regulations scheduled for review during the 
next 12 months in its semi-annual regulatory agendas published in the 
Federal Register. This commenter also suggested that HHS publish semi-
annually in the Federal Register a list of regulations that are 
scheduled to expire in the next 12 months if they are not Assessed and 
Reviewed.
    Other commenters requested clarification on how HHS will treat the 
comments it receives. For example, some commenters asked whether the 
comments would be included as a part of the public record. Other 
commenters mentioned that the proposed rule does not clarify whether 
HHS will be required to respond to all comments made by the public. 
These commenters asked the Department to ensure that it publicly 
display the comments it receives.
    Response: The Department appreciates these comments and seeks to 
minimize costs for the public. Accordingly, this final rule makes some 
revisions in response to these comments. Under this final rule, when 
the Department commences the process of performing an Assessment or 
Review, it shall state on a Department-managed website the Section(s) 
whose assessment or Review it is commencing. It shall also announce 
once a month in the Federal Register those new Assessments or Reviews 
that it has commenced in the last month. The Department will create a 
docket on Regulations.gov for each Assessment or Review that the 
Department is conducting. These docket numbers will be referenced in 
the Federal Register announcements. The public will be able to submit 
comments to the dockets of each rule making being Assessed or Reviewed. 
Each docket shall specify the date by which comments must be received. 
There shall also be a general docket on Regulations.gov where the 
public can submit comments requesting that the Department Assess or 
Review a regulation. These changes address the concern about putting 
the information on a Department website, rather than in the Federal 
Register. The Department anticipates that the process will be similar 
to that currently used by the EPA.\201\ The Department also intends to

[[Page 5733]]

publish the results of the Assessments and Reviews in the dockets for 
the applicable regulations.
---------------------------------------------------------------------------

    \201\ See, e.g., Regulatory Flexibility Act Section 610 Review 
of the Testing and Labeling Regulations Pertaining to Product 
Certification of Children's Products, Including Reliance on 
Component Part Testing, 85 FR 52078 (Aug. 24, 2020).
---------------------------------------------------------------------------

    Separately, in conjunction with this final rule, the Department is 
placing at https://www.hhs.gov/regulations/federal-registry/index.html 
a list of Department rule makings, the year they were initially 
promulgated, the last year the rule making was amended, and the Federal 
Register citation from the time the rule making was last amended. This 
list was generated with artificial intelligence and the Department 
believes it is accurate, but it is conceivable that some Department 
regulations are not included. This list includes all Department 
regulations, including those that may be exempt from this final rule. 
The Department believes it would be informative to the public to 
provide a list of all Department regulations, as well as their Federal 
Register citations and promulgation dates. The Department intends to 
update this list annually with newly-issued regulations. The schedule 
for Assessment and Review is discussed in Section II.F.
    HHS disagrees that this final rule is for the benefit of well-
financed special interests. As the Department observed in the proposed 
rule, empirical evidence confirms that, due to the inherent advantage 
from economies of scale, large, well-capitalized entities are better 
positioned to absorb compliance costs than small entities.\202\ By 
announcing Assessments and Reviews on Regulations.gov, and putting the 
dockets for Assessments and Reviews on Regulations.gov, this final rule 
reduces the costs associated with having to monitor two separate 
websites. The regulatory impact analysis for this final rule addresses 
the estimated impacts for this final rule, including monitoring and 
comment costs.
---------------------------------------------------------------------------

    \202\ 85 FR 70118 & n.145.
---------------------------------------------------------------------------

    Comment: A few commenters suggested that instead of the process set 
forth in the proposed rule, HHS should provide a means of soliciting 
public comment at least every ten years on the Department's existing 
rules, which the Department would then be required to consider.
    Response: The Department is incorporating aspects of this 
suggestion. This final rule makes the nature of complaints or comments 
on a regulation one of the factors to be considered when performing 
Reviews. But the commenters' suggestion by itself would not be adequate 
to address the problem. The Department's rules have always been open 
for public comment under 5 U.S.C. 553(e), yet only limited 
retrospective review has taken place, contrary to Congressional intent. 
The suggestion that the Department take a passive role in retrospective 
review is inconsistent with the RFA, which intends for HHS to engage in 
this analysis on its own initiative.
    Comment: Several commenters stated that, according to the process 
set forth in the proposed rule, it would be difficult, if not 
impossible, for the public to accurately determine whether a regulation 
is subject to an Assessment, and if so, the deadline for informing the 
agency and commenting. These commenters surmise that there could be 
scenarios where a regulation was not Assessed, but it is unclear 
whether it has expired or was exempt from the regulatory review process 
and is still in place. This could leave regulated entities subject to 
the regulation without guidance on what is expected of them, or could 
result in regulations being inadvertently removed with negative impacts 
on beneficiaries, consumers, and the public in general.
    Response: The Department respectfully disagrees. Again, as stated 
above, the Department intends to timely Assess and (if needed) Review 
its regulations. This final rule provides that un-Reviewed and un-
Assessed Sections expire based on the time elapsed since the Year of 
the Section's promulgation. To aid the public, in conjunction with this 
final rule the Department is placing at https://www.hhs.gov/regulations/federal-registry/index.html a list of Department rule 
makings, the year they were initially promulgated, the last year the 
rule making was amended, and the Federal Register citation from the 
time the rule making was last amended. This list was generated with 
artificial intelligence and the Department believes it is accurate, but 
it is conceivable that some Department regulations are not included. 
This list is meant to be an aid to the public and the Department, but 
the Federal Register and Code of Federal Regulations are what have 
legal force and determine the dates of promulgation. Moreover, a 
regulated entity can use the Federal Register and Code of Federal 
Regulations to determine the year in which a Section was promulgated. 
From there, the regulated entity can determine the year by which a 
Section must be Assessed and (if needed) Reviewed. The regulated entity 
can consult the Federal Register document containing the findings of 
the Department's Assessments and Reviews from that year to determine if 
the Section was timely Assessed and (if needed) Reviewed. This is less 
burdensome than many legal research activities that regulated entities 
need to do to determine whether they are in compliance with the law. 
Regulated entities frequently must determine whether a particular 
statute or regulation is still in effect, has been amended, or whether 
there is a proposed change to the statute or regulation before Congress 
or in front of an agency.
    Comment: Several commenters had comments related to APA petitions. 
A commenter stated that the APA also includes a process for the public 
to petition for retrospective review of existing rules. See 5 U.S.C. 
553(e). Other commenters noted the APA does not specify the process for 
receiving petitions. As a result, according to the commenters, how 
petitions are received and treated varies across--and even within--
agencies. These commenters stated that to date, HHS has not adopted any 
particular regulations concerning the form that petitions under section 
553(e) must take. Nor has HHS adopted recommendations by the 
Administrative Conference of the United States for receiving, 
processing, and responding to petitions. A few commenters noted that 
they had submitted petitions but no action had been taken to date on 
their request. For example, one commenter stated that it filed citizen 
petitions in August 2016 and February 2017 asking the agency to remove 
outdated recordkeeping requirements. Another commenter stated that in 
February 2018 it commented to the Food and Drug Administration Center 
for Veterinary Medicine (CVM) on regulations that the commenter claimed 
are outdated or needing improvement.
    Response: The Department respectfully disagrees with the 
commenters' suggestion that the petition mechanism in 5 U.S.C. 553(e) 
somehow undercuts or forecloses this final rule. Indeed, the 
substantive point of these comments--that the agency should 
retrospectively review its rules to determine whether amendment or 
rescission is necessary, especially where pressed to do so by the 
public--is fully consistent with this final rule. The commenters who 
stated they petitioned the Department to amend or rescind regulations, 
yet the Department took no action, further supports why this final rule 
is needed (although the Department takes no position in this final rule 
on whether any particular commenters' petition had merit).\203\ The 
comments

[[Page 5734]]

suggest the Department is not examining its existing regulations as 
often as is desired. Moreover, 5 U.S.C. 553(e)'s petition process does 
not make this final rule unnecessary, because there is reason to 
believe that even some rules that have not been the subject of any 
petitions would benefit from amendment or rescission.\204\ The 
literature and the Department's experience suggest that large numbers 
of regulations are having impacts that, over time, differ from what was 
estimated at the time of promulgation.
---------------------------------------------------------------------------

    \203\ See also Maeve P. Carey, Cong. Rsch. Serv., R46190, 
Petitions for Rulemaking: An Overview 1 (2020) (describing Sec.  
553(e) as ``arguably underused''); ACUS, ``Adoption of 
Recommendations,'' 79 FR 75114, 75117-18 (describing long-standing 
problems in agencies' handling of Sec.  553(e) petitions).
    \204\ See Section II, supra.
---------------------------------------------------------------------------

    Some HHS components have regulations governing petitions.\205\ But 
whether the Department should have additional or different petition 
procedures is outside the scope of this final rule, which, like 5 
U.S.C. 610, operates independently of 5 U.S.C. 553(e)'s petition 
process.
---------------------------------------------------------------------------

    \205\ See, e.g., 21 CFR 10.20, 10.30, 10.33.
---------------------------------------------------------------------------

    Comment: Some commenters stated that it was arbitrary for HHS to 
not meaningfully consider other ``strong incentives'' to revisit its 
own rules besides the process it proposes. For example, commenters 
suggested that HHS could have explored creating a petition process 
whereby parties could request review of certain rules, or could have 
convened a Federal Advisory Committee to advise the Department on which 
rules merit review. In both these scenarios, HHS could incentivize 
itself to act by giving parties a right of judicial review if the 
Department failed to respond to a petition or a Committee 
recommendation.
    Response: HHS respectfully disagrees. The APA itself already 
affords a process for petitioning for review of rules. 5 U.S.C. 553(e) 
(``Each agency shall give an interested person the right to petition 
for the issuance, amendment, or repeal of a rule.''). And denials of 
such petitions may be subject to the APA's judicial review 
procedures.\206\ Notwithstanding the existence of section 553(e), 
comprehensive retrospective review of agency rules has not taken hold. 
The literature suggests large numbers of Department regulations are 
having impacts that differ from their estimated impacts. It is unlikely 
that a Federal Advisory Committee could undertake the scale of review 
needed to comprehensively advise on which regulations merit review.
---------------------------------------------------------------------------

    \206\ See, e.g., Am. Horse Protection Assoc. v. Lyng, 812 F.2d 1 
(D.C. Cir. 1987). Case law also suggests that an agency's failure to 
respond may also be subject to judicial redress. See Jason A. 
Schwartz and Richard L. Revesz, ``Petitions for Rulemaking--Final 
Report to the Administrative Conference of the United States'' at 13 
& n.55, 28-29 (Nov. 5, 2014).
---------------------------------------------------------------------------

    Comment: Some commenters stated that the Department should provide 
clear notice to the public of when a Regulation may be about to expire, 
and provide actual notice of rescissions.
    Response: The Department reiterates its previous response to a 
similar comment. The Department intends to timely Assess and, where 
required, Review all its regulations. However, if the Department has 
not announced that it is Assessing or Reviewing a regulation, and the 
deadline is nearing, the public is on notice that it might expire, just 
as the public is on notice that a regulation might be rescinded when an 
agency issues a notice of proposed rulemaking to rescind the 
regulation.\207\ Moreover, section [XX](f) requires that the 
Department, in announcing the results of Assessments and Reviews, 
``shall also specify the year by which the next assessment (and, if 
required, the next review) of the Section shall be completed.''
---------------------------------------------------------------------------

    \207\ 85 FR 70110.
---------------------------------------------------------------------------

    The Department plans to periodically announce in the Federal 
Register regulations that have expired, and have the Code of Federal 
Regulations revised accordingly.
Final Section [XX](h)
    Accordingly, based on public comments, HHS finalizes section 
[XX](h) to provide that when the Department commences the process of 
performing an Assessment or Review, it shall state on a Department-
managed website the Section(s) whose Assessment or Review it is 
commencing. It shall also announce once a month in the Federal Register 
those new Assessments or Reviews that it has commenced in the last 
month. The Department will create a docket on Regulations.gov for each 
Assessment or Review that the Department is conducting. The public will 
be able to submit comments to the dockets of each rule making being 
Assessed or Reviewed. Each docket shall specify the date by which 
comments must be received. There shall also be a general docket on 
Regulations.gov where the public can submit comments requesting that 
the Department assess or review a Section.
Section [XX](i)
    Lastly, the proposed rule included a severability clause. The 
Department stated in the proposed rule that it believes the proposed 
rule fully complies with applicable law, but does not wish to see the 
entire proposed rule vacated in the event that a portion of it is 
vacated. For example, the Department does not wish to see the entire 
final rule vacated because one of the exceptions listed in section 
[XX](g) is invalidated. However, the Department requested comment in 
the proposed rule on whether the amendments to add expiration dates 
should be severable from other portions of the proposed rule, including 
the requirements to perform Assessments and Reviews. The Department 
stated that it was requesting comments on this because it is not clear 
that the proposed rule could properly function without the expiration 
dates.
    HHS received no comments specific to Section [XX](i) of the 
proposed rule.
    Accordingly, for the reasons stated in the proposed rule, HHS 
finalizes the provisions of Section [XX](i) as proposed.
Additional Comments on Particular Regulations
    Comment: Commenters identified certain regulations that they would 
not want to expire under the proposed rule. These regulations include, 
but are not limited to:
     Regulations implementing Medicare, Medicaid, CHIP, and 
other large programs that HHS administers.
     Regulations implementing the Affordable Care Act (ACA).
     Regulations that operate Temporary Assistance for Needy 
Families (TANF) program, the Child Care and Development Fund (CCDF) 
program, Head Start and Early Head Start Programs, and the Family 
Violence Prevention and Services (FVPSA) Program.
     FDA Regulations at 21 CFR Chapter 1.
     Provisions at 42 CFR 435.603 which determine financial 
eligibility using the Modified Adjusted Gross Income (MAGI) 
methodologies.
     Regulations implementing Income and Eligibility 
Verification requirements at 42 CFR 435.940-435.965.
     42 CFR 435.907, related to Medicaid application 
requirements.
     Medicaid cost-sharing regulations.
     Regulations governing Medicaid waivers, including Section 
1115 and Section 1332 waivers and Home & Community-Based Services 
(HCBS) waivers.
     Fair Hearings for Applicants and Beneficiaries 
requirements in 42 CFR 431 Subpart E.
     Confidentiality regulations in 42 CFR part 431 Subpart F.
     Regulations relating to comparability or services for 
groups of

[[Page 5735]]

beneficiaries and sufficiency of amount, duration, and scope of 
Medicaid services, found at 42 CFR 440.230-440.250.
     The Medicaid balanced billing regulation at 42 CFR 447.15.
     Regulations that shape children's access to care in a wide 
range of areas, including but not limited to: 42 CFR 438.1-438.930--
Medicaid Managed Care; 42 CFR 447.56--Limitations on premiums and cost 
sharing; 42 CFR 447.203--Documentation of access to care and service 
payment rates; 42 CFR 447.204--Medicaid provider participation and 
public process to inform access to care; 42 CFR 447.400--Payments for 
Primary Care Services Furnished by Physicians; 42 CFR 410.78--
Telehealth services; 45 CFR 156.10-156.1256--Health Insurance Issuer 
Standards Under the Affordable Care Act, Including Standards Related to 
Exchanges.
     Regulations concerning infant formula, including: 21 CFR 
101: Food Labeling; 21 CFR 105.65: Infant Foods; 21 CFR 106: Infant 
Formula Requirements Pertaining to Current Good Manufacturing Practice, 
Quality Control; Procedures, Quality Factors, Records and Reports, and 
Notifications; 21 CFR 107: Infant Formula; and 21 CFR 312: 
Investigational New Drug Application.
     Regulations implementing the Vaccines for Children Program 
at 42 CFR 441.600-441.615 and Grants for Childhood Immunization 
Programs at 42 CFR 51b.201-51b.206.
     Regulations implementing title IV-E programs that HHS 
administers, which provide funds for States and Tribes to provide 
foster care, transitional independent living programs for children, 
guardianship assistance, and adoption assistance for children with 
special needs at 45 CFR part 1356.
     Regulations that pertain to maternal and child health 
project grants administered by the Health Resources and Services 
Administration's Maternal and Child Health Bureau at 42 CFR 51a.1-42 
CFR 51a.8.
     Medicaid regulations that outline the mandatory and 
optional benefits that States commonly use to finance home visiting 
services, such as: Extended pregnancy services (42 CFR 440.210, 42 CFR 
440.220); Targeted case management (42 CFR 440.169(b)); Medical or 
other remedial care by licensed practitioners (42 CFR 440.60); Early 
and Periodic Screening, Diagnostic and Treatment (42 CFR 440.40(b)); 
Medicaid Administrative Claiming (42 CFR 433.15); and Managed care (42 
CFR part 438).
     Regulations in 45 CFR Subchapter B that require insurance 
coverage of essential health benefits (EHBs) such as preventive health 
services, prohibit preexisting condition exclusions, and establish fair 
practices in setting health insurance premiums and mental health 
parity, among other protections.
     Regulations in 42 CFR part 441, which sets forth State 
Medicaid plan requirements and Federal Financial Participation for 
specific services. Commenters specifically mentioned Early and Periodic 
Screening, Diagnosis, and Treatment (EPSDT) regulations found 
throughout Part 441, which provide essential comprehensive and 
preventive services to children who are covered by Medicaid.
     Regulations that protect nursing home patients by 
requiring reasonable promptness for medical assistance fair hearing 
obligations (42 CFR 435.930(a), 42 CFR 431.10(c)(3); 435.1200(b).
     Regulations found in 42 CFR part 483 protecting long term 
care facility residents, and specifically Subpart G, which protects 
children in psychiatric residential treatment facilities (PRTFs) from 
restraint and seclusion used as a means of ``coercion, discipline, 
convenience or retaliation.''
     Regulations found in 42 CFR part 460, implementing 
Programs of All-Inclusive Care for the Elderly (PACE).
     Regulations implementing the Medicare Low Income Subsidy 
program under 42 CFR part 423.
     Regulations at 42 CFR part 438 which implement Medicaid 
Managed Care.
     Regulations related to food ingredients, including color 
additives (21 CFR parts 70-82), Generally Recognized as Safe (GRAS) 
regulations, and procedural regulations governing the agency's 
premarket review functions, among others.
     Regulations implementing the Food Safety Modernization Act 
(FSMA), Good Manufacturing Practices (GMPs), low acid canned foods/
acidified foods (LACF/AF), Hazard Analysis and Critical Control Point 
(HACCP) regulations for juice and seafood, Dietary Supplement GMPs, 
import/export requirements, and infant formula, among others).
     Nutrition labeling regulations.
     Regulations implementing Food Standards of Identity and 
Quality (e.g., dairy standards, bottled water (21 CFR 165.110), cacao 
products, and other food categories).
     Regulations implementing the Family Smoking Prevention and 
Tobacco Control Act (the ``TCA'').
     Regulations governing the Indian health system, the Indian 
Health Service's (IHS) Tribal Self-Governance program, and Indian 
specific provisions in the Medicaid, Medicare CHIP and Marketplace 
regulations.
     Regulations implementing the Indian Child Welfare Act, 
which impacts all Indian Health Service regulations (42 CFR parts 136 
and 136a) and the Department's Tribal Self-Governance regulations (42 
CFR part 137).
     Regulations implementing the Mental Health Parity and 
Addiction Equity Act (MHPAEA), which requires that mental health and 
substance use disorder coverage be comparable to general medical 
coverage.
     Regulations that implement programs authorized by the 
Developmental Disabilities Assistance and Bill of Rights Act that help 
ensure people with intellectual or developmental disabilities and their 
families have access to needed community services and individualized 
supports, and other programs that are important to people with 
disabilities, such as the Independent Living programs and critical 
safety net programs such as Medicaid.
     42 CFR 457.520, relating to cost sharing for well-baby and 
well-child care services.
     Regulations in 42 CFR part 407 relating to Hospital 
Insurance Entitlement and Supplementary Medical Insurance Enrollment 
and Entitlement, Part B enrollment including so-called state buy-in 
plans would harm seniors, and retroactive liability for Part B premiums 
when a beneficiary loses eligibility for a buy-in plan.
     Provisions found at 45 CFR 146.136 that apply the federal 
law requiring parity between private health insurance coverage for 
physical ailments and for mental illness and substance use disorders 
would be at risk.
     Regulations that implement the Title X Family Planning 
Program.
     Regulations guiding the practice of social work.
     Regulations implementing the Health Insurance Portability 
and Accountability Act of 1996 (HIPAA), found in 45 CFR parts 160, 162, 
and 164, particularly 45 CFR 164.502, which clarifies and strengthens 
privacy protections people with HIV.
     Preadmission Screening and Resident Review (PASRR) 
regulations found at 483.100 through 483.138.
     Regulations protecting the confidentiality of Substance 
Use Disorder (SUD) patient records, found at 42 CFR part 2.
     Regulations that prohibit insurance plans and issuers from 
imposing

[[Page 5736]]

financial requirements or treatment limitations on mental health and 
SUD benefits that are more restrictive than those that apply to 
medical/surgical benefits.
     Office of Human Research Protections (OHRP) regulations in 
45 CFR part 46, and FDA regulations at 21 CFR part 50, which protect 
human research subjects.
     Regulations in 45 CFR part 96, which govern block grants.
     42 CFR 489.24, related to the special responsibilities of 
Medicare hospitals in emergency cases.
     Regulations concerning Section 1557 of the Affordable Care 
Act, which prevents discrimination on the basis of race, sex, sexual 
orientation, and gender identity in healthcare settings.
     Regulations implementing the Ryan White Program
     Regulations governing Medicare's Six Protected Classes.
     Regulations related to the Congregate and Home-Delivered 
Nutrition Programs.
     Regulations related to over-the-counter medicine products.
     Regulations at 42 CFR 425.612 identify the circumstances 
under which specific payment regulations are waived under the 
accountable care organization (ACO) program.
     Regulations related to non-emergency medical 
transportation (NEMT).
     Regulations affecting the domestic and global seafood 
industry.
     Regulations affecting the pet food industry.
     Regulations implementing the Medicare Modernization Act, 
such as 42 CFR 422.2268, which establishes standards for marketing by 
MA plans.
     Regulations requiring CMS programs to include an 
extraordinary circumstances exception (ECE) policy for natural 
disasters and other circumstances (see 42 CFR 412.140(c)(2) for the 
inpatient quality reporting (IQR) program and 42 CFR 412.160(c)(1)-(4) 
for the value-based purchasing program).
     Regulations at 42 CFR 441.62, which require, according to 
the commenters, that states assure transportation for periodic 
screening and treatment for Medicaid eligible children, and regulations 
at 42 CFR 440.170(a), which provide the definition for what constitutes 
transportation, e.g., ambulance, taxicab, common carrier or other 
appropriate means, as well as meals and lodging for both the child and 
necessary attendant.
     42 CFR 440.230(b)-(d), which requires that services be 
``sufficient in amount, duration, and scope to reasonably achieve their 
purpose,'' directs states not to ``arbitrarily deny or reduce the 
amount, duration, or scope of such services to an otherwise eligible 
individual solely because of the diagnosis, type of illness, or 
condition,'' and permits states to place appropriate limits on a 
service based on such criteria as ``medical necessity'' or on 
utilization review criteria.
     42 CFR 435.831, which establishes the standards for 
determining eligibility for the ``medically needy''--an optional 
category that may enable aged, blind and disabled persons in certain 
states who have ``excess income'' above the Medicaid limits to qualify 
for Medicaid, if they incur certain medical expenses.
     42 CFR 415.174 Exception: Evaluation and management 
services furnished in certain centers.
     42 CFR 457.496--Parity in mental health and substance use 
disorder benefits.
     42 CFR 457.410--Health benefits coverage options.
     What commenters characterized as many highly important and 
sensitive Medicare provisions in Title 42, CFR parts 400-499 that 
directly impact beneficiaries and health care providers. Some of these 
provisions include beneficiary and provider appeal rights (Part 405); 
Part A eligibility and entitlement provisions (Part 406); Part B 
enrollment and entitlement provisions (Part 407); provisions that 
outline the scope of Part A Benefits, including hospital and skilled 
nursing facility coverage (Part 409); Medicare Advantage coverage rules 
and enrollee protections (Part 422); and, Part D prescription drug 
parameters (Part 423).
    Response: The Department thanks the commenters for identifying 
these regulations. The Department intends to timely Assess and (if 
necessary) Review these regulations.
    Comment: Commenters identified certain regulations for which they 
would like the Department to prioritize amendment through its proposed 
retrospective regulatory review process. These regulations include, but 
are not limited to:
     Regulations mandated for review by the 21st Century Cures 
Act, Public Law 114-255, sec. 2034, 130 Stat. 1033 (2016). Section 2034 
of that Act requires the Secretary to lead a review by research funding 
agencies of all regulations and policies related to the disclosure and 
reporting of financial conflicts of interest to reduce administrative 
burden on federally funded researchers. It also calls for the Secretary 
to harmonize the differences between the Basic HHS Policy for the 
Protection of Human Research Subjects (45 CFR part 46, subpart A) and 
the FDA regulations for the protection of human subjects (21 CFR parts 
50 and 56). Commenters stated that these regulations are well overdue 
for assessment and review.
     Regulations covering access to skilled therapy services, 
which commenters say must be updated to reflect the national settlement 
in the Jimmo v. Sebelius litigation to codify the fact that skilled 
services are covered for Medicare beneficiaries not just to improve 
function, but to maintain or prevent deterioration in function.
     The dockets established by FDA's Center for Food Safety 
and Applied Nutrition and Center for Veterinary Medicine on Sept. 8, 
2017,\208\ in which the Centers requested comments and information to 
assist in identifying existing regulations and related paperwork 
requirements that could be modified, repealed or replaced, consistent 
with the law, to achieve meaningful burden reduction while allowing FDA 
to achieve its public health mission and fulfill statutory obligations 
are examples of incomplete regulatory review initiatives.\209\ 
Commenters stated that despite submitting extensive comments that 
detailed numerous regulations that they believe could be modified, 
repealed or replaced, the agency did not take any further action.
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    \208\ E.g., Nonrulemaking Docket FDA-2017-N-5093: Review of 
Existing General Regulatory and Information Collection Requirements 
of the Food and Drug Administration, https://beta.regulations.gov/docket/FDA-2017-N-5093.
    \209\ See Review of Existing General Regulatory and Information 
Collection Requirements of the Food and Drug Administration, 82 FR 
42506 (Sept. 8, 2017); FDA-2017-N-5093, https://beta.regulations.gov/docket/FDA-2017-N-5093.
---------------------------------------------------------------------------

    Response: The Department thanks the commenters for identifying 
these regulations. The Department intends to timely Assess and (if 
necessary) Review these regulations. If the Assessments and Reviews 
suggest these regulations should be amended or rescinded, the 
Department will commence rulemaking to amend or rescind them.
    Comment: Commenters identified certain regulations that they would 
want amended or rescinded. These regulations include, but are not 
limited to:
     What the commenters characterized as unnecessary burdens 
in post-acute care (PAC) regulations.
     What the commenters characterized as the outdated and 
inappropriate ``in the home'' requirement for coverage of durable 
medical equipment (DME), which commenters believe significantly limits 
the mobility devices available to beneficiaries with mobility 
disabilities.

[[Page 5737]]

    Response: The Department thanks the commenters for identifying 
these regulations. The Department intends to timely Assess and (if 
necessary) Review these regulations. If the Assessments and Reviews 
suggest these regulations should be amended or rescinded, the 
Department will commence rulemaking to amend or rescind them.
    Comment: Some commenters provided feedback on what baseline the 
Department could use when conducting an analysis of an existing 
regulation. Commenters suggested that HHS could simply conduct an ex 
ante analysis of how the regulation is likely to perform going forward 
compared with the baseline scenario of what would happen if the 
regulation were allowed to expire. The benefits of this approach, 
according to the commenters, are that HHS already produces ex ante 
analyses (so this approach would not be departing from present 
practices), the analysis could still include a backward-looking 
component to the extent that data on past performance could be used to 
forecast the regulation's future performance, and the regulation's 
future performance is what should ultimately determine whether the 
regulation should continue as-is or be amended or rescinded. Another 
option, according to commenters, is that the Department could perform a 
retrospective cost-benefit analysis that looks at how the regulation 
performed relative to the baseline of what would have happened in the 
absence of the regulation, or relative to the regulation as it stood 
before it was last significantly amended.
    Response: The Department appreciates this comment. The comments 
suggest different approaches may make sense for different regulations. 
Accordingly, the Department declines to adopt in this final rule a 
single method for conducting retrospective reviews. Reviews must be 
conducted in a manner that is not arbitrary and capricious under the 
APA, so that will provide a minimum level of rigor that all Reviews 
will have to meet, though different methodologies may be appropriate in 
different cases. The Department intends to take into account these 
comments when conducting Reviews pursuant to this final rule.

V. Regulatory Impact Analysis (Executive Orders 12866, 13563, 13771)

A. Executive Order 12866 Determination

    Executive Order 12866 directs agencies to assess the costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary and not prohibited by statute, to select regulatory 
approaches that maximize net benefits. Section 3(f) of Executive Order 
12866 defines a ``significant regulatory action'' as an action that is 
likely to result in a regulation (1) having an annual effect on the 
economy of $100 million or more in any one year, or adversely and 
materially affecting a sector of the economy, productivity, 
competition, jobs, the environment, public health or safety, or State, 
local, or tribal governments or communities (also referred to as 
``economically significant''). OMB has designated this rule as 
economically significant for the purposes of Executive Order 12866. 
This regulatory impact analysis fulfills analytical obligations under 
section 3(f) of Executive Order 12866 for economically significant 
rulemakings.\210\
---------------------------------------------------------------------------

    \210\ This analysis was informed by public comments and also by 
work of Dr. James Broughel.
---------------------------------------------------------------------------

B. Need for Regulation

    The first principle of regulation, according to Executive Order 
12866, is that ``Each agency shall identify the problem that it intends 
to address (including, where applicable, the failures of private 
markets or public institutions that warrant new agency action) as well 
as assess the significance of that problem.'' The regulation being 
finalized by the Department addresses lax compliance with periodic 
review requirements under the Regulatory Flexibility Act (RFA) of 1980 
and the need to periodically review existing regulations to determine 
if they are having their intended impacts. Section 610 of the RFA calls 
upon the Department to have a plan to conduct periodic reviews of its 
regulations that have or will have a significant economic impact upon a 
substantial number of small entities (SEISNOSE). The RFA directs 
agencies to consider the following factors as part of those reviews: 
(1) The continued need for the rule; (2) the nature of complaints or 
comments received concerning the rule from the public; (3) the 
complexity of the rule; (4) the extent to which the rule overlaps, 
duplicates or conflicts with other rules; and (5) the length of time 
since the rule has been evaluated or the degree to which technology, 
economic conditions, or other factors have changed in the area affected 
by the rule.
    A review of department semi-annual agenda reports over the last ten 
years, as well as a review of specific rules identified in those 
agendas as completed rulemakings resulting from section 610 reviews, 
indicated three completed final rulemakings that emanated from section 
610 reviews since 2011.\211\ (These rules are presented in table 1 
below). To put this in context, the Department estimates it has roughly 
18,000 regulations under its purview and that five regulations on 
average are part of the same rulemaking. Further, (as discussed in more 
detail below) the Department estimates approximately 11% of its 
regulations have a SEISNOSE, which suggests that approximately 396 
Department rulemakings have a SEISNOSE. The three rules in table 1 
amend approximately 130 sections of the CFR. (If an average rulemaking 
contains five sections, 130 sections correspond to the number of 
sections on average in approximately 26 rulemakings.) Given that 
Section 610 of the RFA sets a 10-year schedule for review of 
rulemakings, one might expect that roughly ten percent of regulations 
with a SEISNOSE would be reviewed each year, which would be 
approximately 40 rulemakings every year.\212\ Moreover, many of these 
regulations should likely be updated to reflect evolving circumstances. 
However, this does not appear to be occurring.\213\
---------------------------------------------------------------------------

    \211\ Note that some rules labeled as 610 reviews in Department 
semi-annual agendas were not, in actuality, a result of section 610 
reviews.
    \212\ There are roughly 3,600 rulemakings (18,000 divided by 5). 
11% of this figure is 396. Ten percent of 396 is roughly 40.
    \213\ A review of Department semiannual regulatory agendas 
issued between June of 2016 and August of 2020 confirms the three 
rules listed in table 1 are the only three final rulemakings to be 
completed in the last five years that are also associated with 
section 610 reviews. One rule, 0938-AT23, was merged with another 
rule, 0938-AS21. See Dept. Health & Human Servs., Semiannual 
Regulatory Agenda, 81 FR 37,294 (Jun. 9, 2016); 81 FR 94742 (Dec. 
23, 2016); 82 FR 40278 (Aug. 24, 2017); 83 FR 27126 (Jun. 11, 2018); 
83 FR 58020 (Nov. 16, 2018); 84 FR 29624 (Jun. 24, 2019); 84 FR 
71130 (Dec. 26, 2019); and 85 FR 52704 (Aug. 26, 2020).

[[Page 5738]]

                      Table 1--Final Actions as a Result of Section 610 Reviews Since 2011
----------------------------------------------------------------------------------------------------------------
                                                                                         Regulatory changes made
        Name of rulemaking           CFR citation and                Year                as a result of Section
                                           RIN                                                 610 reviews
----------------------------------------------------------------------------------------------------------------
Medicare and Medicaid Programs;    42 CFR Parts 403,    2019 (Final Rule).............  Reformed Medicare
 Regulatory Provisions To Promote   416, 418, 441,                                       regulations that were
 Program Efficiency,                460, 482, 483,                                       identified as
 Transparency, and Burden           484, 485, 486,                                       unnecessary, obsolete,
 Reduction; Fire Safety             488, 491, and 494.                                   or excessively
 Requirements for Certain          RIN 0938-AT23......                                   burdensome on health
 Dialysis Facilities; Hospital                                                           care providers and
 and Critical Access Hospital                                                            suppliers, and
 (CAH) Changes To Promote                                                                increased the ability
 Innovation, Flexibility, and                                                            of health care
 Improvement in Patient Care.                                                            professionals to devote
                                                                                         resources to improving
                                                                                         patient care by
                                                                                         eliminating or reducing
                                                                                         requirements that
                                                                                         impede quality patient
                                                                                         care or that divert
                                                                                         resources away from
                                                                                         furnishing high quality
                                                                                         patient care. Updated
                                                                                         fire safety standards
                                                                                         for Medicare and
                                                                                         Medicaid participating
                                                                                         End-Stage Renal Disease
                                                                                         (ESRD) facilities by
                                                                                         adopting the 2012
                                                                                         edition of the Life
                                                                                         Safety Code and the
                                                                                         2012 edition of the
                                                                                         Health Care Facilities
                                                                                         Code, and updated the
                                                                                         requirements that
                                                                                         hospitals and Critical
                                                                                         Access Hospitals must
                                                                                         meet to participate in
                                                                                         the Medicare and
                                                                                         Medicaid programs.
                                                                                         Requirements were
                                                                                         intended to conform to
                                                                                         current standards of
                                                                                         practice and support
                                                                                         improvements in quality
                                                                                         of care, reduce
                                                                                         barriers to care, and
                                                                                         reduce some issues that
                                                                                         may exacerbate
                                                                                         workforce shortage
                                                                                         concerns.
Medicare and Medicaid Programs;    42 CFR Parts 409,    2017 (Final Rule).............  Revised the conditions
 Conditions of Participation for    410, 418, 440,                                       of participation that
 Home Health Agencies.              484, 485 and 488.                                    home health agencies
                                   RIN 0938-AG81......                                   (HHAs) must meet in
                                                                                         order to participate in
                                                                                         the Medicare and
                                                                                         Medicaid programs. The
                                                                                         new requirements focus
                                                                                         on the care delivered
                                                                                         to patients by HHAs,
                                                                                         reflect an
                                                                                         interdisciplinary view
                                                                                         of patient care, allow
                                                                                         HHAs greater
                                                                                         flexibility in meeting
                                                                                         quality care standards,
                                                                                         and eliminate
                                                                                         unnecessary procedural
                                                                                         requirements.
Medicare and Medicaid Programs;    42 CFR Parts 405,    2016 (Final Rule).............  Revised the requirements
 Reform of Requirements for Long-   431, 447, 482,                                       that Long-Term Care
 Term Care Facilities.              483, 485, 488, and                                   facilities must meet to
                                    489.                                                 participate in the
                                   RIN 0938-AR61......                                   Medicare and Medicaid
                                                                                         programs. These changes
                                                                                         are necessary to
                                                                                         reflect the substantial
                                                                                         advances that have been
                                                                                         made over the past
                                                                                         several years in the
                                                                                         theory and practice of
                                                                                         service delivery and
                                                                                         safety.
----------------------------------------------------------------------------------------------------------------

    The Department's limited success in performing retrospective 
regulatory review is further supported by a regulatory reform project 
the Department piloted, which utilized AI-driven data analysis. 
Machine-learning algorithms identified over 1,200 CFR section citations 
that merited consideration for reform and 159 CFR sections that could 
benefit from regulatory streamlining based on their similarities to 
other sections.\214\ That project uncovered that 85% of Department 
regulations created before 1990 have not been edited, and that the 
Department has nearly 300 broken citation references in the CFR (i.e., 
CFR sections that reference other CFR sections that no longer 
exist).\215\ These findings are consistent with a 2018 study by the 
same consulting firm that estimated that 68 percent of federal 
regulations have never been updated.\216\ These findings suggest 
regulations are not being updated to reflect evolving economic 
conditions and technology, even though this is a goal of the RFA.
---------------------------------------------------------------------------

    \214\ Regulatory Streamlining & Analysis, at 11 (Mar. 2019).
    \215\ Id.
    \216\ William D. Eggers & Mike Turley, The Future of Regulation: 
Principles for Regulating Emerging Technologies, Deloitte Ctr. for 
Gov't Insights (2018), https://www2.deloitte.com/content/dam/Deloitte/lu/Documents/risk/lu-future-of-regulation.pdf.
---------------------------------------------------------------------------

    Machine-learning tools also demonstrate the complexity of 
Department rules--and reducing complexity is another goal of the RFA. 
See, e.g., 5 U.S.C. 610(b)(3). Data from the Mercatus Center show that 
the Department's regulations in 2019 received a Shannon entropy score 
of 8.2. Shannon Entropy is a measure of complexity based on the amount 
of information contained in text. It can be thought of as measuring the 
number of new ideas that are introduced in a document, or, 
alternatively, how much computational effort would be required to 
understand a document. To put the Shannon entropy score into context, a 
typical Shakespeare play receives a Shannon entropy score of 8.0. The 
complexity of Department regulations is not entirely surprising given 
that regulations often involve science, engineering, or other highly 
technical material. However, having regulations that are more complex 
than a typical Shakespeare play would seem to be at odds with various 
directives that fall on the Department for regulations to be simple, 
easy to understand, and written in plain language.\217\
---------------------------------------------------------------------------

    \217\ See, e.g., Exec. Order No. 12866; Exec. Order 13563, sec. 
1; and various presidential memoranda and guidance on plain 
language.

         Table 2--2019 Shannon Entropy Score for HHS Regulations
------------------------------------------------------------------------
                                                               Shannon
                         Department                            entropy
                                                                score
------------------------------------------------------------------------
Department of Health and Human Services....................          8.2
------------------------------------------------------------------------
Source: Quantgov.org.

    Without a consistent process for periodically reviewing 
regulations, there is no guarantee that regulations will be

[[Page 5739]]

reviewed and revised to align with technological, economic, and other 
developments. Section 5 of Executive Order 12866 requires agencies to 
submit to the Office of Information and Regulatory Affairs (OIRA) a 
plan to periodically review their existing significant regulations to 
determine whether any such regulations should be modified or eliminated 
so as to make the agency's regulatory program more effective in 
achieving regulatory objectives, less burdensome, or in greater 
alignment with the President's priorities and principles. Section 6 of 
Executive Order 13563 similarly requires agencies to submit to OIRA a 
plan to periodically review their existing significant regulations to 
determine whether any such regulations should be modified, streamlined, 
expanded, or repealed so as to make the agency's regulatory program 
more effective or less burdensome in achieving regulatory objectives.
    However, existing executive orders have not institutionalized a 
process for retrospective review and periodic updating of regulations, 
as evidenced by the fact that relatively few Department regulations are 
updated. Furthermore, every president since Jimmy Carter, including all 
those elected after enactment of 5 U.S.C. 610, has ordered some form of 
retrospective review of regulations,\218\ with mixed effects. This 
suggests that stronger incentives and forcing mechanisms are needed to 
ensure retrospective review occurs to an appropriate extent.
---------------------------------------------------------------------------

    \218\ See Exec. Order No. 12044 of Mar. 23, 1978, 43 FR 12661 
(Mar. 24, 1978) (President Carter) (revoked by Exec. Order No. 12291 
of Feb. 17, 1981, 46 FR 13193 (Feb. 19, 1981) (President Reagan)); 
Memorandum on Reducing the Burden of Government Regulation (Jan. 28, 
1992) (President H.W. Bush); Exec. Order No. 12866 of Sept. 30, 
1993, 58 FR 190 (Oct. 4, 1993) (President Clinton); Exec. Order No. 
13563 of Jan. 18, 2011, 76 FR 3821 (Jan. 21, 2011) (President 
Obama); Exec. Order No. 13771 of Jan. 30, 2017, 82 FR 9339 (Feb. 3, 
2017) (President Trump).
---------------------------------------------------------------------------

    Some commenters suggested that a review of existing regulations 
does not make sense during a pandemic, but this misses the broader 
point that the Department has waived, suspended, or exercised 
enforcement discretion not to enforce many regulations in order to 
respond to the pandemic.\219\ Had the Department not done so, this may 
have hampered the Department's ability to respond nimbly, flexibly and 
quickly to the emergency.\220\ For example, the Department has issued 
waivers or exemptions, or exercised enforcement discretion with respect 
to, certain Medicare, Medicaid, CHIP, and HIPAA restrictions, including 
waivers to increase hospital capacity, ease restrictions on services 
rendered by medical residents, and allow patients to seek more services 
via telehealth. Meanwhile, other regulations that may have facilitated 
pandemic response have remained in place.
---------------------------------------------------------------------------

    \219\ See Regulatory Relief to Support Economic Recovery; 
Request for Information (RFI), 85 FR 75720, at Attachment A (Nov. 
25, 2020).
    \220\ See, for example, Alec Stapp, ``Timeline: The 
Regulations--and Regulators--That Delayed Coronavirus Testing,'' The 
Dispatch (March 20, 2020).
---------------------------------------------------------------------------

    The Department's position is that retrospective review would 
require some change from the status quo, and unless there is a strong 
incentive to change, continuing business as usual is the path of least 
resistance.\221\ Thus, the status quo is maintained. Moreover, 
rescinding a regulation that has already been promulgated is likely to 
meet greater resistance than resistance to foregoing promulgating a 
regulation not yet enacted. This reflects a phenomenon known as loss 
aversion.\222\
---------------------------------------------------------------------------

    \221\ See also Yoon-Ho Alex Lee, An Options Approach to Agency 
Rulemaking, 65 Admin. L. Rev. 881, 895-96 (2013) (positing reasons 
why agencies may be reluctant to perform retrospective reviews).
    \222\ Daniel Kahneman et al., Anomalies: The Endowment Effect, 
Loss Aversion, and Status Quo Bias, 5 J. Econ. Persp. 193 (1991).
---------------------------------------------------------------------------

    The Department's determination is that this final rule will address 
these issues by changing the choice architecture facing the Department 
by enacting a new default rule when the Department fails to conduct 
retrospective reviews. Sunset provisions change the default from rules 
staying on the books indefinitely to rules being eliminated after some 
predetermined amount of time unless evidence is presented for why rules 
should continue. When a default rule is changed, the choice 
architecture confronting decision makers is altered and can spur 
changes in behavior. A consistent finding in the literature on 
behavioral anomalies is that choice architecture and default rules have 
an important influence on decision making.\223\ Changes in the 
Department's choice architecture can ultimately result in changes in 
public wellbeing.
---------------------------------------------------------------------------

    \223\ Richard H. Thaler et al., Choice Architecture, in The 
Behavioral Foundations of Public Policy 428, (Eldar Shafir ed., 
2012).
---------------------------------------------------------------------------

    To conclude, this final rule is intended to address a failure to 
periodically review regulations as often as desired in line with the 
RFA and other directives for retrospective review. The Department 
believes that this final rule, by changing the default for regulations 
from continued existence to expiration unless periodic review is 
conducted, will result in more widespread retrospective review of 
regulations. Requiring the expiration of rules that have not been 
assessed or reviewed in accordance with section 610 of the RFA should 
result in more regulations being updated to reflect evolving 
circumstances.

C. Alternatives Considered

    The Department considered several alternatives to the proposed 
regulation. First, it considered not issuing this final rule. However, 
the RFA and certain Executive Orders direct the Department to 
periodically review certain Department regulations. Moreover, the 
literature and the Department's experience suggest that large numbers 
of regulations are having estimated impacts that, over time, differ 
from what was estimated at the time the regulations were promulgated, 
so many regulations should be periodically reviewed.\224\ The 
Department's experience over the last forty years is that, absent a 
strong incentive such as the potential expiration of a regulation, the 
Department will not review an adequate number of its regulations.
---------------------------------------------------------------------------

    \224\ Office of Mgmt. & Budget, Validating Regulatory Analysis: 
2005 Report to Congress on the Costs and Benefits of Federal 
Regulations and Unfunded Mandates on State, Local, and Tribal 
Entities, at 46-47 (2005), http://perma.cc/R8LX-BQMJ (collecting 
studies comparing ex ante and ex post analyses of regulations' costs 
and benefits, including examples where cost and benefit estimates 
were off by more than a factor of ten); Winston Harrington, Grading 
Estimates of the Benefits and Costs of Federal Regulation 33 (Res. 
for the Future, Discussion Paper 06-39, 2006), http://papers.ssrn.com/sol3/papers.cfm?abstract_id=937357.; Richard 
Morgenstern, Retrospective Analysis of U.S. Federal Environmental 
Regulation, J. of Benefit Cost Anal. 9 no. 2, 2018, at 285.
---------------------------------------------------------------------------

    Next, the Department considered seeking to perform the reviews 
called for by the RFA without implementing a new forcing mechanism. 
Given past experience, however, it seems unrealistic to assume this 
would bring about meaningful change. First, the fact that these reviews 
are not already occurring is evidence they are unlikely to occur in the 
future. Second, as discussed above, there is a strong bias towards the 
status quo in governmental action, and this may stand in the way of 
behavior changes. Third, the literature suggests that enforcement 
mechanisms are needed to spur more periodic reviews, and specifically 
that sunset provisions are a useful enforcement mechanism.\225\ 
Moreover,

[[Page 5740]]

even if the Department conducted the reviews called for by the RFA 
absent a new forcing mechanism, there might be benefits to this final 
rule, albeit ones that are hard to quantify. For example, this final 
rule could guard against a decrease in the frequency of Department 
retrospective reviews in future years.
---------------------------------------------------------------------------

    \225\ Curtis W. Copeland, Cong. Rsch. Serv., RL32801, 
Reexamining Rules: Section 610 of the Regulatory Flexibility Act 
(2008); Michael Greenstone, Toward a Culture of Persistent 
Regulatory Experimentation and Evaluation, in New Perspectives on 
Regulation 111, 113 (David Moss & John Cisternino eds., 2009); 
Australian Gov't Att'y Gen.'s Dep't, Guide to Managing the 
Sunsetting of Legislative Instruments, at 3 (July 2020), https://www.ag.gov.au/sites/default/files/2020-07/Guide%20to%20Managing%20Sunsetting%20of%20Legislative%20Instruments.pdf.
---------------------------------------------------------------------------

    Another alternative the Department considered is conducting in-
depth Reviews of all of its Regulations (absent those that are exempt 
from this rulemaking), not just those designated as having a SEISNOSE. 
The Department sees value in conducting such widespread Reviews. 
However, the Department has opted not to require a complete Review of 
all Department regulations at the present time, although it leaves open 
the option to require such Reviews in the future.
    The Department also considered conducting Reviews of significant 
regulations, as that term is defined in Executive Order 12866. The 
Department is choosing to Review those regulations that have a 
SEISNOSE, in order to maintain a close connection between this final 
rule and the RFA. The Department sought comment on whether to Review 
additional regulations, such as those that are significant under 
Executive Order 12866. Given limited responses to this request, the 
Department will not Review other regulations at this time beyond those 
designated as having a SEISNOSE. However, the Department leaves open 
the possibility to conduct Reviews of other regulations in the future.
    The Department considered only Reviewing those regulations that, at 
the time of promulgation, the Department determined had a SEISNOSE. 
However, such determinations were not made for regulations that were 
promulgated prior to the passage of the RFA,\226\ and some post-RFA 
regulations that did not have such a SEISNOSE at the time of 
promulgation might have such a SEISNOSE today. One commenter suggested 
that an alternative to the proposed rule would be to attach sunset 
dates only prospectively for regulations finalized after the effective 
date of this rule. The same commenter suggested requiring retrospective 
reviews only for those regulations specifically identified by 
stakeholders as problematic. But as a general matter, the Department 
believes that older regulations are more likely to be obsolete. As a 
result, the Department believes that this final rule should apply to 
them. Moreover, only reviewing regulations identified by stakeholders 
is unlikely to suffice. Regulations are known to create entry barriers 
into industries and these barriers often affect small businesses 
disproportionally.\227\ Therefore, the Department believes stakeholder 
input cannot be the only source of information to spur reviews. 
Concentrated interest groups will lobby to protect regulations that 
have been specifically constructed for their benefit. Meanwhile, 
consumers, small businesses, and the public more generally often 
experience dispersed costs that are not taken into account by these 
stakeholders. The work of political scientist Mancur Olson explains why 
these groups that comprise broader society, because they are larger, 
face collective action problems and often find it costly to organize 
and lobby on behalf of their own interests.\228\ Meanwhile, more 
narrow, concentrated interests find it relatively easier to organize 
and lobby for their own interests. Thus, stakeholders may not identify 
to the Department many regulations that are unduly burdensome to the 
public at large.\229\
---------------------------------------------------------------------------

    \226\ The Department estimates that 16% of its regulations that 
are more than ten years old were promulgated prior to 1980, when 
Congress passed the RFA.
    \227\ See, e.g., Regulatory Reform: Hearings on S. 104, S. 262, 
S. 755, S. 1291 Before the Subcomm. on Admin. Practice & Procedure 
of the Comm. on the Judiciary, 96th Cong. 3-4 (1979) (statement of 
Peter J. Petkas, Director, The Regulatory Council) (describing the 
disproportionate impact on small businesses and uncertainty about 
benefits resulting from burdensome regulations); 142 Cong. Rec. 
S1637 (daily ed. Mar. 7, 1996) (statement of Sen. Bond) (``The SBA 
chief counsel for advocacy released a report that said that small 
businesses bear a disproportionate share of the regulatory 
burden.''); Nicole V. Crain & W. Mark Crain, The Impact of 
Regulatory Costs on Small Firms, (U.S. Small Bus. Admin., Office of 
Advocacy, Washington, DC), at 55, 57 (2010) (finding that 
``regulations cost small firms an estimated $10,585 per employee. 
Regulations cost medium-sized firms $7,454 per employee, and large 
firms $7,755 per employee,'' and that in the health care sector, the 
cost per employee is 45 percent higher in small firms than in 
medium-sized firms, and 28 percent higher in small firms than in 
large firms).
    \228\ Mancur Olson, The Logic of Collective Action (Harv. U. 
Press 1971).
    \229\ The Department welcomes comments from all members of the 
public on (1) regulations being Assessed or Reviewed pursuant to 
this final and (2) future notices of proposed rulemaking. The 
Department will consider comments received from all members of the 
public. We merely make this observation to explain why relying 
solely on stakeholders may not enable the Department to identify 
certain regulations that should be amended or rescinded.
---------------------------------------------------------------------------

    The Department is also aware of literature suggesting that agencies 
have not been consistent in deciding which rules have a SEISNOSE or 
have avoided such a finding in order to avoid the RFA's 
requirements.\230\ Moreover, 5 U.S.C. 610 presupposes the agency will 
make a determination about which regulations have or will have a 
SEISNOSE. This suggests there is good reason to Assess most of the 
Department's regulations. For these reasons, the Department has chosen 
to Assess all of its Regulations (subject to the exceptions listed 
herein) to determine which have a SEISNOSE and to Review those 
Regulations that have a SEISNOSE using the criteria listed in 5 U.S.C. 
610 (as well as whether they comply with applicable law).
---------------------------------------------------------------------------

    \230\ See, e.g., Connor Raso, Agency Avoidance of Rulemaking 
Procedures, 67 Admin. L. Rev. 65, 93-95, 99-101 (2015); Michael R. 
See, Willful Blindness: Federal Agencies' Failure to Comply with the 
Regulatory Flexibility Act's Periodic Review Requirement--And 
Current Proposals to Reinvigorate the Act, 33 Fordham Urb. L. J. 
1199, 1222-25 (2006).
---------------------------------------------------------------------------

    Finally, some commenters suggested that the Department include a 
provision granting the Secretary the authority to extend the expiration 
date in certain circumstances. Other commenters suggested that the 
proposed rule's two-year Assessment and Review period affecting some of 
the Department's older regulations was too short. In response, the 
Department has made several modifications to the final rule from its 
proposed form. First, regulations older than ten years will expire 
after five years, as opposed to expiring after two years, if these 
Regulations are not Assessed and (when necessary) Reviewed. Second, 
this final rule grants the Secretary a one-time option to push back 
this expiration date by one year for a given Regulation. Both of these 
modifications have the effect of lowering some costs of this final rule 
as compared to the proposed rule, because these changes lengthen the 
expected Assessment and Review period, pushing some costs into the 
future. This reduces the present value of these costs.

D. Cost Analysis

    5 U.S.C. 610 already directs the Department to undertake periodic 
reviews of its regulations. Nevertheless, because the Department 
believes this final rule will stimulate a behavior change at the 
Department and among the public, the regulation has some costs 
associated with it. Therefore, the Department performed the following 
analysis to estimate the costs and burdens to the Department and the 
public from (1) Assessing which Department regulations have a SEISNOSE, 
and (2) Reviewing those regulations.
    The Department has roughly 18,000 regulations, the vast majority of 
which it believes would need to be Assessed.\231\ Roughly 12,400 of 
these

[[Page 5741]]

regulations are over ten years old, and roughly 17,200 are more than 
five years old.\232\ The vast majority of these would need to be 
Assessed within five years of this final rule's effective date (or six 
years if the optional extension is exercised by the Secretary). The 
Department estimates that roughly five regulations on average are part 
of the same rulemaking due to the number of unique Federal Register 
citations associated with its regulations. This would suggest the 
Department would have to perform roughly 3,440 Assessments in the first 
five years (or six for certain of these regulations if the extension is 
exercised by the Secretary, and 3,600 Assessments in total.
---------------------------------------------------------------------------

    \231\ See Enhancing Regulatory Reform Through Advanced Machine 
Learning Findings (internal HHS slide) (the sum of the numbers 
listed in the table under the column denoted ``#'' is 17,890 
Department regulations).
    \232\ See id. (adding the figures listed in the ``#'' columns 
for the 1950s, 1960s, 1970s, 1980s, 1990s, and 2000s yields 12,383 
regulations. 17,200 regulations are estimated to have been issued by 
the end of 2016).
---------------------------------------------------------------------------

    However, some of these rulemakings are exempt from this final rule. 
The Department estimates that approximately 66 parts of the CFR that 
the Department actively updates contain the vast majority of the 
regulations that are exempt from this final rule. According to analysis 
from the Mercatus Center, however, the Department has approximately 
8,574 active parts of the CFR.\233\ 66 parts are therefore less than 1% 
of the Department's active parts. As a result, the Department does not 
believe the exemptions will significantly alter the costs of this final 
rule.\234\
---------------------------------------------------------------------------

    \233\ These data are available at Quantgov.org.
    \234\ The exempt parts may on average have more Sections than 
other parts. But even still, it seems unlikely the exemptions would 
significantly alter the costs of this final rule. If the Department 
were incorrect about this assumption, costs from this final rule 
would likely be lower than estimated herein. Similarly, the 
Department does not have enough information at present to determine 
whether the CFR sections that could potentially benefit from 
regulatory streamlining based on their similarities to, overlap 
with, or duplicativeness of other Sections will lead to a reduction 
in Department costs of Assessments and Reviews, due to duplication 
of work. The initial Assessment of all non-exempt regulations would 
determine whether this is the case.
---------------------------------------------------------------------------

    To help estimate the impact of this final rule, the Department 
conducted a limited randomized sampling \235\ of its regulations and 
assessed whether the sampled regulations would be exempt from this 
final rule and whether, at the time of issuance, the regulations were: 
Economically significant; found to have a SEISNOSE; or subject to the 
Unfunded Mandates Reform Act (UMRA) of 1995. This information is 
included in table 3. Also included in table 3 is the estimated impact 
of the regulations when they were first promulgated.
---------------------------------------------------------------------------

    \235\ With the aid of a random number generator, the Department 
selected Department regulations in each of its three main titles 
(21, 42, and 45) of the Code of Federal Regulations. The random 
number generator was used to identify the relevant part of each 
title of the CFR to assess.

                                                         Table 3--Sampled Department Regulations
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                              Impact
            Title                 Rulemaking         Citation      Exempt from this    Economically       SEISNOSE?        Subject to      estimates at
                                                                      Final Rule?      significant?                          UMRA?           issuance
--------------------------------------------------------------------------------------------------------------------------------------------------------
21...........................  Toll-Free Number  73 FR 63886.....  No..............  No..............  No.............  No.............  ``[O]ne-time
                                for Reporting                                                                                             costs will
                                Adverse Events                                                                                            range from
                                on Labeling for                                                                                           approximately
                                Human Drug                                                                                                $38.0 million
                                Products.                                                                                                 to $49.6
                                                                                                                                          million and
                                                                                                                                          annual costs
                                                                                                                                          will range
                                                                                                                                          from $12.4
                                                                                                                                          million to
                                                                                                                                          $46.3
                                                                                                                                          million.'' 236
21...........................  Unique Device     78 FR 58786.....  No..............  Yes.............  Yes............  Yes............  ``Over 10
                                Identification                                                                                            years, the
                                System.                                                                                                   estimated
                                                                                                                                          present value
                                                                                                                                          of the total
                                                                                                                                          domestic costs
                                                                                                                                          is $642.2
                                                                                                                                          million using
                                                                                                                                          a 7 percent
                                                                                                                                          discount rate
                                                                                                                                          and $737.7
                                                                                                                                          million using
                                                                                                                                          a 3 percent
                                                                                                                                          rate, and the
                                                                                                                                          annualized
                                                                                                                                          costs are
                                                                                                                                          $85.7 million
                                                                                                                                          using a 7
                                                                                                                                          percent
                                                                                                                                          discount rate
                                                                                                                                          and $84.1
                                                                                                                                          million using
                                                                                                                                          a 3 percent
                                                                                                                                          discount
                                                                                                                                          rate.'' 237
21...........................  Requirements for  81 FR 60170.....  No..............  No..............  No.............  No.............  ``We estimate
                                Foreign and                                                                                               one-time total
                                Domestic                                                                                                  costs of $59.7
                                Establishment                                                                                             million and
                                Registration                                                                                              recurring
                                And Listing for                                                                                           costs of $0.5
                                Human Drugs,                                                                                              million. These
                                Including Drugs                                                                                           costs
                                That Are                                                                                                  represent
                                Regulated Under                                                                                           total
                                a Biologics                                                                                               annualized
                                License                                                                                                   costs of $9
                                Application,                                                                                              million when
                                and Animal                                                                                                calculated at
                                Drugs.                                                                                                    a 7-percent
                                                                                                                                          discount rate
                                                                                                                                          over 10 years,
                                                                                                                                          and $7.5
                                                                                                                                          million when
                                                                                                                                          calculated
                                                                                                                                          using a 3-
                                                                                                                                          percent
                                                                                                                                          discount rate.
                                                                                                                                          The largest
                                                                                                                                          cost elements
                                                                                                                                          will be for
                                                                                                                                          registrants
                                                                                                                                          reading and
                                                                                                                                          understanding
                                                                                                                                          the final rule
                                                                                                                                          and making
                                                                                                                                          changes to
                                                                                                                                          their standard
                                                                                                                                          operating
                                                                                                                                          procedures.''2
                                                                                                                                          38
21...........................  Human Tissue      62 FR 40429.....  No..............  No..............  No.............  No.............  FDA confirmed
                                Intended for                                                                                              ``that the
                                Transplantation.                                                                                          only economic
                                                                                                                                          impact of the
                                                                                                                                          rule would be
                                                                                                                                          related to
                                                                                                                                          recordkeeping
                                                                                                                                          burdens'' that
                                                                                                                                          already
                                                                                                                                          existed.239
42...........................  Medicare          70 FR 57368.....  No..............  Yes.............  No.............  No.............  ``The Congress
                                Program; Health                                                                                           provided
                                Care                                                                                                      $142,000,000
                                Infrastructure                                                                                            for the loan
                                Improvement                                                                                               program
                                Program;                                                                                                  effective July
                                Selection                                                                                                 1, 2004
                                Criteria of                                                                                               through
                                Loan Program                                                                                              September 30,
                                for Qualifying                                                                                            2008, and not
                                Hospitals                                                                                                 more than
                                Engaged in                                                                                                $2,000,000 may
                                Cancer-Related                                                                                            be used for
                                Health Care.                                                                                              the
                                                                                                                                          administration
                                                                                                                                          of the loan
                                                                                                                                          program for
                                                                                                                                          each of the
                                                                                                                                          fiscal years
                                                                                                                                          (that is, 2004
                                                                                                                                          through
                                                                                                                                          2008).''240

[[Page 5742]]

 
42...........................  Organ             63 FR 16296.....  No..............  Yes.............  No.............  No.............  Although
                                Procurement and                                                                                           incremental
                                Transplantation                                                                                           effects
                                Network.                                                                                                  attributable
                                                                                                                                          to the rule
                                                                                                                                          were not
                                                                                                                                          estimated,
                                                                                                                                          impact
                                                                                                                                          categories
                                                                                                                                          would have
                                                                                                                                          included life-
                                                                                                                                          years saved by
                                                                                                                                          non-renal
                                                                                                                                          organ
                                                                                                                                          transplants,
                                                                                                                                          quality of
                                                                                                                                          life
                                                                                                                                          improvements
                                                                                                                                          for kidney
                                                                                                                                          recipients,
                                                                                                                                          and the
                                                                                                                                          admittedly
                                                                                                                                          expensive
                                                                                                                                          costs of
                                                                                                                                          transplantatio
                                                                                                                                          n.241
42...........................  Medicare          53 FR 47199.....  No..............  No..............  No.............  N/A (rule        N/A: ``We have
                                Program;                                                                                 issued prior     determined
                                Hospital                                                                                 to UMRA being    that a
                                Insurance                                                                                enacted).        regulatory
                                Entitlement and                                                                                           impact
                                Supplementary                                                                                             analysis is
                                Medical                                                                                                   not required
                                Insurance                                                                                                 for these
                                Enrollment and                                                                                            rules because
                                Entitlement.                                                                                              they would not
                                                                                                                                          have an annual
                                                                                                                                          impact of $100
                                                                                                                                          million or
                                                                                                                                          more.''242
45...........................  Cooperation in    56 FR 8926......  No..............  No..............  No.............  N/A (rule        ``[T]he cost of
                                Identifying and                                                                          issued prior     implementation
                                Providing                                                                                to UMRA being    is expected to
                                Information To                                                                           enacted).        be
                                Assist States                                                                                             insignificant.
                                in Pursuing                                                                                               ''243
                                Third Party
                                Health Coverage.
45...........................  Responsibility    76 FR 53256.....  No..............  No..............  No.............  No.............  Estimated
                                of Applicants                                                                                             annual cost of
                                for Promoting                                                                                             $23,236,238.24
                                Objectivity in                                                                                            4
                                Research for
                                which Public
                                Health Service
                                Funding is
                                Sought and
                                Responsible
                                Prospective
                                Contractors.
45...........................  Rate Increase     76 FR 29964.....  No..............  No..............  No.............  No.............  ``CMS estimates
                                Disclosure and                                                                                            that issuers
                                Review.                                                                                                   will incur
                                                                                                                                          approximately
                                                                                                                                          $10 million to
                                                                                                                                          $15 million in
                                                                                                                                          one-time
                                                                                                                                          administrative
                                                                                                                                          costs, and
                                                                                                                                          $0.6 million
                                                                                                                                          to $5.5
                                                                                                                                          million in
                                                                                                                                          annual ongoing
                                                                                                                                          administrative
                                                                                                                                          costs related
                                                                                                                                          to complying
                                                                                                                                          with the
                                                                                                                                          requirements
                                                                                                                                          of this final
                                                                                                                                          rule from 2011
                                                                                                                                          through 2013.
                                                                                                                                          In addition,
                                                                                                                                          States will
                                                                                                                                          incur very
                                                                                                                                          small
                                                                                                                                          additional
                                                                                                                                          costs for
                                                                                                                                          reporting the
                                                                                                                                          results of
                                                                                                                                          their reviews
                                                                                                                                          to the Federal
                                                                                                                                          government,
                                                                                                                                          and the
                                                                                                                                          Federal
                                                                                                                                          government
                                                                                                                                          will incur
                                                                                                                                          approximately
                                                                                                                                          $0.7 million
                                                                                                                                          to $5.9
                                                                                                                                          million in
                                                                                                                                          annual costs
                                                                                                                                          to conduct
                                                                                                                                          reviews of
                                                                                                                                          justifications
                                                                                                                                          filed by
                                                                                                                                          issuers in
                                                                                                                                          States that do
                                                                                                                                          not perform
                                                                                                                                          effective
                                                                                                                                          reviews.''
                                                                                                                                          \245\
--------------------------------------------------------------------------------------------------------------------------------------------------------

    None  of the sampled regulations would be exempt from this final 
rule, meaning all sampled rules would need to be Assessed. This is 
consistent with the assumption that few enough regulations would be 
exempt from this final rule to significantly affect the cost estimates 
presented here. At the time the ten sampled regulations were 
promulgated, the Department believed that one of the ten had a 
SEISNOSE. If the Assessments' findings mirror the findings from the 
time of issuance, one of the ten sampled regulations would need to be 
Reviewed. Similarly, an academic study found 11.1% of Department final 
rules issued in 1993 had a SEISNOSE.\246\ A more recent study found 
that 92% of agency rules were found to not be subject to the RFA, 
suggesting agencies believe roughly 8% of their regulations have a 
SEISNOSE.\247\
---------------------------------------------------------------------------

    \236\ Toll-Free Number for Reporting Adverse Events on Labeling 
for Human Drug Products, 73 FR 63,886, 63,892 (Oct. 28, 2008).
    \237\ Unique Device Identification System, 78 FR 58786, 58811 
(Sept. 24, 2013).
    \238\ Requirements for Foreign and Domestic Establishment 
Registration And Listing for Human Drugs, Including Drugs That Are 
Regulated Under a Biologics License Application, and Animal Drugs, 
81 FR 60170, 60171 (Aug. 31, 2016).
    \239\ Human Tissue Intended for Transplantation, 62 FR 40429, 
40442 (Jul. 29, 1997).
    \240\ Medicare Program; Health Care Infrastructure Improvement 
Program; Selection Criteria of Loan Program for Qualifying Hospitals 
Engaged in Cancer-Related Health Care, 70 FR 57368, 57372 (Sept. 30, 
2005).
    \241\ Organ Procurement and Transplantation Network, 63 FR 
16296, 16321-29 (Apr. 2, 1998).
    \242\ Medicare Program; Hospital Insurance Entitlement and 
Supplementary Medical Insurance Enrollment and Entitlement, 53 FR 
47199, 47201 (Nov. 22, 1988).
    \243\ Cooperation in Identifying and Providing Information To 
Assist States in Pursuing Third Party Health Coverage, 56 FR 8926, 
8929 (Mar. 4, 1991).
    \244\ Responsibility of Applicants for Promoting Objectivity in 
Research for which Public Health Service Funding is Sought and 
Responsible Prospective Contractors, 76 FR 53256, 53280 (Aug. 25, 
2011).
    \245\ Rate Increase Disclosure and Review, 76 FR 29964, 29978 
(May 23, 2011).
    \246\ Michael R. See, Willful Blindness: Federal Agencies' 
Failure to Comply with the Regulatory Flexibility Act's Periodic 
Review Requirement--And Current Proposals to Reinvigorate the Act, 
33 Fordham Urb. L. J. 1199, 1217 (2006).
    \247\ Connor Raso, Agency Avoidance of Rulemaking Procedures, 67 
Admin. L. Rev. 65, 69 (2015).
---------------------------------------------------------------------------

    Assuming the Department has roughly 3,600 total rulemakings that 
are subject to this final rule; 3,440 of these are more than five years 
old (i.e. would be ten years old by the end of 2026); and that roughly 
11% \248\ have a SEISNOSE, then the Department might have to perform 
roughly 396 Reviews in total, of which 378 would have to be completed 
in the five years after this rule is finalized. However, some of these 
rulemakings might be reviewed as part of section 610 reviews even in 
absence of this final rule (i.e., in the baseline scenario). As noted 
above, the Department estimates that the three completed rulemakings 
emanating from section 610 reviews over the last decade amend 
approximately 130 sections of the CFR.

[[Page 5743]]

If the decade following implementation of this final rule is similar to 
the previous decade, then the Department can expect to review and amend 
130 sections of the CFR, which is equivalent to 26 average rulemakings 
if 5 regulations correspond with one rulemaking on average. These 26 
rulemakings are assumed to be what would be Reviewed in the baseline 
scenario. Therefore, the Department expects to conduct 370 Reviews in 
total, of which 353 would have to be completed in the five years after 
this rule is finalized.\249\
---------------------------------------------------------------------------

    \248\ The Department chooses 11%, rather than 8% or 10%, because 
the study that found 11.1% of Department regulations had a 
significant economic impact upon a substantial number of small 
entities was focused solely on the Department's regulations.
    \249\ Since approximately 95 percent of Department rules were 
finalized before 2016, this analysis assumes 25 Reviews in the 
baseline scenario would occur in the first five years following 
implementation of this final rule, and one Review would occur in the 
subsequent five years.
---------------------------------------------------------------------------

    Of the 353 rulemakings subject to Reviews in the first five years 
(or six years if the Secretary exercises the one-year extension 
authority), the Department estimates roughly 44 rulemakings were 
promulgated prior to the requirement for prospective regulatory 
flexibility analyses. Those 44 Reviews will require more Department 
resources than the estimated 309 Reviews of rulemakings promulgated 
after the prospective analysis requirement went into effect.
    Therefore, as a result of this final rule, the Department expects 
to have to conduct 370 Reviews in total. These include approximately 44 
rulemakings that were promulgated prior to the requirement for 
prospective regulatory flexibility analyses, and 326 Reviews of 
rulemakings promulgated after the prospective analysis requirement went 
into effect. Of these 326, the Department assumes most Reviews will 
occur earlier in the coming ten years such that 309 Reviews are 
conducted in the first five calendar years following implementation of 
this final rule and 17 of the Reviews occur in the second five calendar 
years. This is consistent with the fact that the vast majority, roughly 
95 percent, of Department regulations are older than five years (and 
therefore will be more than ten years old by the end of 2026).
1. Costs Related to Section 610 Reviews of Regulations More Than Five 
Years Old
    The majority of the Reviews conducted in response to this 
regulation will have to be conducted in the first five calendar years 
following implementation of this regulation, because the vast majority 
of the Department's regulations were finalized before the end of 2016. 
A full initial Regulatory Flexibility Act (RFA) analysis requires 250 
to 500 hours to complete because federal agencies must analyze the 
impact of their regulatory actions on small entities (small businesses, 
small non-profit organizations and small jurisdictions of government) 
and, where the regulatory impact is likely to be ``significant'' and 
affecting a ``substantial number'' of these small entities, seek less 
burdensome alternatives for them. This involves defining the market and 
determining costs for each small entity. The section 610 review is a 
more streamlined analysis because the regulatory flexibility analysis 
is the starting point. The section 610 review focuses on five areas of 
analysis: (1) Whether there is a continued need for the rule, (2) the 
number and nature of complaints, (3) the complexity of the regulation, 
(4) whether there is duplication, and (5) the degree to which 
technology, economic conditions, or other factors have changed in the 
area affected by the rule, as well as whether the Regulation complies 
with applicable law. As such, the Department estimates that a Review 
will require significantly less time than a full RFA analysis.
    The Department recognizes that some regulations were promulgated 
prior to when the requirement for prospective regulatory analysis went 
into effect, and that a section 610 review of such rulemakings may be 
more time intensive. The Department estimates 309 rulemakings from 2016 
or earlier will be subject to section 610 review where some prospective 
analysis has been performed, in which case such reviews will take 40 to 
100 hours. The Department estimates it will undertake section 610 
reviews of 44 rules for which no prospective regulatory analysis was 
performed. The Department assumes that between 250 to 500 hours may be 
required for these reviews, even though the section 610 review is more 
circumscribed than a full regulatory flexibility analysis and will 
therefore generally take less time to perform. The Department also 
notes that there could be costs associated with publishing the notices 
of Assessments and Reviews to the Department's website and the Federal 
Register for public comment, but that such costs will be minimal and 
would not require the hiring of additional personnel.
    Therefore, the Department estimates that a total of between 23,360 
and 52,900 hours will be spent on Reviews outside the Assessment 
process during the first five years (the number of hours may ultimately 
be slightly less if the Secretary exercises the optional one-year 
extension with respect to some regulations), which will clear the 
backlog of section 610 reviews for regulations at least five years old. 
The Department assumes 40 to 100 hours per Review for the estimated 309 
Reviews for which an initial prospective analysis was performed. The 
Department assumes 250 to 500 hours per Review for the estimated 44 
Reviews where no such initial prospective analysis was performed.
    The Department estimates that the fully-loaded cost per hour to the 
Department to employ a person to conduct a Review or Assessment is 
$244.98 per hour (referred to as ``LaborCost'').\250\ Assuming the 
23,360 to 52,900 estimated hours are spread evenly across the first 
five years following implementation of this final rule, and assuming a 
7 percent discount rate, the present value of these costs ranges from 
$4.7 to $10.6 million in total. Without discounting, this is equal to 
20.1 to 45.6 full-time equivalents (FTEs) working at LaborCost to 
initiate and conduct Reviews of regulations in the first 5 years.
---------------------------------------------------------------------------

    \250\ Here, the Department uses the reported ``FY 2021 average 
fully supported cost to [FDA of] $284,174 per FTE,'' divided by 
1,160 ``Net Supported Direct FDA Work Hours Available for 
Assignments'' per year to arrive at $244.98 per hour. Food Safety 
Modernization Act Domestic and Foreign Facility Reinspection, 
Recall, and Importer Reinspection Fee Rates for Fiscal Year 2021, 85 
FR 46669, 46670 (Aug. 3, 2020).
---------------------------------------------------------------------------

2. Costs Related to Rulemakings That ``Age In'' To Section 610 Review
    The Department estimates 17 rulemakings would ``age in'' \251\ to 
the section 610 review requirement during years six through ten after 
this rule is finalized. The Department estimates it will require 
between 680 to 1,700 hours to Review these rules, because the 
Department assumes those 17 Reviews would take between 40 to 100 hours 
per Review, as each of those rulemakings were promulgated after 
prospective regulatory analysis was required. Assuming hours reviewing 
these rulemakings are spread equally across years six through ten, the 
Department estimates the present value of the cost of Reviewing 17 
rulemakings in years six through ten to be between $0.1 million and 
$0.3 million at a seven percent discount rate. Without discounting, 
this represents 0.6 to 1.5 FTEs working at LaborCost to conduct 17 
Reviews of rules that age into the Review requirement during the decade 
following implementation of this regulation.
---------------------------------------------------------------------------

    \251\ ``Age in,'' meaning that the rules become ten years old 
during years six through ten.

---------------------------------------------------------------------------

[[Page 5744]]

3. Costs Related to Assessments
    In addition to conducting Reviews of rulemakings that have a 
SEISNOSE, the Department will allocate resources towards conducting 
Assessments of its rulemakings to determine whether a Review is 
required. At the time of promulgation, regulations are evaluated as to 
whether they had a SEISNOSE under the RFA. However, some regulations 
were promulgated prior to the RFA, while others were certified exempt 
from having to produce a regulatory flexibility analysis because they 
were certified as not having a SEISNOSE. This final rule will require 
the Department to make a determination as to whether covered 
rulemakings currently have a SEISNOSE and, if so, to Review those 
regulations. Because circumstances could change over time, the 
designation that a regulation has a SEISNOSE is likely to change for 
some rules. As a result, this final rule requires the Department to 
timely Assess all of its regulations (subject to the exceptions in this 
final rule) to determine whether they have a SEISNOSE, otherwise the 
regulations would expire. As discussed above, some rulemakings may 
overlap with or be duplicative of one another, reducing the number of 
Reviews that will be eventually required. However, the Department 
believes an initial Assessment of all rulemakings (subject to this 
final rule's exceptions) will likely be required first to determine the 
extent of such overlap or duplication.
    The Department believes each Assessment will require between three 
and 10 hours to perform. The Department estimates that it will have to 
conduct roughly 3,062 Assessments in the first five years after this 
rule is finalized, and an additional 142 Assessments in the subsequent 
five years, for a total of 3,204 Assessments across ten years.\252\
---------------------------------------------------------------------------

    \252\ 3,062 is 3,440 total Department rulemakings older than 
2016, minus 25 rulemakings Reviewed in the baseline scenario, minus 
the 353 rulemakings Reviewed in the first five years. 142 is 160 
rulemakings affected by this final rule in the second five years, 
minus one rulemaking Reviewed in the baseline scenario, minus the 17 
rulemakings expected to be Reviewed in the second five years.
---------------------------------------------------------------------------

    As such, the Department believes 9,186 to 30,620 hours will be 
spent on Assessments in the first five years. The Department believes 
426 to 1,420 hours will be spent on Assessments in the following five 
years. Assuming these hours are spread evenly across their respective 
ranges of years, the present value of costs associated with these 
Assessments ranges from $1.9 to $6.4 million at a 7 percent discount 
rate. Without discounting, this represents 8.3 to 27.6 FTEs working on 
a total of 3,204 Assessments over ten years. If, as seems plausible, 
Assessments of regulations more than ten years old will 
disproportionately occur in the latter half of the 2021-2026 time 
period, the present value of the cost of Assessments will be slightly 
less than estimated herein.
4. Costs Related to Review of Additional Rulemakings Found To Have a 
SEISNOSE
    Depending on the outcome of the Assessments, the Department may 
have to Review additional rulemakings. The Department estimates roughly 
5% of Assessments of Regulations not initially found to have a SEISNOSE 
will conclude that a Review is required. The Department believes this 
is a reasonable estimate because the 5% rate is roughly half of the 
percentage of all Department regulations that the Department currently 
believes have a SEISNOSE. Accordingly, the Department estimates 153 
Reviews will be required in the first five years,\253\ and seven 
Reviews will be required in the subsequent five years,\254\ for a total 
of 160 additional Reviews. The Department estimates the 153 Reviews 
will require 6,120 to 15,300 hours,\255\ and that the seven Reviews 
will require 280 to 700 hours in the subsequent five years.
---------------------------------------------------------------------------

    \253\ 5% of 3,062 is 153.
    \254\ 5% of 142 is 7.
    \255\ Each review will take 40-100 hours.
---------------------------------------------------------------------------

    Assuming these hours are spread evenly across the corresponding 
time frames, multiplying these hour estimates by LaborCost and 
discounting at a seven percent discount rate yields an estimated $1.3 
to $3.2 million over ten years, which corresponds with 5.5 to 13.8 FTEs 
for additional post-Assessment Reviews over ten years (without 
discounting). If, as seems plausible, Reviews of regulations in this 
category will not be spread evenly across the corresponding time frames 
but will disproportionately occur in the latter half of the time 
frames, the present value of the cost of these Reviews will be slightly 
less than estimated herein.
5. Monitoring Costs
    Some commenters argued that the proposed rule's regulatory impact 
analysis underestimated the costs of this rulemaking, because it did 
not consider the costs to the regulated community of: Monitoring which 
regulations may expire; commenting either during the Assessment and 
Review process or to request that the Department conduct an Assessment 
or Review; and, when necessary, writing and submitting comments on 
regulations amended as a result of retrospective reviews conducted 
pursuant to this final rule.
    The Department believes the cost of monitoring Assessments will be 
relatively trivial. This final rule requires the Department to announce 
on its website, as well as on Regulations.gov, when it has commenced 
Reviews and Assessments. Making the announcement on Regulations.gov (as 
opposed to only on the Department's website, as proposed) will reduce 
the monitoring costs raised by the commenters, because the regulated 
community already monitors Regulations.gov.
    Moreover, in conjunction with this final rule, the Department is 
placing at https://www.hhs.gov/regulations/federal-registry/index.html 
a list of Department regulations, the year they were initially 
promulgated, the last year the rule was amended, and the Federal 
Register citation from the time the rule was initially promulgated. 
This list was generated with artificial intelligence and the Department 
believes it is accurate, but it is conceivable that some Department 
regulations are not included. This list can be used to easily create a 
schedule of expiration dates, so that the monitoring public does not 
need to identify these dates itself. Announcements of this kind conform 
to Organisation for Economic Co-operation and Development guidelines 
that recommended creating a predetermined schedule for when regulations 
are due for assessment and review.\256\ This type of ``programmed 
review'' would give both the Department and the public ample time to 
prepare for the Review and to submit comments as needed. It would also 
reduce the time and effort required of the public to track those 
regulations that are set to expire or be revised. As such, the 
monitoring public should not bear any significant expense keeping track 
of when regulations are set to expire or reminding the Department of 
when regulations are set to expire. Additionally, monitoring costs 
associated with Assessments are likely to not be significant because 
Assessments are unlikely to result in amendments of regulations, absent 
a subsequent Review also occurring. This final rule only mandates 
amendment or rescission of certain regulations that have been Reviewed.
---------------------------------------------------------------------------

    \256\ Organisation for Economic Co-operation and Development, 
``Reviewing the Stock of Regulation'' (2020).
---------------------------------------------------------------------------

    In addition, the Department intends to create on its website a 
dashboard that shows its progress on its Assessments and Reviews, 
including when it commenced those Assessments and Reviews, its 
progress, and when it

[[Page 5745]]

expects them to be completed. If they so choose, the public can view 
this dashboard to see the Department's progress on its Assessments and 
Reviews of particular regulations. The dashboard will also help to keep 
the Department on track to timely complete Assessments and Reviews.
    Based on the experience of North Carolina,\257\ the Department 
estimates that approximately 10 percent of Reviewed rulemakings will be 
rescinded and 30 percent of Reviewed rulemakings will be amended in 
some way. Since 530 rulemakings are expected to be Reviewed in 
total,\258\ this suggests 53 regulations will be rescinded and 159 will 
be updated.
---------------------------------------------------------------------------

    \257\ Jon Sanders, Rule removal under periodic review has slowed 
down, but a new law tightens the process, The John Locke Found.: The 
Locker Room (July 22, 2019), https://lockerroom.johnlocke.org/2019/07/22/rule-removal-under-periodic-review-has-slowed-down-but-a-new-law-tightens-the-process/.
    \258\ This is 370 Reviews from rules that were initially 
identified as having a SEISNOSE plus the 160 Reviews from 
Assessments determining that additional rulemakings have a SEISNOSE.
---------------------------------------------------------------------------

    To estimate how much interest these expiring and amended 
regulations are likely to generate, the Department notes that it 
received 486 comments on the proposed rule as of the close of the 30-
day public comment period. A typical commenter is likely to be someone 
with a legal background. According to the Bureau of Labor 
Statistics,\259\ the mean hourly wage of a lawyer is $71.60 (2020$). 
Assuming base salary constitutes one half of fully-loaded wages,\260\ 
this suggests the fully loaded cost per hour of writing comments is 
$143.20.
---------------------------------------------------------------------------

    \259\ See Bureau of Labor Statistics, Occupational Employment 
Statistics, 23-1011 Lawyers. https://www.bls.gov/oes/current/oes231011.htm.
    \260\ This assumption is in line with Department guidelines on 
regulatory analysis. See U.S. Dep't of Health & Hum. Servs., 
Guidelines for Regulatory Impact Analysis, at 28 (2016).
---------------------------------------------------------------------------

    If a typical comment takes 5 to 15 hours to write, and if the 486 
comments the Department received on the proposed rule is a good proxy 
for the interest the Department will receive on the 159 rulemakings 
expected to be amended as a result of this final rule over the next 
decade, then the total (undiscounted) monitoring cost related to 
writing comments on those 159 regulations is $55.3 to $166.0 
million.\261\ However, rulemakings are not likely to all be amended at 
the same time. Further, if the Secretary determines that completion of 
an amendment or a rescission is not feasible by the required date, he 
or she can certify this in a statement published in the Federal 
Register and may extend the completion date by one year at a time, no 
more than three times.
---------------------------------------------------------------------------

    \261\ This is 159 rulemakings x 486 commenters x $143.20 per 
hour x 5 to 15 hours per comment.
---------------------------------------------------------------------------

    Assuming the Secretary does not extend the completion date (this 
assumption is relaxed in the sensitivity analysis below), the 
Department expects 152 of the amended rulemakings will be Reviewed in 
the first five years and seven regulations Reviewed in the second five 
years. Assuming monitoring costs are spread equally across these 
timeframes (with the understanding that this may overestimate costs 
somewhat since rulemakings are likely to be amended after they are 
Reviewed, which would push amendment to the later end of the timeframe) 
the present value of these monitoring costs ranges from $44.8 to $134.3 
million at a seven percent discount rate.
    The Department expects it will receive less interest in regulations 
that are rescinded after being Reviewed, given that many regulations 
that are sunset in states often face little resistance from the public, 
perhaps because their rescission is uncontroversial. For example, the 
state of Idaho underwent a sunset review process for its entire 
regulatory code in 2019. As a result of the review, 19 percent of rule 
chapters, 10 percent of pages, and more than 19,000 regulatory 
restrictions were rescinded when the code was rewritten in the summer 
of 2019.\262\ This occurred with little controversy, suggesting many 
regulations that were rescinded were obviously outdated or 
counterproductive, such that their removal was uncontroversial.\263\
---------------------------------------------------------------------------

    \262\ Office of Gov. Brad Little, Idaho's Historic Regulatory 
Cuts (July 2019).
    \263\ The fact that there seemed to be little controversy 
surrounding rescinded rules may imply some of those rescissions were 
fairly trivial in some cases. While data on the extent to which 
rescissions were trivial or nontrivial are unavailable, news stories 
provide some basis for this belief. Note that rescinded rules being 
relatively trivial is not evidence that amended rules were trivial. 
See, e.g., Editorial, Idaho Quits Worrying About Snails, Wall St. 
J., June 28, 2019, https://www.wsj.com/articles/idaho-quits-worrying-about-snails-11561763217.
---------------------------------------------------------------------------

    The North Carolina experience, which has been ongoing for several 
years, may be a better representation of what the Department can expect 
from its reviews, since the circumstances in Idaho were somewhat 
unique. Nonetheless, the 10 percent of reviewed rules being rescinded 
in North Carolina is comparable to the 10 percent of pages of rules 
repealed during Idaho's mid-2019 review. The Department assumes 
rescinded regulations will receive half as many comments as amended 
regulations. In that case, 53 rescinded regulations, of which 51 are 
expected in the first five years, should generate costs of $7.5 to 
$22.4 million (discounted at a 7 percent discount rate, assuming 
rescinded regulations are spread across corresponding timeframes in a 
manner consistent with the amended regulations described above). Thus, 
the total cost of monitoring is likely to range from $52.2 to $156.7 
million (at a seven percent discount rate).
6. Total Estimated Costs From Implementing This Rulemaking
    The Department estimates a total cost of between $60.2 to $199.3 
million over ten years in order to do the following: (a) Conduct 
section 610 Reviews for Department rulemakings from 2016 or earlier in 
years 1 to 5, (b) conduct section 610 Reviews of rulemakings that ``age 
in'' to section 610 review in years 6 to 10, (c) conduct Assessments of 
rulemakings in years 1 to 10, and (d) conduct section 610 Reviews of 
rulemakings deemed to be subject to Review following an Assessment in 
years 1 to 10. The total number of Department employees required to 
conduct these activities is estimated to be 34.5 to 88.5 FTEs over ten 
years. The Department has also estimated the cost of increased 
monitoring falling on regulated entities. Results are presented in 
table 4 below, which also includes cost estimates discounted at a 3 
percent discount rate for sensitivity purposes.\264\
---------------------------------------------------------------------------

    \264\ The Office of Management and Budget recommends a 7 percent 
base-case default discount rate be used in regulatory impact 
analysis. OMB also recommends a 3 percent consumption rate of 
interest be used as an alternative. See Office of Mgmt. & Budget, 
Circular A-4, Regulatory Analysis (Sept. 17, 2003).

    Table 4--Present Value of Estimated Cost of Assessing and Reviewing Department Regulations Over Ten Years
                             (Millions of 2020$), at 3 and 7 Percent Discount Rates
----------------------------------------------------------------------------------------------------------------
             Type of cost                     Cost  (7%)               Cost  (3%)                  FTEs
----------------------------------------------------------------------------------------------------------------
Department Costs:

[[Page 5746]]

 
    A. Costs Related to Section 610    $4.7 to $10.6 million..  $5.2 to $11.9..........  20.1 to 45.6.
     Reviews of Regulations More Than
     Five Years Old.
    B. Costs Related to Rulemakings    $0.1 to $0.3...........  $0.2 to $0.4...........  0.6 to 1.5.
     That ``Age In'' to Section 610
     Review.
    C. Costs Related to Assessments..  $1.9 to $6.4...........  $2.1 to $7.1...........  8.3 to 27.6.
    D. Costs Related to Review of      $1.3 to $3.2...........  $1.4 to $3.6...........  5.5 to 13.8.
     Additional Rulemakings Found to
     Have a SEISNOSE.
Private Costs:
    E. Cost to Monitoring Public.....  $52.2 to $156.7........  $58.8 to $176.3........  N/A.
                                      --------------------------------------------------------------------------
        Total........................  $60.2 to $177.2........  $67.7 to $199.3........  34.5 to 88.5.
----------------------------------------------------------------------------------------------------------------

    These figures can also be presented on an annualized basis, 
calculations of which are presented in table 5 below. Annualized costs 
are estimated to range from $7.9 million to $25.2 million per year over 
the decade following implementation of this final rule.

                         Table 5--Accounting Statement: Annualized Costs of Final Rules
----------------------------------------------------------------------------------------------------------------
                                            Discount rate                    Annualized, millions of 2020$ per
    Present value  (millions of 2020$)        (percent)     Time horizon                    year
----------------------------------------------------------------------------------------------------------------
$60.2 to $177.2..........................               7       2021-2030  $8.6 to $25.2.
$67.7 to $199.3..........................               3       2021-2030  $7.9 to $23.4.
----------------------------------------------------------------------------------------------------------------

7. Sensitivity Analysis
    One commenter noted that conducting a retrospective analysis can be 
as time-consuming and expensive as a prospective regulatory analysis, 
suggesting the Department's estimates of the time and expense of 
Reviews may be understated. The Department believes that on average 
Reviews of rulemakings implemented after the RFA are likely to be less 
time consuming than those implemented before. Moreover, 250 to 500 
hours is the amount of time estimated to produce a full initial RFA 
analysis, which requires more time than a section 610 review, even one 
where no RFA analysis was conducted when the rulemaking was 
promulgated. Nevertheless, for the sake of testing the sensitivity of 
the cost estimates for Reviews, the Department calculates the costs of 
Reviews assuming all Reviews take 250 to 500 hours, rather than the 
assumption of 40 to 100 hours for post-RFA regulations made above. In 
this case, the present value of the total cost of Reviews (A, B and D 
in table 4) would rise to $26.5 to $53.0 million from $6.1 to $14.1 
million (at a seven percent discount rate), and would rise to $29.7 to 
$59.4 million from $6.8 to $15.8 million (at a three percent discount 
rate).
    However, there are also reasons to believe the costs estimated in 
table 4 are overestimated. First, this final rule permits the Secretary 
to extend by up to one year the expiration date for particular 
regulations. Having this option might have the effect of pushing back 
the time horizon for certain Reviews and Assessments by one year. This 
would suggest the costs presented in table 4 above are overestimated to 
the extent that the present value of these costs will fall as some 
costs are pushed into the future. Assuming all costs are pushed back by 
one year, discounting the total costs by one additional year at a seven 
percent discount rate yields a present value of total costs in the 
range of $56.3 million to $165.6 million, and at a three percent rate 
yields a present value of total costs in the range of $65.7 to $193.5 
million. These potential reduced costs are one reason the Department 
has decided to modify the final rule from its proposed form.
    Similarly, the costs of monitoring might be pushed into the future 
if the Secretary exercises his or her right to extend the completion 
date by one year at a time, up to three times, with respect to 
amendment or rescission of regulations after Review. Assuming amended 
or rescinded regulations are pushed back three years in the future, the 
present value of monitoring costs would fall to $42.6 to $127.9 million 
at a seven percent discount rate and to $53.8 to $161.3 million at a 
three percent discount rate. If, as some commenters stated, this final 
rule resulted in the Department issuing fewer new notices of proposed 
rulemaking, the reduction in commenting costs from the reduction in new 
notices of proposed rulemaking would cause the monitoring costs from 
this final rule to drop.
8. Other Possible Costs
    Some commenters noted that there might be other sources of cost 
associated with this rulemaking other than those cited in the 
regulatory impact analysis accompanying the proposed rule. Some of 
these costs have been accounted for above, such as the cost of 
monitoring or the potential for Reviews to take longer than estimated 
in the proposed rule. Other commenters cited increased uncertainty to 
businesses and members of the regulated community as a possible cost 
due to the increased chance that rules may expire in the future. The 
Department does not believe uncertainty among the regulated community 
will add significantly to the costs of this rulemaking for the 
following reasons. The Department's sporadic use of periodic 
retrospective review--notwithstanding the RFA and Executive Orders--
itself leads to ``uncertainty'' about how robustly the Department 
implements directives that make for good policy.\265\ To the extent 
that the Department can maintain compliance with its obligations, this 
should build trust in the Department

[[Page 5747]]

and reduce uncertainty (offsetting some or all of the uncertainty 
discussed by the commenters, if such uncertainty exists). Further, as 
noted above, the Department plans to release information about the 
18,000 regulations under its authority and when they were adopted, such 
that any uncertainty surrounding the expiration dates of the 
Department's various rulemakings will be reduced substantially, if not 
entirely. Additional measures to mitigate private costs are discussed 
in the ``Operationalization of This Final Rule'' section of this final 
rule.
---------------------------------------------------------------------------

    \265\ To the extent this uncertainty has been lessened because 
the public has seen how the Department has implemented these 
directives over the course of many years, the same can be said for 
this final rule once it has been implemented for several years.
---------------------------------------------------------------------------

    Second, the Department notes that many states have sunset 
provisions that are a routine part of their regulatory processes. New 
Jersey, Indiana, and North Carolina have sunset provisions for their 
regulations. Missouri has a sunset provision for regulations, which is 
tied to a periodic review requirement.\266\ Colorado, California, and 
Texas have sunset review processes for entire boards, commissions, and 
agencies. Some states have an annual sunset review process for their 
entire administrative code.\267\ Although the sunset clause is rarely 
exercised, there nevertheless is always the possibility the entire 
regulatory code will expire in these states in any particular year. In 
fact, two states (Idaho and Rhode Island) replaced their regulatory 
codes in recent years as part of sunset processes, and these 
experiences seemed to work relatively seamlessly.\268\
---------------------------------------------------------------------------

    \266\ Missouri Revised Statutes, Title XXXVI Sec.  536.175.5.
    \267\ Utah Code Ann. Sec.  63G-3-502(2) (2020); Idaho Code Ann. 
Sec.  67-5292 (2020).
    \268\ James Broughel, The Mighty Waves of Regulatory Reform: 
Regulatory Budgets and the Future of Cost-Benefit Analysis, 3 Bus. 
Entrepreneurship & Tax L. Rev. 206, at 216 (2019).
---------------------------------------------------------------------------

    Similarly, many major federal laws have sunset clauses attached to 
them. Notable among these are the Patriot Act, enacted in the aftermath 
of the 9/11 terrorist attack, and tax laws passed as part of the budget 
reconciliation process under the Byrd Rule in the U.S. Senate. Federal 
agencies like the Food and Drug Administration within the Department 
periodically go through a reauthorization process, not unlike a sunset 
review.\269\ Sunset provisions are also routinely used in other 
countries, notably in Australia, Canada and the United Kingdom. A 
recent OECD report noted that just under half of OECD member countries 
have some form of sunsetting arrangements in place.\270\ In Australia, 
since the passage of the Legislation Act of 2003,\271\ all regulations 
(known as legislative instruments), with some exceptions, automatically 
expire 10 years after enactment unless parliament acts to extend the 
period or a replacement instrument is adopted.\272\ The Australian 
Federal Register of Legislation (the equivalent of the Federal Register 
in the United States) maintains the sunset dates for qualifying 
legislation and provides notice about legislative instruments set to 
expire soon.\273\ The Department also plans to provide advance notice 
of expiration dates, and will provide updates on its progress 
conducting its regulatory reviews.
---------------------------------------------------------------------------

    \269\ See FDA Reauthorization Act of 2017, Public Law 115-52 
(Aug. 18, 2017).
    \270\ OECD, Reviewing the Stock of Regulation, at 25 (2020).
    \271\ Legislation Act 2003 (Cth) (Austl.)
    \272\ Australian Gov't Att'y Gen.'s Dep't, Guide to Managing the 
Sunsetting of Legislative Instruments, at 6 (July 2020), https://www.ag.gov.au/sites/default/files/2020-07/Guide%20to%20Managing%20Sunsetting%20of%20Legislative%20Instruments.pdf.
    \273\ ``Federal Register of Legislation,'' Australian 
Government, accessed November 30, 2020, https://www.legislation.gov.au/Browse/Results/BySunsetDate/LegislativeInstruments/SunsettingSoon/2022/0/0/.
---------------------------------------------------------------------------

    The Australian government also notes that sunset provisions are a 
useful way to spur periodic review of regulations, stating in a report 
that ``Sunsetting provides an opportunity for agencies to review and 
streamline legislative instruments. It is an important mechanism for 
reducing red tape, delivering clearer laws and aligning existing 
legislation with current government policy.'' \274\
---------------------------------------------------------------------------

    \274\ Id. at 3.
---------------------------------------------------------------------------

    The Republic of Korea (ROK) enacted regulatory sunset legislation 
in the late 1990s and formed a Regulatory Reform Committee (RRC) to 
review newly-introduced regulations and to improve the quality of 
existing regulations.\275\ According to a report from the OECD, ``The 
overall aim of the sunset clause is to periodically review regulations 
in order to determine whether it will be retained or abolished.'' \276\ 
In 2009, ROK broadened the scope of its regulatory sunset process by 
tying in requirements for retrospective analysis.\277\ About 20 percent 
of existing regulations are reviewed every three to five years and 
rescinded if found to ``not serve the originally intended purpose.'' 
\278\ Moreover, according to the OECD, ``[i]n 2014, the RRC set goals 
to reduce the economic regulations by 10% . . . As a result, 995 out of 
9,876 economic regulations were improved, which amounts to 10.1% of the 
total.'' \279\
---------------------------------------------------------------------------

    \275\ OECD, Regulatory Policy in Korea: Towards Better 
Regulation (2017).
    \276\ Id. at 20.
    \277\ Id.at 71.
    \278\ Id. at 41.
    \279\  Id. at 84.
---------------------------------------------------------------------------

    These jurisdictions' sunset provisions do not all work identically 
to this final rule. However, in some ways this final rule is more lax 
than these other jurisdictions' sunset provisions, because the 
requirements to extend expiration dates are more modest compared to 
some other jurisdictions. For example, conducting an Assessment, and 
when necessary, a Review, is a relatively easy way to extend an 
expiration date compared to having to initiate an entirely new 
rulemaking. If the sunset reviews in these other jurisdictions do not 
create tremendous uncertainty, it stands to reason that neither will 
this final rule.
    Some commenters expressed concern that regulations might 
accidentally expire due to the Department not timely conducting an 
Assessment or Review. The Department intends to review all regulations 
subject to this final rule, and that any regulations that are 
eliminated will be formally rescinded following the Review process. 
This is consistent with the experiences of other jurisdictions with 
sunset provisions, where rules (or boards or commissions) are first 
subjected to a review process before they are reauthorized or 
rescinded. As an example, Idaho recently conducted a sunset review of 
its entire regulatory code. While a significant number of rule chapters 
were eliminated as part of that effort, those chapters were rescinded 
as part of a deliberate review process.
    New Jersey is a state that attaches a 7-year sunset provision to 
regulations. According to the Office of Administrative Law in the 
state, it is a relatively rare phenomenon that rules expire due to 
administrative error.\280\ Similarly, accidental expiration of rules 
appears to be uncommon in Missouri, a state that connects a sunset 
provision to a periodic review requirement, much like this final 
rule.\281\
---------------------------------------------------------------------------

    \280\ Personal communication with an official from the New 
Jersey Office of Administrative Law (Dec. 9, 2020).
    \281\ Personal communication with an official from the Missouri 
Office of the Attorney General (Dec. 31, 2020).
---------------------------------------------------------------------------

    Data from North Carolina's sunset review process can be informative 
about the extent to which rules are likely to be rescinded, modified, 
or kept without change as part of a sunset review. A North Carolina 
public policy organization found that 19,361 rules were reviewed as 
part of that state's sunset review process in recent years.\282\

[[Page 5748]]

Of these, 5,542 were sent back through the rule adoption process 
(28.6%), presumably to be updated, and 11,811 rules were automatically 
re-upped with no change (61.0%). About 10 percent of regulations 
reviewed under the recent sunset review process were rescinded,\283\ 
and this occurred under the supervision of the state Rules Review 
Commission that was overseeing the process.
---------------------------------------------------------------------------

    \282\ Jon Sanders, Rule removal under periodic review has slowed 
down, but a new law tightens the process, The John Locke Found.: The 
Locker Room (July 22, 2019), https://lockerroom.johnlocke.org/2019/07/22/rule-removal-under-periodic-review-has-slowed-down-but-a-new-law-tightens-the-process/.
    \283\ Jon Sanders, Rule removal under periodic review has slowed 
down, but a new law tightens the process, The John Locke Found.: The 
Locker Room (July 22, 2019), https://lockerroom.johnlocke.org/2019/07/22/rule-removal-under-periodic-review-has-slowed-down-but-a-new-law-tightens-the-process/.
---------------------------------------------------------------------------

    These numbers reinforce that there is little empirical basis to 
support fears that thousands of regulations might accidentally expire 
as a result of the Department's final regulation. The experiences in 
Idaho, New Jersey, Missouri and North Carolina demonstrate that sunset 
reviews tend to be orderly processes. Even in states like Idaho and 
Rhode Island, where significant portions of their regulatory codes were 
eliminated in recent years, these processes took place in an orderly 
fashion under the supervision of the state budget offices in those 
states.
    Moreover, the Department has built in safeguards to prevent 
inadvertent expiration of regulations, such as seeking comment on the 
proposed rule regarding regulations that are important to Assess and 
Review, and enabling the public to submit comments requesting that the 
Department commence an Assessment or Review. Most importantly, the 
Department plans to release a list of when all of the regulations under 
its authority were created and last modified. This can be used to 
easily determine the expiration date of all regulations under its 
authority, which will significantly lower the chance any regulation 
might expire accidentally. The fact that a schedule of the Department's 
rules, along with their corresponding creation and modification dates, 
will be made public by the Department means the public will also be 
aware of which rules are scheduled to expire and when, thereby 
providing an additional safeguard against accidental expirations. 
Additionally, the timeline for initial reviews of older regulations has 
also been extended to five years in this final rule, with the option of 
a one-year extension, which should give the Department ample time to 
conduct Assessments and Reviews and should result in few, if any, 
accidental expirations.
    One might worry that periodic reviews may distract from other 
potentially beneficial rulemakings, which could impose a cost that the 
Department has not fully considered in the proposed rule. However, 
there is some indication that when regulators are undergoing 
retrospective review efforts, if a rulemaking is an urgent priority to 
them, they often find ways to justify it as part of their reviews, even 
if the rulemaking would have occurred absent the review.\284\ In other 
words, regulators maintain some flexibility to enact necessary new 
regulations by folding them into retrospective reviews, including the 
amendment and rescission process, alleviating some of the concern 
raised by the commenters. To the extent that any new rulemaking is 
displaced as a result of reviews required by the current regulation, it 
is likely to be the case that relatively lower priority rulemakings are 
displaced first (as presumably the Department will first implement high 
priority regulations before moving on to lower priority regulations).
---------------------------------------------------------------------------

    \284\ Randall Lutter, Regulatory Policy: What Role for 
Retrospective Analysis and Review?, 4 J. Benefit-Cost Analysis 17 
(2013).
---------------------------------------------------------------------------

    Unfortunately, it is unknown with certainty whether Department 
rules impose benefits in excess of costs on average. The vast majority 
of Department rules do not have cost-benefit reports associated with 
them. Even for those that do, there are large uncertainties, and the 
literature suggests that many regulations are having estimated impacts 
that, over time, differ from what was estimated at the time the 
regulations were promulgated.\285\ This suggests that if a regulation 
did expire accidentally, this could be a cost or a benefit of this 
final rule, depending on the circumstances, since it is unknown whether 
the net benefits of the preponderance of Department rules are positive 
or negative. Regulations that are rescinded through sunset procedures 
are sometimes obviously problematic, such that their removal is 
uncontroversial. And if a regulation accidentally expired, it could 
very well be because neither the Department nor interested members of 
the public saw a discernible benefit from the regulation. Regulations 
with discernible benefits are unlikely to go under the radar.
---------------------------------------------------------------------------

    \285\ Office of Mgmt. & Budget, Validating Regulatory Analysis: 
2005 Report to Congress on the Costs and Benefits of Federal 
Regulations and Unfunded Mandates on State, Local, and Tribal 
Entities, at 46-47 (2005) http://perma.cc/R8LX-BQMJ (collecting 
studies comparing ex ante and ex post analyses of regulations' costs 
and benefits, including examples where cost and benefit estimates 
were off by more than a factor of ten); Winston Harrington, Grading 
Estimates of the Benefits and Costs of Federal Regulation, at 33 
(Resources for the Future, Discussion Paper No. 06-39, 2006), http://papers.ssrn.com/sol3/papers.cfm?abstract_id=937357.; Richard 
Morgenstern, Retrospective Analysis of U.S. Federal Environmental 
Regulation, 9 J. Benefit-Cost Analysis 285, at 294 (2018).
---------------------------------------------------------------------------

    A related concern in comments is that Assessments and Reviews will 
take Department time and resources away from responding to the COVID-19 
pandemic. Under this final rule, no Assessments or Reviews need to be 
completed until the end of 2026, well after the COVID-19 pandemic is 
likely to have subsided. Hence it is unlikely that this final rule will 
hamper the response to the pandemic.
    The Department recognizes that this final rule requires the 
Department to undertake certain tasks. But given the importance of 
retrospective review, the Department believes that review should be a 
priority and it is willing to commit the necessary resources towards 
performing Assessments and Reviews.\286\
---------------------------------------------------------------------------

    \286\ See also In re Barr Labs., Inc., 930 F.2d 72, 76 (D.C. 
Cir. 1991) (courts ``have no basis for reordering agency priorities. 
The agency is in a unique--and authoritative--position to view its 
projects as a whole, estimate the prospects for each, and allocate 
its resources in the optimal way.'').
---------------------------------------------------------------------------

    The expertise of Department analysts may also be best leveraged 
through Assessments and Reviews that could facilitate the Department's 
response to future pandemics or emergencies. As noted earlier, the 
Department waived or exercised enforcement discretion with respect to 
many regulations as part of its response to the pandemic. A review of 
those regulations is entirely appropriate to determine whether those 
regulations are undermining Department goals. Additionally, the COVID-
19 pandemic has raised serious questions about whether certain 
Department regulations are protecting public health or otherwise 
achieving their objectives. In fact, it is possible that in the coming 
years even absent this final rule the Department would find it 
necessary to conduct in-depth reviews of Department regulations given 
the need to suspend, waive, or exercise enforcement discretion with 
respect to certain regulations during the COVID-19 pandemic. If such 
reviews would have taken place even absent this final rule, the cost of 
this final rule could be significantly lower than estimated (since 
those costs would be built into the baseline scenario).
    Some commenters cited a report that stated ``sunset requirements 
produce perfunctory reviews and waste

[[Page 5749]]

resources.'' \287\ Indeed, the same report was cited in the preamble of 
the proposed version of this rule. However, as noted in the proposed 
rule's preamble, this statement from the report does not appear to be 
supported by the evidence. For example, the report noted that some 
states have repealed their sunset provisions, highlighting that ``North 
Carolina was first to repeal its sunset law, and many other states 
quickly followed suit,'' and concluded that ``sunset provisions quickly 
proved to be an expensive, cumbersome, and disappointing method for 
enhancing legislative control.'' \288\ However, North Carolina 
reenacted a sunset process for regulations in 2013 \289\ (after the 
report in question was published). Moreover, not every jurisdiction 
uses sunset provisions as a mechanism for enhancing legislative 
control. As already noted, the purpose of sunset provisions is often to 
spur retrospective review and analysis of regulation or legislation, 
not necessarily to empower the legislative branch of government. Nor is 
it the Department's intention with this final rule to enhance 
legislative control, but instead to encourage more retrospective review 
and improve outcomes resulting from the Department's regulations.
---------------------------------------------------------------------------

    \287\ Jason A. Schwartz, 52 Experiments with Regulatory Review, 
Inst. for Pol'y Integrity, at 24 (Nov. 2010), https://policyintegrity.org/files/publications/52_Experiments_with_Regulatory_Review.pdf.
    \288\ Id. at 33.
    \289\ Regulatory Reform Act of 2013, H.B. 74, 2013 Gen. Assemb., 
2013 Sess. (N.C. 2013).
---------------------------------------------------------------------------

    Sunset provisions are set up in institutionally diverse ways across 
diverse jurisdictions. Different jurisdictions set different expiration 
time horizons on rules and grant authority to different governing 
bodies to decide whether regulations should be extended or not. New 
Jersey and Indiana grant the authority to renew regulations to the 
regulating agency, not the legislature (similar to this final rule). 
Meanwhile, Idaho and Tennessee task the legislature with renewing 
regulations.
    While legal scholars have sometimes argued that sunset provisions 
have a useful role to play in strengthening legislative control,\290\ 
sunset provisions' benefits in terms of improving the impacts of 
regulations are equally if not more important than these legislative 
oversight or separation of powers issues. It may be the case that 
sometimes legislators do not want or do not have time to devote to in-
depth reviews of large numbers of regulations, which is perhaps why 
sunset reviews that engage the legislature have sometimes turned into 
pro forma exercises.\291\ In other words, it seems likely that the 
criticisms of sunset provisions that have appeared sporadically in the 
academic literature may relate to whether sunsets spur legislative 
engagement in rulemaking, rather than whether they are useful in terms 
of spurring retrospective review (where there seems to be less 
controversy).
---------------------------------------------------------------------------

    \290\ Jonathan H. Adler & Christopher Walker, Delegation and 
Time, 105 Iowa L. Rev. 1931 (2020).
    \291\ Robert W. Hahn, State and Federal Regulatory Reform: A 
Comparative Analysis, 29 The J. Legal Stud. 873 (2000).
---------------------------------------------------------------------------

    To conclude, the Department acknowledges that some categories of 
costs have not been quantified here. While other categories of costs do 
exist than those calculated in table 4, they may be subject to greater 
uncertainty, be more challenging to estimate, or be relatively minor 
such that their estimation would not substantially alter the 
conclusions of this cost analysis.
    As is common practice, this regulatory impact analysis has not 
sought to quantify the benefits of this final rule, but the Department 
believes they will be substantial.

E. Summary of Regulatory Impact Analysis

    A forcing mechanism will help ensure robust compliance with the 
Department's statutory obligations, which will strengthen the rule of 
law in the United States. Given how much of federal spending is driven 
by Department spending, regulatory reviews may also constitute a way to 
cut the federal budget deficit. If the Department is not able to review 
its own regulations in a timely manner, it is not clear how any member 
of the public can be expected to comply with all of the regulations the 
Department has written for them (plus all of the regulations issued by 
other federal, state, and local agencies). Fortunately, the Department 
intends to timely Assess and (where needed) Review those regulations 
not exempt from this final rule. Even if for some reason the Department 
cannot, it has provided itself an opportunity to delay the expiration 
date where the public interest requires so doing.

Regulatory Flexibility Act

    The Department has examined the economic implications of this final 
rule as required by the RFA (5 U.S.C. 601-612). The RFA generally 
requires that when an agency issues a proposed rule, or a final rule 
pursuant to section 553(b) of the APA or another law, the agency must 
prepare a regulatory flexibility analysis that meets the requirements 
of the RFA and publish such analysis in the Federal Register. 5 U.S.C. 
603, 604. Specifically, the RFA normally requires agencies to describe 
the impact of a rulemaking on small entities by providing a regulatory 
impact analysis. Such analysis must address the consideration of 
regulatory options that would lessen the economic effect of the rule on 
small entities. The RFA defines a ``small entity'' as (1) a proprietary 
firm meeting the size standards of the Small Business Administration 
(SBA); (2) a nonprofit organization that is not dominant in its field; 
or (3) a small government jurisdiction with a population of less than 
50,000. 5 U.S.C. 601(3)-(6). Except for such small government 
jurisdictions, neither State nor local governments are ``small 
entities.'' Similarly, for purposes of the RFA, individual persons are 
not small entities. The requirement to conduct a regulatory impact 
analysis does not apply if the head of the agency ``certifies that the 
rule will not, if promulgated, have a significant economic impact on a 
substantial number of small entities.'' 5 U.S.C. 605(b). The agency 
must, however, publish the certification in the Federal Register at the 
time of publication of the rule, ``along with a statement providing the 
factual basis for such certification.'' Id. If the agency head has not 
waived the requirements for a regulatory flexibility analysis in 
accordance with the RFA's waiver provision, and no other RFA exception 
applies, the agency must prepare the regulatory flexibility analysis 
and publish it in the Federal Register at the time of promulgation or, 
if the rule is promulgated in response to an emergency that makes 
timely compliance impracticable, within 180 days of publication of the 
final rule. 5 U.S.C. 604(a), 608(b).
    The Department considers a rule to have a significant impact on a 
substantial number of small entities if it has at least a three percent 
impact on revenue on at least five percent of small entities. 
Department regulations impact at least NAICS industry sectors 11, 31-
33, 42, 44-45, 48-49, 52, 54, 62, 81, and 92.
    The Regulatory Impact Analysis in the prior section also satisfies 
the Department's obligation to conduct a regulatory flexibility 
analysis under section 604. For the reasons described in this final 
rule, this final rule will benefit small entities.

Congressional Review Act

    The Congressional Review Act (CRA) defines a ``major rule'' as 
``any rule that the Administrator of the Office of Information and 
Regulatory Affairs

[[Page 5750]]

(OIRA) of the Office of Management and Budget finds has resulted in or 
is likely to result in--(A) an annual effect on the economy of 
$100,000,000 or more; (B) a major increase in costs or prices for 
consumers, individual industries, Federal, State, or local government 
agencies, or geographic regions; or (C) significant adverse effects on 
competition, employment, investment, productivity, innovation, or on 
the ability of United States-based enterprises to compete with foreign-
based enterprises in domestic and export markets.'' 5 U.S.C. 804(2). 
Based on the analysis of this final rule under Executive Order 12866, 
this rule is expected to be a major rule for purposes of the CRA. The 
Department will comply with the CRA's requirements to inform Congress.

Unfunded Mandates Reform Act

    Section 202 of the Unfunded Mandates Reform Act of 1995 (Unfunded 
Mandates Act) (2 U.S.C. 1532) requires that covered agencies prepare a 
budgetary impact statement before promulgating a rule that includes any 
Federal mandate that may result in the expenditure by State, local, and 
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 $156 million. If a budgetary impact 
statement is required, section 205 of the Unfunded Mandates Act also 
requires covered agencies to identify and consider a reasonable number 
of regulatory alternatives before promulgating a rule.

National Environmental Policy Act (NEPA)

    HHS has determined that the proposed rule will not have a 
significant impact on the environment.

Executive Order 12988: Civil Justice Reform

    HHS has reviewed this rule under Executive Order 12988 on Civil 
Justice Reform and has determined that this final rule complies with 
this Executive Order.

Executive Order 13132: Federalism

    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a rule that imposes substantial 
direct costs on State and local governments or has federalism 
implications. The Department has determined that this final rule does 
not impose substantial direct costs on State and local governments or 
have federalism implications as defined in Executive Order 13132. The 
final rule requires the Department to periodically review certain of 
its regulations, and provides that if the regulations are not reviewed 
by a certain date, they will expire. Any rescission of a regulation 
would only occur because of acts independent of this final rule--either 
the findings of a Review determining a regulation should be amended, or 
a failure to perform an Assessment or Review. Thus, this final rule 
would impose no substantial direct costs on State and local 
governments.
    The Department notes, though, that this final rule might indirectly 
have beneficial federalism implications. Among other things, the 
Reviews called for by this final rule require the Department to 
determine if certain Department regulations overlap, duplicate or 
conflict with State and local government rules and, if so, to consider 
that when determining whether to amend or rescind the regulations. If a 
Review conducted pursuant to this final rule were to find that a 
Department regulation should be amended or rescinded, the Department 
would comply with Executive Order 13132 in amending or rescinding the 
regulation.

Plain Writing Act of 2010

    Under the Plain Writing Act of 2010 (Pub. L. 111-274, October 13, 
2010), executive departments and agencies are required to use plain 
language in documents that explain to the public how to comply with a 
requirement the federal government administers or enforces. The 
Department has attempted to use plain language in promulgating this 
proposed rule, consistent with the Federal Plain Writing Act 
guidelines.

Assessment of Federal Regulation and Policies on Families

    Section 654 of the Treasury and General Government Appropriations 
Act of 1999, Public Law 105-277, sec. 654, 112 Stat. 2681 (1998) 
requires Federal departments and agencies to determine whether a policy 
or regulation could affect family well-being. Section 601 (note) 
required agencies to assess whether a regulatory action (1) impacted 
the stability or safety of the family, particularly in terms of marital 
commitment; (2) impacted the authority of parents in the education, 
nurturing, and supervision of their children; (3) helped the family 
perform its functions; (4) affected disposable income or poverty of 
families and children; (5) was justified if it financially impacted 
families; (6) was carried out by State or local government or by the 
family; and (7) established a policy concerning the relationship 
between the behavior and personal responsibility of youth and the norms 
of society.
    This final rule would apply to and amend certain Department 
regulations to add dates by which they would expire unless the 
Department periodically reviews the regulations using certain criteria. 
Standing alone, absent the failure to perform an Assessment or Review, 
this final rule would have no direct impact, other than resulting in 
the Department amending or rescinding Regulations that it determines do 
not satisfy the Review criteria.
    If the family well-being determination requirement were still in 
force, for the reasons described in this final rule's Regulatory Impact 
Analysis, the Department concludes that the benefits to the public, 
including families, that flow from periodic Assessments and Reviews of 
Regulations far outweigh any potential adverse impact on family well-
being that might result from a regulation expiring because the 
Department did not Assess or Review it. The Department believes that 
impacted families benefit greatly when a regulatory body considers the 
real-world impacts of its regulations, and whether changes in 
technology, the economy, or the legal landscape counsel in favor of 
amending or rescinding regulations. It is conceivable that a regulation 
affecting the disposable income or poverty of families or children 
could expire. It is also possible that the expiration of a regulation 
that the Department does not Review could have beneficial impacts on 
family well-being. If, pursuant to this final rule, the Department 
amends or rescinds a regulation, it would conduct any required 
assessment of the policy on families at the time of such rulemaking.

Paperwork Reduction Act of 1995

    In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
3506; 5 CFR 1320 Appendix A.1), HHS has reviewed this final rule and 
has determined that there are no new collections of information 
contained therein.

List of Subjects

21 CFR Part 6

    Administrative practice and procedure.

42 CFR Part 1

    Administrative practice and procedure.

42 CFR Part 404

    Administrative practice and procedure.

[[Page 5751]]

42 CFR Part 1000

    Administrative practice and procedure.

45 CFR Part 8

    Administrative practice and procedure.

45 CFR Part 200

    Administrative practice and procedure.

45 CFR Part 300

    Administrative practice and procedure.

45 CFR Part 403

    Administrative practice and procedure.

45 CFR Part 1010

    Administrative practice and procedure.

45 CFR Part 1390

    Administrative practice and procedure.

    For the reasons set forth in the preamble, the Department amends 21 
CFR, chapter I, 42 CFR chapters I, IV, and V; 45 CFR subtitle A; and 45 
CFR subtitle B, chapters II, III, IV, X, and XIII, as follows:

Title 21--Food and Drugs

CHAPTER I--FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN 
SERVICES

0
1. Add part 6 to read as follows:

PART 6--REVIEW OF REGULATIONS

Sec.
6.1 Retrospective Review of Existing Regulations.
6.2 through 6.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610; 15 U.S.C. 402; 15 U.S.C. 
409; 15 U.S.C. 1261-1276; 15 U.S.C. 1333; 15 U.S.C. 1451-1461; 15 
U.S.C. 4402; 18 U.S.C. 1905; 19 U.S.C. 1490-1491; 19 U.S.C. 2531-
2582; 21 U.S.C. 41-50; 21 U.S.C. 141-149; 21 U.S.C. 301 et seq.; 21 
U.S.C. 355 note; 21 U.S.C. 301-397; 21 U.S.C. 467f; 21 U.S.C. 679; 
21 U.S.C. 821; 21 U.S.C. 1034; 21 U.S.C. 1401-1403; 28 U.S.C. 2112; 
35 U.S.C. 156; 42 U.S.C. 201-262; 42 U.S.C. 263a; 42 U.S.C. 263b-
263n; 42 U.S.C. 264; 42 U.S.C. 265; 42 U.S.C. 271; 42 U.S.C. 300aa-
28; 42 U.S.C. 300u-300u-5; 42 U.S.C. 4321; 42 U.S.C. 4332, 42 U.S.C. 
7671 et seq.; Sec. 121, Pub. L. 105-115, 111 Stat. 2296; Pub. L. 
107-109; Pub. L. 107-188, 116 Stat. 594, 668-69; Pub. L. 108-155; 
Secs. 201 and 202, Pub. L. 111-31, 123 Stat. 1776; Secs. 901(b) and 
906(d), Pub. L. 111-31; Pub. L. 111-353, 124 Stat. 3885, 3889; Pub. 
L. 113-54.

Sec.  6.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not

[[Page 5752]]

feasible by the established date, he shall so certify in a statement 
published in the Federal Register and may extend the completion date by 
one year at a time, no more than three times, for a total of not more 
than five years (inclusive of the initial two-year period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (8) 21 CFR parts 131, 133, 135-137, 139, 145, 146, 150, 152, 155, 
156, 158, 160, 161, 163-166, 168, and 169.
    (9) 21 CFR parts 331-333, 335-336, 338, 340-341, 343-344, 346-350, 
352, 355, 357, and 358.
    (10) 21 CFR parts 862, 864, 866, 868, 870, 872, 874, 876, 878, 880, 
882, 884, 886, 888, 890, 892, 895, and 898.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec. Sec.  6.2 through 6.5  [Reserved].

Title 42--Public Health

CHAPTER I--PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN 
SERVICES

0
2. Add part 1 to read as follows:

PART 1--REVIEW OF REGULATIONS

Sec.
1.1 Retrospective Review of Existing Regulations
1.2 through 1.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610, 8 U.S.C. 1182, 8 U.S.C. 
1222, 29 U.S.C. 670(a), 30 U.S.C. 957, 31 U.S.C. 9701, 42 U.S.C. 
216, 42 U.S.C. 241, 42 U.S.C. 300a-4, 42 U.S.C. 10801, 42 U.S.C. 
1302, 42 U.S.C. 1395hh, 42 U.S.C. 702(a), 42 U.S.C. 702(b)(1)(A), 42 
U.S.C. 706(a)(3), 42 U.S.C. 243, 42 U.S.C. 247b, 247c, 42 U.S.C. 
247d-6e, 31 U.S.C. 1243 note, 42 U.S.C. 252, 42 U.S.C. 254c, 42 
U.S.C. 262a, 42 U.S.C. 256b, 42 U.S.C. 263, 42 U.S.C. 263a, 42 
U.S.C. 264-271, 42 U.S.C. 273-274d; 42 U.S.C. 274e; 42 U.S.C. 
290aa(m), 42 U.S.C. 284g, 42 U.S.C. 285a-6(c)(1)(E), 42 U.S.C. 285a-
7(c)(1)(G), 42 U.S.C. 285b-4, 42 U.S.C. 285c-5, 42 U.S.C. 285c-8, 42 
U.S.C. 285d-6, 42 U.S.C. 285e-2, 42 U.S.C. 285e-3, 42 U.S.C. 285e-
10a, 42 U.S.C. 285f-1, 42 U.S.C. 285g-5, 42 U.S.C. 285g-7, 42 U.S.C. 
285g-9, 42 U.S.C. 285m-3, 42 U.S.C. 285o-2, 42 U.S.C. 286a-
7(c)(1)(G), 42 U.S.C. 287c-32(c), 42 U.S.C. 288, 42 U.S.C. 289a, 42 
U.S.C. 289b, 42 U.S.C. 290aa, et seq., 42 U.S.C. 290aa(d), 42 U.S.C. 
290aa(m), 42 U.S.C. 290cc-21, et seq., 42 U.S.C. 290dd-2, 42 U.S.C. 
290kk, et seq., 42 U.S.C. 300 through 300a-6, 42 U.S.C. 300cc-16, 42 
U.S.C. 300mm-300mm-61, 42 U.S.C. 300x-21, et seq, 42 U.S.C. 7384n, 
42 U.S.C. 7384q, 42 U.S.C. 6939a.

Sec.  1.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if

[[Page 5753]]

required) the review of a Section are published in the Federal Register 
pursuant to paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (8) 42 CFR part 73.
    (9) 42 CFR 100.3.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec. Sec.  1.2 through 1.5  [Reserved]

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
HEALTH AND HUMAN SERVICES

0
3. Add part 404 to subchapter A to read as follows:

PART 404--REVIEW OF REGULATIONS

Sec.
404.1 Retrospective Review of Existing Regulations
404.2 through 404.5 [Reserved]

    Authority: 5 U.S.C. 301; 5 U.S.C. 610; 31 U.S.C. 9701; 42 U.S.C. 
263a; 42 U.S.C. 273; 42 U.S.C. 300e; 42 U.S.C. 300e-5; 42 U.S.C. 
300e-9; 42 U.S.C. 405(a), 42 U.S.C. 1302; 42 U.S.C. 1306; 42 U.S.C. 
1315a; 42 U.S.C. 1320a-7; 42 U.S.C. 1320a-7j; 42 U.S.C. 1320b-8; 42 
U.S.C. 1320b-12; 42 U.S.C. 1395; 42 U.S.C. 1395aa(m); 42 U.S.C. 
1395cc; 42 U.S.C. 1395d(d); 42 U.S.C. 1395ddd; 42 U.S.C. 1395eee(f); 
42 U.S.C. 1395f(b); 42 U.S.C. 1395ff; 42 U.S.C. 1395g; 42 U.S.C. 
1395hh; 42 U.S.C. 1395i; 42 U.S.C. 1395i-3; 42 U.S.C. 1395l(a), (i), 
(n), and (t); 42 U.S.C. 1395jjj; 42 U.S.C. 1395kk; 42 U.S.C. 1395m; 
42 U.S.C. 1395nn; 42 U.S.C. 1395rr; 42 U.S.C. 1395rr(b)(l); 42 
U.S.C. 1395tt; 42 U.S.C. 1395w-5; 42 U.S.C. 1395w-101 through 1395w-
152; 42 U.S.C. 1395ww; 42 U.S.C. 1395ww(k); 42 U.S.C. 1395x; 
1395x(e), the sentence following 1395x(s)(11) through 1395x(s)(16)); 
42 U.S.C. 1395x(v); 42 U.S.C. 1395y(a); 42 U.S.C. 1396r; 42 U.S.C. 
1396r-8; 42 U.S.C. 1396u-4(f); 44 U.S.C. Chapter 35; Section 1331 of 
the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-

[[Page 5754]]

148, 124 Stat. 119), as amended by the Health Care and Education 
Reconciliation Act of 2010 (Pub. L. 111-152, 124 Stat 1029); Pub. L. 
112-202 amendments to 42 U.S.C. 263a; sec. 105, Pub. L. 114-10, 129 
Stat. 87.

Sec.  404.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (8) The annual Medicare payment update rules.

[[Page 5755]]

    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec. Sec.  404.2 through 404.5  [Reserved]

CHAPTER V--OFFICE OF INSPECTOR GENERAL--HEALTH CARE, DEPARTMENT OF 
HEALTH AND HUMAN SERVICES

0
4. Add subpart A to part 1000 to read as follows:

PART 1000--Introduction, General Definitions

Subpart A--Review of regulations

Sec.
1000.1 Retrospective Review of Existing Regulations
1000.2 through 1000.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610; 31 U.S.C. 6101 note; 42 
U.S.C. 262a; 42 U.S.C. 405(a); 42 U.S.C. 405(b); 42 U.S.C. 405(d); 
42 U.S.C. 405(e); 42 U.S.C. 1302; 42 U.S.C.1320; 42 U.S.C. 1320a-
7d(b); 1320b-10; 42 U.S.C. 1320c-5; 42 U.S.C. 1395cc(b)(2)(D), (E), 
and (F); 42 U.S.C. 1395cc(j); 42 U.S.C. 1395dd(d)(1); 42 U.S.C. 
1395hh; 42 U.S.C. 1395mm; 42 U.S.C. 1395nn(g); 42 U.S.C. 1395ss(d); 
42 U.S.C. 1395u(j); 42 U.S.C. 1395u(k); 42 U.S.C. 1395w-104(e)(6); 
42 U.S.C. 1395w-141(i)(3); 42 U.S.C. 1395y(d); 42 U.S.C. 1395y(e); 
42 U.S.C. 1396(a)(4)(A); 42 U.S.C. 1396a(p); 42 U.S.C. 1396a(a)(39); 
42 U.S.C. 1396a(a)(41); 42 U.S.C. 1396a(a)(61); 42 U.S.C. 
1396b(a)(6); 42 U.S.C. 1396b(b)(3); 42 U.S.C. 1396b(i)(2); 42 U.S.C. 
1396b(m); 42 U.S.C. 1396b(q); 42 U.S.C. 1842(j)(1)(D)(iv); 42 U.S.C. 
1842(k)(1); 42 U.S.C. 11131(c); 42 U.S.C. 11137(b)(2).

Sec.  1000.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the

[[Page 5756]]

Department shall have two years from the date that the findings of the 
review are published in the Federal Register pursuant to paragraph (f) 
of this section to amend or rescind the Section. If the Secretary 
determines that completion of the amendment or rescission is not 
feasible by the established date, he shall so certify in a statement 
published in the Federal Register and may extend the completion date by 
one year at a time, no more than three times, for a total of not more 
than five years (inclusive of the initial two-year period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (8) 42 CFR 1001.952.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec. Sec.  1000.2 through 1000.5  [Reserved]

Title 45--Public Welfare

Subtitle A--Department of Health and Human Services

0
5. Add part 8 to read as follows:

PART 8--REVIEW OF REGULATIONS

Sec.
8.1 Retrospective Review of Existing Regulations
8.2 through 8.5 [Reserved]

    Authority: 5 U.S.C. 301; 5 U.S.C. 504(c)(1); 5 U.S.C. 552; 5 
U.S.C. 552a; 5 U.S.C. 553; 5 U.S.C. 5514; 5 U.S.C. 7301; 8 U.S.C. 
1182(e)); 8 U.S.C. 1182(j)(2)(A); 18 U.S.C. 207(j); 18 U.S.C. 1905; 
20 U.S.C. 91; 20 U.S.C. 1405; 20 U.S.C. 1681 et seq.; 20 U.S.C. 1681 
through 1688; 21 U.S.C. 1174; 22 U.S.C. 2151b(f) (e.g., Pub. L. 116-
6, Div. F, sec. 7018); 22 U.S.C. 2451 et seq.; 22 U.S.C. 7631(d); 22 
U.S.C. 7631(f); 26 U.S.C. 36B; 26 U.S.C. 5000A(d)(2); 28 U.S.C. 
2672; 29 U.S.C. 669(a)(5); 29 U.S.C. 794; 31 U.S.C. 1243 note; 31 
U.S.C. 1352; 31 U.S.C. 3711(d); 31 U.S.C. 3720A; 31 U.S.C. 3720D; 31 
U.S.C. 3721; 31 U.S.C. 3801-3812; 31 U.S.C. 6506; 31 U.S.C. 7501-
7507; 31 U.S.C. 9701; 40 U.S.C. 121(c); 40 U.S.C. 318-318d; 40 
U.S.C. 484; 40 U.S.C. 484(k); 40 U.S.C. 486; 42 U.S.C. 216; 42 
U.S.C. 216(b); 42 U.S.C. 238n; 42 U.S.C. 263a(f)(1)(E); 42 U.S.C. 
280g-1(d); 42 U.S.C. 289(a); 42 U.S.C. 289b-1; 42 U.S.C. 290bb-
36(f); 42 U.S.C. 290dd-2; 42 U.S.C. 299c-4; 42 U.S.C. 300a-7; 42 
U.S.C. 300aa-11; 42 U.S.C. 300gg through 300gg-63; 42 U.S.C. 300gg-1 
through 300gg-5; 42 U.S.C. 300gg-11 through 300gg-23; 42 U.S.C. 
300gg-18; 42 U.S.C. 300gg-91; 42 U.S.C. 300gg-92; 42 U.S.C. 300gg-
94; 42 U.S.C. 300jj-11; 42 U.S.C 300jj-14; 42 U.S.C. 300jj-52; 42 
U.S.C. 300w et seq.; 42 U.S.C. 300x et seq.; 42 U.S.C. 300y et seq.; 
42 U.S.C. 618; 42 U.S.C. 622(b); 42 U.S.C. 629b(a); 42 U.S.C. 
652(a); 42 U.S.C. 652(d); 42 U.S.C. 654A; 42 U.S.C. 671(a); 42 
U.S.C. 701 et seq.; 42 U.S.C. 1302; 42 U.S.C. 1302(a); 42 U.S.C. 
1306(c); 42 U.S.C. 1310; 42 U.S.C. 1315; 42 U.S.C. 1315a; 42 U.S.C. 
1320a-1; 42 U.S.C. 1320a-7e; 42 U.S.C. 1320c-11; 42 U.S.C. 
1395cc(f); 42 U.S.C. 1320d-2 (note); 42 U.S.C. 1320d-1320d-9; 42 
U.S.C. 1395i-3; 42 U.S.C. 1395i-5; 42 U.S.C. 1395w-22(j)(3)(B); 42 
U.S.C. 1395w-26; 42 U.S.C. 1395w-27; 42 U.S.C. 1395x; 42 U.S.C. 
1396a; 42 U.S.C. 1396a(a); 42 U.S.C. 1396a(w)(3); 42 U.S.C. 1396f; 
42 U.S.C. 1396r; 42 U.S.C. 1396r-2; 42 U.S.C. 1396s(c)(2)(B)(ii); 42 
U.S.C. 1396u-2(b)(3)(B); 42 U.S.C. 1397 et seq.; 42 U.S.C. 1397j-
1(b); 42 U.S.C. 2000d et seq.; 42 U.S.C. 2000d-1; 42 U.S.C. 2942; 42 
U.S.C. 3334; 42 U.S.C. 3505; 42 U.S.C. 3535(d); 42 U.S.C. 5106i(a); 
42 U.S.C. 6101 et seq.; 42 U.S.C. 8621 et seq.; 42 U.S.C. 9858; 42 
U.S.C. 9901 et seq.; 42 U.S.C. 11101-11152; 42 U.S.C. 11411; 42 
U.S.C. 14406; 42 U.S.C. 18021-18024; 42 U.S.C. 18031-18033; 42 
U.S.C. 18041(a); 42 U.S.C. 18041-18042; 42 U.S.C. 18044; 42 U.S.C. 
18051; 42 U.S.C. 18054; 42 U.S.C. 18061 through 18063; 42 U.S.C. 
18071; 42 U.S.C. 18081-18083; 42 U.S.C. 18113; 42 U.S.C. 18116; 48 
U.S.C. 1469a; 50 U.S.C. App. 2061-2171; 27 Stat. 395; Sec. 1(a), 80 
Stat. 306; secs. 1, 5, 6, and 7 of Reorganization Plan No. 1 of 
1953, 18 FR 2053, 67 Stat. 631 and authorities cited in the 
Appendix; Sec. 203, 63 Stat. 385; Section 213, Uniform Relocation 
Assistance and Real Property Acquisition Policies Act of 1970, Pub. 
L. 91-646, 84 Stat. 1894 (42 U.S.C. 4633) as amended by the Surface 
Transportation and Uniform Relocation Assistance Act of 1987, Title 
IV of Pub. L. 100-17, 101 Stat. 246-256 (42 U.S.C. 4601 note); Sec. 
223, 58 Stat. 683, as amended by 81 Stat. 539: 42 U.S.C. 217b; Sec. 
602, 78 Stat. 252; Sec. 501 of Pub. L. 100-77, 101 Stat. 509-10, 42 
U.S.C 11411; Pub. L. 100-259, 102 Stat. 28 (Mar. 22, 1988); 5 U.S.C. 
301, Pub. L. 100-259, 102 Stat. 28 (Mar. 22 1988); Public Law 101-
410, Sec. 701 of Public Law 114-74, 31 U.S.C. 3801-3812; Section 
5301 of Pub. L. 100-690, the Anti-Drug Abuse Act of 1988, 102 Stat. 
4310, 21 U.S.C. 853a; secs. 13400-13424, Pub. L. 111-5, 123 Stat. 
258-279; Sec. 1101 of the Patient Protection and Affordable Care Act 
(Pub. L. 111-148); Section 1103 of the Patient Protection and 
Affordable Care Act (Pub. L. 111-148); secs. 1104 and 10109 of Pub. 
L. 111-148, 124 Stat. 146-154 and 915-917; Title I of the Affordable 
Care Act, Sections 1311, 1312, 1411, 1412, Pub. L. 111-148, 124 
Stat. 119; Medicare Advantage (e.g., Pub. L. 115-245, Div. B, sec. 
209); the Weldon Amendment (e.g., Pub. L. 115-245, Div. B, sec. 
507(d)); 5 U.S.C. 610.

Sec.  8.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this subtitle.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in

[[Page 5757]]

consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (8) The annual Notice of Benefit and Payment Parameters update 
rules.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by

[[Page 5758]]

which comments must be received. There shall also be a general docket 
on Regulations.gov where the public can submit comments requesting that 
the Department assess or review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec.  8.2 through 8.5   [Reserved]

Subtitle B--Regulations Relating to Public Welfare

CHAPTER II--OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), 
ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND 
HUMAN SERVICES

0
6. Add part 200 to read as follows:

PART 200--REVIEW OF REGULATIONS

Sec.
200.1 Retrospective Review of Existing Regulations
200.2 through 200.5 [Reserved]

    Authority: 5 U.S.C. 301; 5 U.S.C. 610; 24 U.S.C. 321-329; 31 
U.S.C. 7501 et seq.; 42 U.S.C. 301; 42 U.S.C. 303; 42 U.S.C. 601; 42 
U.S.C. 601 note; 42 U.S.C. 602; 42 U.S.C. 602 (note); 42 U.S.C. 
602(a)(44); 42 U.S.C. 603; 42 U.S.C. 603(a)(4); 42 U.S.C. 604; 42 
U.S.C. 605; 42 U.S.C. 606; 42 U.S.C. 607; 42 U.S.C. 608; 42 U.S.C. 
609; 42 U.S.C. 610; 42 U.S.C. 611; 42 U.S.C. 612; 42 U.S.C. 613; 42 
U.S.C. 613(i); 42 U.S.C. 616; 42 U.S.C. 619; 42 U.S.C. 654; 42 
U.S.C. 862a; 42 U.S.C. 1202; 42 U.S.C. 1203; 42 U.S.C. 1301; 42 
U.S.C. 1302; 42 U.S.C. 1306(a); 42 U.S.C. 1308; 42 U.S.C. 1313; 42 
U.S.C. 1316; 1320b-7: 42 U.S.C. 1973gg-5; 42 U.S.C. 1337; 42 U.S.C. 
1352; 42 U.S.C. 1353; 42 U.S.C. 1382 (note); 42 U.S.C. 1383 (note); 
sections 1, 5, 6, and 7 of Reorganization Plan No. 1 of 1953, 67 
Stat. 631; Secs. 1-11, 74 Stat. 308-310; Sec. 302, 75 Stat. 142, 
sec. 1102, 49 Stat. 647; sec. 6 of Pub. L. 94-114, 89 Stat. 579; 
Pub. L. No. 97-248, 96 Stat. 324, and Pub. L. No. 99-603, 100 Stat. 
3359; sec. 4 of Pub. L. 97-458, 96 Stat. 2513; sec. 2 of Pub. L. 98-
64, 97 Stat. 365; sec. 1883 of Pub. L. 99-514, 100 Stat. 2916; sec. 
15 of Pub. L. 100-241, 101 Stat. 1812; sec. 105(f) of Pub. L. 100-
383, 102 Stat. 908; sec. 206(d) of Pub. L. 100-383, 102 Stat. 914; 
sec. 105(i) of Pub. L. 100-707, 102 Stat. 4693; sec. 1(a) of Pub. L. 
101-201, 103 Stat. 1795; sec. 10405 of Pub. L. 101-239, 103 Stat. 
2489; sec. 501(c) of Pub. L. 101-392, 104 Stat. 831; sec. 6(h)(2) of 
Pub. L. 101-426, 104 Stat. 925; and sec. 471(a) of Pub. L. 102-325, 
106 Stat. 606; Sec. 7102, Pub. L. 109-171, 120 Stat. 135; Public Law 
111-5; Sec. 4004, Pub. L. 112-96, 126 Stat. 197; 49 Stat. 647.

Sec.  200.1   Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.

[[Page 5759]]

    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting.The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec.  200.2 through 200.5  [Reserved]

CHAPTER III--OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT 
ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, 
DEPARTMENT OF HEALTH AND HUMAN SERVICES

0
7. Add part 300 to read as follows:

PART 300--REVIEW OF REGULATIONS

Sec.
300.1 Retrospective Review of Existing Regulations
300.2 through 300.5 [Reserved]

    Authority: 5 U.S.C. 301; 5 U.S.C. 610; 25 U.S.C. 1603(12); 25 
U.S.C. 1621e; 42 U.S.C. 609(a)(8); 42 U.S.C. 651 through 658; 42 
U.S.C. 652(a)(4) and (g); 42 U.S.C. 654(15)(A); 42 U.S.C. 655(f); 42 
U.S.C. 658a; 42 U.S.C. 659a; 42 U.S.C. 660; 42 U.S.C. 663; 42 U.S.C. 
664; 42 U.S.C. 666 through 669A; 42 U.S.C. 1301; 42 U.S.C. 1302; 42 
U.S.C. 1396a(a)(25); 42 U.S.C. 1396b(d)(2); 42 U.S.C. 1396b(o); 42 
U.S.C. 1396b(p); 42 U.S.C. 1396(k).

Sec.  300.1   Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination,

[[Page 5760]]

which shall not exceed one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec.  300.2 through 300.5  [Reserved]

CHAPTER IV--OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR 
CHILDREN AND FAMILIES DEPARTMENT OF HEALTH AND HUMAN SERVICES

0
8. Add part 403 to read as follows:

PART 403--REVIEW OF REGULATIONS

Sec.
403.1 Retrospective Review of Existing Regulations
403.2 through 403.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610; 6 U.S.C. 279; 8 U.S.C. 
1103(a)(3); 8 U.S.C. 1232; 8 U.S.C. 1255a note; 8 U.S.C. 1522 note; 
8 U.S.C. 1522(a)(9); 42 U.S.C. 15607(d).

Sec.  403.1   Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.

[[Page 5761]]

    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

[[Page 5762]]

Sec.  403.2 through 403.5  [Reserved]

CHAPTER X--OFFICE OF COMMUNITY SERVICES, ADMINISTRATION FOR 
CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

0
9. Add part 1010 to read as follows:

PART 1010--REVIEW OF REGULATIONS

Sec.
1010.1 Retrospective Review of Existing Regulations
1010.2 through 1010.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610; 42 U.S.C. 604 nt.; 42 
U.S.C. 9901 et seq.; 42 U.S.C. 11302 (101 Stat. 485); 42 U.S.C. 
11461-11464; 42 U.S.C. 11472 (101 Stat. 532-533).

Sec.  1010.1   Retrospective Review of Existing Regulations

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was promulgated or the last time the rulemaking was reviewed 
by the Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.

[[Page 5763]]

    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec.  1010.2 through 1010.5  [Reserved]

CHAPTER XIII--ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT 
OF HEALTH AND HUMAN SERVICES

0
10. Add subchapter A to read as follows:

SUBCHAPTER A--[include your preferred subchapter heading]

PART 1300--REVIEW OF REGULATIONS

Sec.
1300.1 Retrospective Review of Existing Regulations.
1300.2 through 1390.5 [Reserved]

    Authority:  5 U.S.C. 301; 5 U.S.C. 610; 29 U.S.C. 709; 29 U.S.C. 
3343; 42 U.S.C. 620 et seq., 42 U.S.C. 670 et seq.; 42 U.S.C. 1302; 
42 U.S.C. 1395b-4; 42 U.S.C. 2991, et seq.; 42 U.S.C. 3001 et seq.; 
Title III of the Older Americans Act; 42 U.S.C. 3001; Title VI, Part 
A of the Older Americans Act; 42 U.S.C. 3001; Title VI Part B of the 
Older Americans Act; 42 U.S.C. 3515e; 42 U.S.C. 5701; 42 U.S.C. 9801 
et seq.; 42 U.S.C. 10401 et seq.; 42 U.S.C. 15001 et seq.

Sec.  1300.1  Retrospective Review of Existing Regulations.

    (a) This section applies to and shall be deemed to amend all 
regulations issued by the Secretary or his delegates or sub-delegates 
in this chapter.
    (b) For purposes of this section,
    (1) Assess shall refer to a determination by the Department, in 
consultation with other Federal agencies as appropriate, as to whether 
the Sections issued as part of the same rulemaking (and any amendments 
or additions that may have been added thereafter) currently have a 
significant economic impact upon a substantial number of small 
entities.
    (2) Review shall refer to a process conducted by the Department, in 
consultation with other Federal agencies as appropriate, the purpose of 
which shall be to determine whether Sections that were issued as part 
of the same rulemaking (and any amendments or additions that may have 
been issued thereafter) should be continued without change, or should 
be amended or rescinded, consistent with the stated objectives of 
applicable statutes, to minimize any significant economic impact of the 
Sections upon a substantial number of small entities.
    (3) Section (when capitalized) shall mean a section of the Code of 
Federal Regulations. For example, 42 CFR 2.13 is a Section, and 42 CFR 
2.14 is another Section (see 1 CFR 21.11).
    (4) Year of the Section's promulgation shall mean the year the 
Section first became effective, irrespective of whether it was 
subsequently amended.
    (5) Significant economic impact upon a substantial number of small 
entities shall have the meaning of that term in section 610 of title 5 
of the United States Code.
    (c)(1) Unless a Section expires earlier or is rescinded, all 
Sections issued by the Secretary or his delegates or sub-delegates in 
this chapter shall expire at the end of:
    (i) Five calendar years after the year that this section first 
becomes effective;
    (ii) Ten calendar years after the year of the Section's 
promulgation; or
    (iii) Ten calendar years after the last year in which the 
Department assessed and (if review of the Section is required pursuant 
to paragraph (d) of this section) reviewed the Section, whichever is 
latest.
    (2) The last year in which the Department assessed and (if review 
of the Section is required) reviewed the Section shall be the year 
during which the findings of the assessment and (if required) the 
review of a Section are published in the Federal Register pursuant to 
paragraph (f) of this section.
    (3)(i) If, prior to the expiration of a Section under paragraph 
(c)(1) of this section, the Secretary makes a written determination 
that the public interest requires continuation of the Section in force 
beyond the date on which the Section would otherwise expire under 
paragraph (c)(1), the Secretary may continue the Section in force one 
time for a period stated in the determination, which shall not exceed 
one calendar year.
    (ii) The Department shall promptly publish in the Federal Register 
any written determination under paragraph (c)(3)(i) of this section.
    (iii) The authority of the Secretary under paragraph (c)(3)(i) of 
this section is not delegable and may be exercised only by the 
Secretary or, when the office of the Secretary is vacant or the 
Secretary has become unable to perform the functions and duties of the 
office of the Secretary, by the individual acting as Secretary in 
accordance with the law.
    (d) The Department is required to review those rulemakings (and any 
amendments or additions that may have been added thereafter) that the 
Department assesses have a significant economic impact upon a 
substantial number of small entities. In reviewing rulemakings to 
minimize any significant economic impact on a substantial number of 
small entities in a manner consistent with the stated objectives of 
applicable statutes, the Department's review shall consider the 
following factors:
    (1) The continued need for the rulemaking, consideration of which 
shall include but not be limited to the extent to which the rulemaking 
defines terms or sets standards used in or otherwise applicable to 
other Federal rules;
    (2) The nature of complaints or comments received concerning the 
rulemaking from the public;
    (3) The complexity of the rulemaking;
    (4) The extent to which the rulemaking overlaps, duplicates or 
conflicts with other Federal rules, and, to the extent feasible, with 
State and local governmental rules;
    (5) The degree to which technology, economic conditions, or other 
factors have changed in the area affected by the rulemaking since the 
rulemaking was

[[Page 5764]]

promulgated or the last time the rulemaking was reviewed by the 
Department; and
    (6) Whether the rulemaking complies with applicable law.
    (e) If the review concludes the Section should be amended or 
rescinded, the Department shall have two years from the date that the 
findings of the review are published in the Federal Register pursuant 
to paragraph (f) of this section to amend or rescind the Section. If 
the Secretary determines that completion of the amendment or rescission 
is not feasible by the established date, he shall so certify in a 
statement published in the Federal Register and may extend the 
completion date by one year at a time, no more than three times, for a 
total of not more than five years (inclusive of the initial two-year 
period).
    (f) The results of all assessments and reviews conducted in a 
calendar year, including the full underlying analyses and data used to 
support the results (subject to any applicable privilege, protections 
for confidential business information, or explicit legal prohibition on 
disclosure), shall be published in a single document in the Federal 
Register during that calendar year. The document shall be organized in 
a manner that enables both the Department and the public to readily 
determine which assessments and reviews were conducted during that 
calendar year. The document shall also specify the year by which the 
next assessment (and, if required, the next review) of the Section 
shall be completed.
    (g) Paragraph (c) of this section shall not apply to:
    (1) Sections that are prescribed by Federal law, such that the 
Department exercises no discretion as to whether to promulgate the 
Section and as to what is prescribed by the Section. For Sections 
described in this paragraph (g)(1) that are adopted after the effective 
date of this section, the Federal law described in this paragraph 
(g)(1) shall be cited in the notice of adoption.
    (2) Sections whose expiration pursuant to this section would 
violate any other Federal law.
    (3) This section.
    (4) Sections that involve a military or foreign affairs function of 
the United States.
    (5) Sections addressed solely to internal agency management or 
personnel matters.
    (6) Sections related solely to Federal Government procurement.
    (7) Sections that were issued jointly with other Federal agencies, 
or that were issued in consultation with other agencies because of a 
legal requirement to consult with that other agency.
    (h) When the Department commences the process of performing an 
assessment or review, it shall state on a Department-managed website 
the Section(s) whose assessment or review it is commencing. It shall 
also announce once a month in the Federal Register those new 
assessments or reviews that it has commenced in the last month. The 
Department will create a docket on Regulations.gov for each assessment 
or review that the Department is conducting. The public will be able to 
submit comments to the dockets of each rulemaking being assessed or 
reviewed. Each docket shall specify the date by which comments must be 
received. There shall also be a general docket on Regulations.gov where 
the public can submit comments requesting that the Department assess or 
review a Section.
    (i) Any provision of this section held to be invalid or 
unenforceable by its terms, or as applied to any person or 
circumstance, shall be construed so as to continue to give the maximum 
effect to the provision permitted by law, unless such holding shall be 
one of utter invalidity or unenforceability, in which event the 
provision shall be severable from this section and shall not affect the 
remainder thereof or the application of the provision to persons not 
similarly situated or to dissimilar circumstances.

Sec.  1300.2 through 1300.5   [Reserved]

    Dated: January 8, 2021.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
[FR Doc. 2021-00597 Filed 1-15-21; 8:45 am]
BILLING CODE 4150-26-P