Department of Health and Human Services: Patient Safety and Quality Improvement, GAO-09-229R, December 8, 2008
Pursuant to section
801(a)(2)(A) of title 5, United States Code, this is our report on a major rule
promulgated by the Department of Health and Human Services (HHS), entitled “Patient
Safety and Quality Improvement” (RIN: 0919-AA01). We received the rule on
The final rule implements certain provisions of the
Patient Safety and Quality Improvement Act of 2005, Pub. L. No. 109-41, 119
Stat. 424 (
The Congressional Review Act requires major rules to have a
60-day delay in their effective date following publication in the Federal Register or receipt of the rule
by Congress, whichever is later. 5
U.S.C. sect. 801(a)(3)(A). Although this
rule was received on
Enclosed is our assessment of HHS’s compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. Our review indicates that, except for the delay in the effective date, HHS complied with the applicable requirements.
If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact Michael R. Volpe, Assistant General Counsel, at (202) 512-8236.
Robert J. Cramer
Associate General Counsel
(i) Cost-benefit analysis
The Department of Health and Human Services (HHS) analyzed the costs and benefits of this final rule. HHS estimated the costs and cost savings from reductions in adverse events, and net benefits for the years 2009 to 2013. The estimated costs of this rule for each year from 2009 to 2013 are, respectively, $68.9 million, $122.1 million, $167.8 million, $179.0 million, and $186.5 million. The estimated cost savings from reduced adverse events for each year from 2009 to 2013 are, respectively, $11.5 million, $69 million, $138 million, $215.6 million, and $293.3 million. HHS estimates that the rule will have net costs at a 3-percent discount rate of $55.7 million in 2009, $50.0 million in 2010, and $27.3 in 2011. However, HHS estimates the rule will have net benefits at a 3-percent discount rate of $32.5 million in 2012 and $92.1 million in 2013. HHS also made these estimates using a 7-percent discount rate: -$53.6 million (2009), -$46.4 million (2010), -$24.3 (2011), $27.9 million (2012), and $76.1 million (2013).
(ii) Agency actions relevant to the Regulatory Flexibility Act, 5 U.S.C. sections 603-605, 607, and 609
HHS determined that this final rule will not have a significant impact on a substantial number of small entities.
(iii) Agency actions relevant to sections 202-205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. sections 1532-1535
HHS determined that this final rule does not impose any mandates on any state, local, or tribal governments or on the private sector within the meaning of the Act.
(iv) Other relevant information or requirements under acts and executive orders
Administrative Procedure Act, 5 U.S.C. sections 551 et seq.
CMS promulgated this final rule using the notice and
comment procedures found in the Administrative Procedure Act. 5 U.S.C. sect. 553. On
Paperwork Reduction Act, 44 U.S.C. sections 3501-3520
This final rule contains information collection
requirements under the Act. HHS has
published the proposed information collection forms for public comment and has
submitted them to the Office of Management and Budget for review. 73 Fed. Reg. 9336 (
Statutory authorization for the rule
HHS promulgated this final rule under the authority of sections 216, 299b-21 to 299b-26 and 299c-6 of title 42, United States Code.
Executive Order No. 12,866
HHS has determined that this final rule may be economically significant under the Order because the economic impact may approach $100 million. HHS also determined that this rule is significant under the Order because it raises novel legal and policy issues, and the rule was reviewed by the Office of Management and Budget.
Executive Order No. 13,132 (Federalism)
To the extent that the Patient Safety and Quality Improvement Act of 2005 is inconsistent with any state law, including state court decisions, the statute preempts such state law. HHS determined that this final rule will not have any greater preemptive effect on state or local governments than that imposed by the statute. HHS held public listening sessions prior to drafting the proposed rule to which representatives of several states attended. Following publication of the proposed rule, HHS consulted with state officials and organizations specifically seeking input on federalism issues.