An administrative agency is a government organization that has the concurrent authority to make laws, enforce laws, and interpret laws. While the Constitution does not specifically allow for the establishment of an administrative agency, the United States Supreme Court has interpreted the Congress’ Article I legislative power to mean that it has the authority to create administrative agencies. Under the Court’s analysis, with the congressional ability to create administrative agencies, it is unlikely that Congress would have the time, resources, and expertise to monitor and regulate the myriad issues that part of modern society (Mistretta v. United States, 1989). Despite, the reasonableness of the Court’s findings, the administrative agency framework, nevertheless remains a controversy legal-political topic of debate, especially, an administrative agencies ability to make law, otherwise known as rulemaking.
As healthcare in the United States is a vast, and complex system of organizations, procedures, and regulations. In other words, healthcare is precisely the type of policy area that Congress could not adequately police without delegating some of its authority to administrative agencies. To be sure, there are over ten federal government agencies, including the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS). Moreover, each state has its own administrative agencies involved in the regulation of their individual healthcare industries. Accordingly, administrative agency rulemaking is an important element in healthcare both at the federal and state level.
The in order to better track, research, and inform the global community about the specifics of a disease, including its signs, symptoms, causes, and diagnoses, the World Health Organization (WHO) has developed the International Statistical Classification of Diseases and Related Health Problems (ICD) for use in any participating nation’s healthcare system. Currently, the ICD is in its tenth updated and revised form, and is known as ICD-10 (NCHS, 2016). In 2000 Congress passed the Healthcare Insurance Portability and Accountability Act (HIPAA). Under HIPAA, healthcare organizations are required use ICD-10 as a means of classifying diseases and other relevant medical issues that they encounter during the normal course of their business. HIPAA and ICD-10, are both fairly complex works that Congress, on its own, does not not have the ability to appropriately regulate. Accordingly, Congress delegated their authority to see that the ICD-10 is integrated with HIPAA to two administrative agencies, namely, the National Center for Health Science Statistics (NCHS) and the CMS.
In terms of rulemaking, the NCHS has been tasked with adopting the ICD-10 more be more easily integrated with the intricacies of the American healthcare system. In order to do this, the NCHS, has made modifications that healthcare organizations must implement (NCHS, 2016). In other words, it has made rules that healthcare organizations must follow or suffer the consequences of non-compliance. Naturally, before it made its final rule, the NCHS was required to follow the provisions of the APA by providing public notice and allowing the public, especially the medical community a say in their proposal (NCHS, 2016). As for the CMS, once the NCHS created and disseminated its modifications to the ICD-10, it was tasked with making sure that the ICD-10 was implemented into and throughout the U.S. healthcare system. In order to achieve this, the CMS had to make rules for healthcare providers to follows and that CMS could track as a means of monitoring implementation (CMS, 2015). Without these rules, a healthcare organization could ignore implementing the modified ICD-10 or avoid implementation in the manner that was the most effective. Again, the rules that CMS made for implementation were done so under the APA. Moreover, failure to abide by the CMS rules will lead to a violation of HIPAA and potential federal liability.
The healthcare industry in the U.S. is not only one of its most important but also one of its most difficult to regulate. Congress created administrative agencies to assist it in the regulation of such complex industries as the healthcare industry. One way that administrative agencies regulate and are is by making rules that stakeholders in the area have a say in creating but are ultimately bound by. Several federal agencies such as the CMS and the NCHS, have been deeply involved in healthcare industry rulemaking, such as for the implementation of ICD-10 classification system of diseases into all healthcare organizations.
References
Center for Medicare and Medicaid Services (CMS). (2015). ICD-10 overview. Retrieved from https://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/icd-coding/icd.html
Lawson, G. (1994). The Rise and Rise of the Administrative State. Retrieved from http://www.nesl.edu/userfiles/academics/friedman/the%20rise%20and%20rise%20of%20the%20administrative%20state.pdf
Mistretta v. United States, 488 U.S. 361 (1989). Retrieved from https://supreme.justia.com/cases/federal/us/488/361/case.html
National Center for Health Statistics (NCHS). (2016, Apr. 29). International classification of diseases, tenth revision, clinical modification (ICD-10-CM). Retrieved from http://www.cdc.gov/nchs/icd/icd10cm.htm
