On January 20, 2009, Rahm Emanuel, Assistant to the President and Chief of Staff, sent a memo to all federal department and agency heads announcing that all regulations approved or pending at the end of the Bush Administration must be reviewed by the Obama Administration before being implemented. Specifically, except in cases of emergency situations, such as urgent health, safety, environmental, financial, or national security matters, no proposed or final regulation should be sent to the Office of the Federal Register for publication unless reviewed and approved by an department or agency head appointed or designated by President Obama, and pending Bush Administration regulations not yet published in the Federal Register must be withdrawn for review. Moreover, agencies are directed to consider extending for 60 days the effective date of Bush Administration rules that have been published but not yet taken effect, with a reopening of the public comment period. Although the Administration has not released a complete listing of regulations subject to this review, the Centers for Medicare & Medicaid Services (CMS) published a notice January 27, 2009 delaying for 60 days the effective date of a November 25, 2008 final rule designed to provide state Medicaid agencies with increased flexibility to impose premium and cost sharing requirements on certain Medicaid recipients. The new effective date is March 27, 2009, and the comment period has been reopened until February 26, 2009. Additional Department of Health and Human Services (HHS) rules also may be affected by the regulatory review.