Health plans and other covered entities under the Health Insurance Portability & Accountability Act won’t have to begin using Health Plan Identifiers (HPIDs) and conducting transactions on the Department of Health & Human Services (HHS) Health Plan and Other Entity Enumeration System (HPOES) by November 5, 2014 after all.
On Halloween, HHS announced it is delaying until further notice enforcement of the HPID and related HPOES use requirements that had been scheduled to take effect on November 5, 2014 under the HPID final rule adopted by HHS as part of its Administrative Simplification electronic transactions rules under 45 CFR 162, Subpart E.
In its October 31, 2014 announcement of its enforcement delay of the HPID/HPOES requirements, the HHS Centers for Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) stated this enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses. OESS is the HHS division responsible for enforcement of compliance with HIPAA’s standard transactions, code sets, unique identifiers and operating rules.
CMS’ announcement of the HPID and related requirements likely comes as welcome relief for health insurers, health plans, third party administrators and others who before the announcement were required to begin conducting transactions in accordance with the new requirements.
HHS has struggled to rollout the HPID and HPOES system over the past several months. It has made numerous refinements to the guidance and HPOES system. In recent months, it has issued an ongoing series of exemptions, corrections and other guidance in response to widespread glitches,users and others have expressed concern about problems in CMS’ regulations as well as the readiness of the HPOES system itself. As the November 5, deadline for implementation approached, as well as undertaken significant user and other outreach to the anticipated user community and others about the guidance and use of the system. See e.g. 11/5 Deadline For Many Health Plans To Get Health Plan ID From CMS, HHS Warns Insurers, TPAS Complete ACA Reinsurance & Risk Adjustment Edge Server Pre-Registration Steps By 9/27. Despite these and other efforts, covered entities and others have expressed confusion and other concern about the requirements and the readiness of the HPOES.
These and other concerns apparently lead HHS to delay enforcement of the requirements. On September 23, 2014, these and other concerns prompted the National Committee on Vital and Health Statistics (NCVHS), an advisory body to HHS, recommended that HHS rectify in rule making that all covered entities (health plans, healthcare providers and clearinghouses, and their business associates) not use the HPID in the HIPAA transactions. HHS says that its delay in enforcement of the HPID rule will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps before enforcement begins.
While health plans, health insurers and other covered entities have more time to come into compliance, they and their business associates need to continue to monitor HHS guidance for new developments and refinements to the system and its associated requirements and preparations to adapt their processes and systems so as to be positioned to comply with the HPID requirements when CMS lifts its enforcement delay.
About Author Cynthia Marcotte Stamer
If you need help reviewing or updating your health benefit program for compliance or with any other employment, employee benefit, compensation or internal controls matter, please contact the author of this article, attorney Cynthia Marcotte Stamer.
A Fellow in the American College of Employee Benefits Council, immediate past-Chair and current Welfare Benefit Committee Co-Chair of the American Bar Association (ABA) RPPT Employee Benefits & Other Compensation Arrangements, an ABA Joint Committee on Employee Benefits Council Representative, the ABA TIPS Employee Benefit Plan Committee Vice Chair, former ABA Health Law Section Managed Care & Insurance Interest Group Chair, past Southwest Benefits Association Board Member, Employee Benefit News Editorial Advisory Board Member, and a widely published speaker and author, Ms. Stamer has more than 24 years experience advising businesses, plans, fiduciaries, insurers. plan administrators and other services providers, and governments on health care, retirement, employment, insurance, and tax program design, administration, defense and policy. Nationally and internationally known for her creative and highly pragmatic knowledge and work on health benefit and insurance programs, Ms. Stamer’s experience includes extensive involvement in advising and representing these and other clients on ACA and other health care legislation, regulation, enforcement and administration.
Widely published on health benefit and other related matters, Ms. Stamer’s insights and articles have been published by the HealthLeaders, Modern Health Care, Managed Care Executive, the Bureau of National Affairs, Aspen Publishers, Business Insurance, Employee Benefit News, the Wall Street Journal, the American Bar Association, Aspen Publishers, World At Work, Spencer Publications, SHRM, the International Foundation, Solutions Law Press and many others.
For additional information about Ms. Stamer and her experience, see www.CynthiaStamer.com.
For Added Information and Other Resources
If you found this update of interest, you also may be interested in reviewing some of the other updates and publications authored by Ms. Stamer available including:
- Plan’s Purchase of Company Stock Triggers $6.48 Million Judgment Against ESOP Sponsor, Shareholder, Board Members & Trustees
- Government Contractors Get More Time To Comment On Burdens Of OFCCP Proposed Compensation Transparency Disclosure Regs
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- Encourage Workers To Review Withholding As Part Of Annual Enrollment
- OFCCP FAQs On Veteran Hiring & Telework Rules
- New EEOC Lawsuit Challenges Orion Energy Systems Employee Benefit Program Under ADA
- Shell Oil/Motiva Enterprises $4.5M FLSA Overtime Backpay Settlement Reminder To Pay Workers Properly
- OFCCP Proposes Compensation Transparency Mandates For Government Contractors
- Labor Department Adds State Unemployment Insurance To War Against Worker Misclassification
- EBSA Invites Input By November 19 On Need for More Regulation Of Investment Windows
- House Hearings Consider Authorizing House Lawsuit Challenging Constitutionality of Obama’s Health Care Reform Actions
- Review & Update HR & Benefit Practices For DOL Proposed Change In FMLA Regs, Other Rules Treating Some Same-Sex Couples As Spouses
- Employee & Other Whistleblower Complaints Common Source of HIPAA Privacy & Other Complaints
- Consider Fiduciary & Other Risk Management When Planning For ACA Transitional Reinsurance Costs, Other Plan Design Changes
- HHS Claims Average $69/Month Cost for Subsidized Coverage Shows ACA Success Challenged
- HIPAA Compliance & Breach Data Shares Helpful Lessons For Health Plans, Providers and Business Associates
- Review & Update Health Plan Notices, Language & Process For New Guidance On COBRA, Other Key Health Plan Rules
- EEOC Suit Against Pipe Fitting Business Shows Disability Discrimination Risks For Employers Hiring Vets With PTSD
- Businesses Face Rising Disability Discrimination Enforcement Risks
- EEOC Finalizes Updates To Disability Regulations In Response to ADA Amendments Act: Employers Should Manage Risks
- NLRB Settlement Shows Care Necessary When Employers Use Social Networking & Other Policies Restricting Employee Communications
- Wage & Hour Law Settlements Highlight Rising Wage & Hour Risks of U.S. Employers
- OCR Requires Rhode Island DHS To Provide Translation, Other Services For Limited English, Other Language Impaired Accommodations
For Help Or More Information
If you need assistance in auditing or assessing, updating or defending your organization’s compliance, risk manage or other internal controls practices or actions, please contact the author of this update, attorney Cynthia Marcotte Stamer here or at (469)767-8872.
Board Certified in Labor & Employment Law by the Texas Board of Legal Specialization, management attorney and consultant Ms. Stamer is nationally and internationally recognized for more than 24 years of work helping employers and other management; employee benefit plans and their sponsors, administrators, fiduciaries; employee leasing, recruiting, staffing and other professional employment organizations; and others design, administer and defend innovative workforce, compensation, employee benefit and management policies and practices. Her experience includes extensive work helping employers implement, audit, manage and defend union-management relations, wage and hour, discrimination and other labor and employment laws, privacy and data security, internal investigation and discipline and other workforce and internal controls policies, procedures and actions. The Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Committee, a Council Representative on the ABA Joint Committee on Employee Benefits, Government Affairs Committee Legislative Chair for the Dallas Human Resources Management Association, and past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Ms. Stamer works, publishes and speaks extensively on management, reengineering, investigations, human resources and workforce, employee benefits, compensation, internal controls and risk management, federal sentencing guideline and other enforcement resolution actions, and related matters. She also is recognized for her publications, industry leadership, workshops and presentations on these and other human resources concerns and regularly speaks and conducts training on these matters.Her insights on these and other matters appear in the Bureau of National Affairs, Spencer Publications, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, and many other national and local publications. For additional information about Ms. Stamer and her experience or to access other publications by Ms. Stamer see hereor contact Ms. Stamer directly.
About Solutions Law Press
Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources at www.solutionslawpress.com.
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©2014 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press. All other rights reserved.
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