Proposed Rule for Certification of Compliance for Health Plans Withdrawn by HHS

In January 2014, the HHS proposed a new rule for certification of compliance for health plans. The rule would have required all controlling health plans (CHPs) to submit a range of documentation to HHS to demonstrate compliance with electronic transaction standards set by the HHS under HIPAA Rules. The main aim of the proposed rule – Administrative Simplification:
Certification of Compliance for Health Plans – was to promote more consistent testing processes for CHPs. The HHS has now announced that the proposed rule has now been withdrawn.

Had the proposed rule made it to the final rule stage, CHPs would have been required to demonstrate compliance with HIPAA administration simplification standards for three electronic transactions: Eligibility for a health plan, health care claim status, and health care electronic funds transfers (EFT) and remittance advice. The failure to comply with the new rule would have resulted in financial penalties for CHPs.

Most employers’ health plans were handled by their insurance carriers, so the proposed rule would not have affected them directly, although a significant burden would have been placed on self-funded employers by the rule change. Following publication of the proposed rule in the federal register in January 2014, HHS received more than 72 public comments. After examining those comments, the HHS made the decision to withdraw the proposed rule.

HHS will be re-examining the issues raised in the comments and will be exploring options and alternatives to comply with statutory requirements.

The Secretary of the HHS explained that regulations have already been established for compliance with HIPAA administration simplification standards, and enforcement of compliance with those standards. While the proposed rule has been withdrawn, the HHS has confirmed that covered entities are still required to comply with 45 CFR parts 160 and 162.

Author: Steve Alder has many years of experience as a journalist, and comes from a background in market research. He is a specialist on legal and regulatory affairs, and has several years of experience writing about HIPAA. Steve holds a B.Sc. from the University of Liverpool.