Section 1104 of the Affordable Care Act (ACA) requires health plans to certify compliance with HIPAA administrative simplification standards and operating rules for electronic transactions. On January 2, 2014 the Department of Health and Human Services (HHS) issued a proposed rule giving plans a deadline of December 31, 2015 to submit documentation demonstrating their compliance. HHS accepted comments on the proposed rule and is still analyzing them, according to the Centers for Medicare & Medicaid (CMS) website, as visited on October 26, 2015. It has yet to issue a final rule. With the deadline fast approaching and no final rule, what should plan sponsors do?

While we cannot predict what HHS is going to do about the December 31, 2015 certification deadline, it would be difficult or impossible for health plans to comply with a rule that is not yet spelled out and finalized. One problem is health plans need a health plan identifier number (HPID) to certify compliance. The January 2, 2014 proposed rule assumed most health plans would have a health plan identifier number (HPID) by November 5, 2014. However, on October 31, 2014, HHS delayed enforcement of the requirement to obtain an HPID until further notice, which it has not yet issued. As a result, many health plans have not obtained an HPID.

Bottom line? Sit tight and stay tuned. You can register on CMS.gov to receive administrative simplification e-mail notices (click on “Administrative Simplification E-Mail Updates” near the bottom of the CMS.gov “Latest News” page).

The International Foundation will publish updates to the rule in Today’s Headlines and on the HIPAA webpage, as soon as they are released.

Lois Mathis-Gleason, CEBS
Manager, Reference/Research Services at the International Foundation