HHS Withdraws Proposed Rule for Health Plans Certification of Compliance

A new rule for certification of compliance for health plans was proposed by the HHS In January 2014, requiring all controlling health plans (CHPs) to submit a range of documentation to HHS to demonstrate HIPAA compliance.

The proposed rule ‘Administrative Simplification: Certification of Compliance for Health Plans’ was drafted to promote more consistent testing procedures for CHPs. The HHS has now dediced to withdraw the proposal.

If the rule had been passed, CHPs would have been required to show adherence 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. Not complying with the new rule could have lead to significant financial penalties for CHPs.

Most employers’ health plans were controlled by their insurance providers, so the proposed rule would not have applied to them directly, although a major burden would have been felt by self-funded employers if rule had come into being. When the proposed rule was published in the federal register in early 2014, HHS recorded more than 72 public comments which it reviewed After completing a review the HHS withdrew the proposed rule.

The concerns highlighted in the comments will be investigated by the HHS and they will be looking at other measures to ensure compliance with statutory requirements.

Eric Hargan, the Secretary of the HHS, commented saying that regulations have already been put in place to ensure compliance with HIPAA administration simplification standards along with enforcing compliance. While the HHS has withdrawn the proposed rule, the body has stated that covered bodies are still obliged to comply with 45 CFR parts 160 and 162.

Author: Maria Perez