Final Health Plan Identifier Rules Include Delayed Compliance and Implementation Dates | Practical Law

Final Health Plan Identifier Rules Include Delayed Compliance and Implementation Dates | Practical Law

The Department of Health and Human Services (HHS) has issued final regulations addressing the adoption of unique health plan identifiers, as required under the Affordable Care Act (ACA). The final regulations delay the compliance and implementation dates for these requirements.

Final Health Plan Identifier Rules Include Delayed Compliance and Implementation Dates

by PLC Employee Benefits & Executive Compensation
Published on 28 Aug 2012 • USA (National/Federal)
The Department of Health and Human Services (HHS) has issued final regulations addressing the adoption of unique health plan identifiers, as required under the Affordable Care Act (ACA). The final regulations delay the compliance and implementation dates for these requirements.
On August 24, 2012, HHS finalized regulations adopting standard and implementation requirements for the unique health plan identifiers (HPID) required under the Affordable Care Act (ACA). The final regulations largely incorporate requirements in the proposed version of these regulations, which were issued in April 2012 (see Legal Update, HHS Proposed Regulations Address Unique Health Plan Identifiers and Delay Code Sets Compliance Date). However, the final regulations include delayed compliance and implementation dates.
The ACA requires HHS to issue final rules establishing a unique health plan identifier (HPID), based on input from a federal advisory committee. These rules are intended to standardize the identifiers that are used in health plan functions. The existing, non-standardized identifiers, which often vary in length and format, have resulted in:
  • Errors in identifying the correct health plan during claims processing.
  • Misrouting and rejection of plan transactions.
  • Complications in assessing patient eligibility.
The adoption of uniform HPIDs in HIPAA standard transactions is expected to promote greater automation for health providers to process:
  • Billing and insurance-related tasks.
  • Eligibility responses from health plans.
  • Remittance advice describing health care payments.
Among other things, the final regulations adopt:
  • Standards for a national unique HPID and related implementation requirements.
  • An "other entity identifier" (OEID) for non-health plan entities (for example, third-party administrators (TPAs)) that need to be identified in standard transactions.
The regulations include an enumeration system that will:
  • Assign a single, unique HPID to a health plan.
  • Collect and maintain information about health plans that apply for (or are assigned) an HPID.
Like the proposed rules, the final regulations require all covered entities to use an HPID whenever the covered entity identifies a health plan in a covered transaction. The effective date of the final regulations, which marks the beginning of the HPID implementation period, is November 5, 2012. In the preamble to the final regulations, HHS clarifies a point under the proposed regulations, in which HHS indicated that the regulations would be effective the first day that:
  • Health plans could apply to obtain an HPID.
  • Covered entities could begin to access the enumeration system and learn more about the application process.
According to the preamble, covered entities will not be able to obtain identifiers on the effective date, although they will be able to access the enumeration system and begin reviewing the application process. Under the final regulations, the compliance date for obtaining HPIDs is, for:
  • Health plans other than small health plans, November 5, 2014.
  • Small health plans, November 5, 2015.
In addition, full compliance with the HPID requirements (that is, the date by which all covered entities must use HPIDs to identify health plans that have an HPID) will be November 7, 2016 for both large and small health plans. However, small plans and other covered entities are permitted to use HPIDs in transactions at any time before their applicable compliance dates.

Practical Impact

Health plans will welcome the extended compliance and full implementation dates under the final regulations, which will provide plans additional time to:
  • Obtain their identifiers and communicate them to covered entities.
  • Implement required changes to their internal systems to accommodate the HPIDs and carry out testing.
Also, the preamble to the final regulations includes a chart of HIPAA compliance dates for requirements under the ACA that plans may find useful in carrying out their implementation efforts (see Practice Note, HIPAA Electronic Transactions under the ACA).