Last-minute Delay in Health Plan Identifier Enforcement | Practical Law

Last-minute Delay in Health Plan Identifier Enforcement | Practical Law

The Centers for Medicare and Medicaid Services (CMS) announced a delay until further notice of the health plan identifier (HPID) requirements, just days before the November 5, 2014 compliance deadline, for certain plans. HPIDs will be used to identify plans in standard electronic transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Last-minute Delay in Health Plan Identifier Enforcement

Practical Law Legal Update 9-586-7666 (Approx. 3 pages)

Last-minute Delay in Health Plan Identifier Enforcement

by Practical Law Employee Benefits & Executive Compensation
Published on 04 Nov 2014 • USA (National/Federal)
The Centers for Medicare and Medicaid Services (CMS) announced a delay until further notice of the health plan identifier (HPID) requirements, just days before the November 5, 2014 compliance deadline, for certain plans. HPIDs will be used to identify plans in standard electronic transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
On October 31, 2014, HHS' Centers for Medicare and Medicaid Services (CMS) announced an enforcement delay "until further notice" of the health plan identifier (HPID) requirements (see Practice Note, Health Plan Identifiers). The enforcement delay, which applies to all covered entities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), was issued just days before the general compliance deadline for health plans (except small health plans). Under previous regulations, large health plans (that is, plans with annual receipts of more than $5 million) were required to obtain HPIDs by November 5, 2014 (see Practice Notes, Health Plan Identifiers: Effective Date and Compliance Steps and HIPAA Electronic Transactions under the ACA).
Under the delay, health plans that had not already obtained identifiers need not do so until further notice.

HPID Enforcement Delay

The CMS announcement delays enforcement of the regulations addressing health plan enumeration (that is, the process of obtaining an HPID (see Practice Note, Health Plan Identifiers: Enumeration System)) and use of HPIDs in certain HIPAA transactions.
The delay came as a result of a recent recommendation letter from the National Committee on Vital and Health Statistics (NCVHS), which was established by Congress as an advisory body to HHS. In its letter, the NCVHS noted significant issues regarding the HPID requirements, including:
  • Lack of a clear business need and purpose for HPIDs and other entity identifiers (OEIDs) (for example, how the identifiers would be used) in health care administrative transactions.
  • Concern that HPIDs might replace an existing payer ID that is already widely adopted and used in the health care industry.
  • Implementation challenges for health plans involving the meaning of controlling health plans (CHPs) and sub-health plans (SHPs), which are key definitional terms under the HPID rules.
  • Use of HPIDs for health plans that do not conduct HIPAA standard transactions.
The NCVHS recommended, among other things, that HHS clarify in regulations that health plans and other HIPAA covered entities will not use HPIDs in administrative transactions, and that the existing payer ID will not be replaced by HPIDs.

Practical Impact

The HPID rules have been the source of confusion as health plans and other covered entities had scrambled to comply with the November 5 deadline, so this indefinite enforcement delay will come as welcome news. It appears likely that HHS will issue additional guidance addressing the HPID requirements, but the CMS announcement did not include a timeline for subsequent guidance.