By Rebecca Mayo, J.D.
After receiving overwhelming feedback from stakeholders and industry, HHS has proposed a rule to rollback the policy of requiring the use of a health plan identifier (HPID) in HIPAA transactions. The previous rule was published in 2012 and industry began voicing concerns that it would be a costly, complicated, and burdensome disruption to implement the HPID. HHS now believes, based on recommendations and overwhelming and persistent industry input, the HPID and other entities identifier (OEID) do not, and cannot, serve the purpose for which they were adopted (Notice, 83 FR 65118, December 19, 2018).
Old rule. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and HIPAA require HHS to adopt a standard unique health plan identifier to improve the effectiveness and efficiency of the health care system by establishing standards and requirements for the electronic transmission of certain health information. On September 5, 2012, HHS published a final rule that adopted the HPID as the standard unique identifier for health plans, defined the terms "controlling health plan" (CHP) and "subhealth plan" (SHP), required all covered entities to use an HPID whenever a covered entity identifies a health plan in a covered transaction, established requirements for CHPs and SHPs, and adopted a data element to serve as an OEID.
HHS believed that the policies specifying requirements for health plans to obtain identifiers, and use them in HIPAA transactions when appropriate, resolved or took steps towards resolving the issues of transaction routing, difficulty determining patient eligibility, and challenges identifying the health plan during claims processing. HHS believed the adoption of the HPID and the OEID would increase standardization within HIPAA transactions and provide a platform for other regulatory and industry initiatives, and that their adoption would allow for a higher level of automation for health care provider officers, particularly for provider processing of billing and insurance related tasks, eligibility responses from health plans, and remittance advice that describes healthcare claim payments.
Concerns. As the enumeration process began, professional associations for both health plans and health care providers submitted feedback that stated there was no need for the HPID in HIPAA transactions, and that the policy requirements were problematic, costly, and burdensome. HHS then delayed enforcement of the regulations pertaining to HPID enumeration and use of the HPID in the HIPAA transactions in order to review recommendations and consider appropriate next steps. A request for information was published which received 53 timely comments, with the overwhelming majority of submissions recommending that the HPID not be required in the HIPAA transactions either alone or in combination with Payer IDs.
Multiple hearings were also held and between all of the information collected it was made clear that the industry already had satisfactorily functioning mechanisms to route claims and other HIPAA transactions using the existing Payer IDs. There were also concerns that it would likely be a costly, complicated, and burdensome disruption for the industry to have to implement the HPID because it would require mapping existing Payer IDs to the new HPIDs, which would likely result in the misrouting of claims and other transactions. Further, the HPID framework did not provide added value for other anticipated purposes such as including certain information in the transaction, including the name of the health plan, the level of benefits or coverage description, or co-payment and co-insurance responsibility for certain services and required coverage types.
Proposed rule. The new rule proposes to remove Subpart E—Standard Unique Health Identifier for Health Plans at 45 CFR 162, as well as the definitions of "controlling health plan" (CHP) and "subhealth plan" (SHP) at 45 CFR 162.103.
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