Certification of Compliance for Health Plans: HHS Withdraws Proposed Rule

by | Oct 17, 2017

At the beginning of 2014 the HHS proposed a new rule for certification of compliance for health plans which would have required all controlling health plans (CHPs) to complete a range of documentation. This would have shown the  HHS that the CHPS were in compliance with electronic transaction standards governed by the HHS under HIPAA Rules.

The main objective of the rule that was proposed – Administrative Simplification: Certification of Compliance for Health Plans – was to promote more uniform testing processes for CHPs. The HHS has now revealed that they have now withdrawn the proposed rule.

Had the rule made reached the final rule stage, CHPs would have been asked to show compliance 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. Any failure to adhere with the proposed rule would have lead in possible monetary fines for CHPs.

The majority of employers’ health plans were operated by their insurance carriers, so the proposed rule would not have affected them directly, although a large burden would have been placed on self-funded employers by the rule change. After publication of the proposed rule in the federal register at the beginning of 2014, HHS received more than 72 public comments. After looking over those comments, the HHS made the decision to pull the proposed rule.

HHS will be looking at the issues brought up in the comments and will be reviewing options and alternatives to adhere with statutory requirements.

The Secretary of the HHS said, in statement that regulations have already been put in place for compliance with HIPAA administration simplification standards and enforcement of compliance with those standards. While the proposed rule has been pulled, the HHS has confirmed that covered organizations must comply with 45 CFR parts 160 and 162.

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Patrick Kennedy

Patrick Kennedy is a highly accomplished journalist and editor with nearly two decades of experience in the field. With expertise in writing and editing content, Patrick has made significant contributions to various publications and organizations. Over the course of his career, Patrick has successfully managed teams of writers, overseeing the production of high-quality content and ensuring its adherence to professional standards. His exceptional leadership skills, combined with his deep understanding of journalistic principles, have allowed him to create cohesive and engaging narratives that resonate with readers. A notable area of specialization for Patrick lies in compliance, particularly in relation to HIPAA (Health Insurance Portability and Accountability Act). He has authored numerous articles delving into the complexities of compliance and its implications for various industries. Patrick's comprehensive understanding of HIPAA regulations has positioned him as a go-to expert, sought after for his insights and expertise in this field. Patrick's bachelors degree is from the University of Limerick and his master's degree in journalism is from Dublin City University. You can contact Patrick through his LinkedIn profile:

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