Certification of Compliance for Health Plans: HHS Withdraws Proposed Rule

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 The HHS has now revealed that they have now withdrawn the proposed rule.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.