HIPAA Transaction Rules Compliance Enforcement Delayed Until April 2013

The Centers for Medicare & Medicaid Services will postpone the start of HIPAA Transaction Rules compliance enforcement for 90 days, according to a recent announcement.

See CMS press release here. Via CMS website:

Today, the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that to reduce the potential of significant disruption to the health care industry, it will not initiate enforcement action until March 31, 2013, with respect to HIPAA covered entities (including health plans, health care providers, and clearinghouses, as applicable) that are not in compliance with the operating rules adopted for the following transactions as required by the Affordable Care Act: eligibility for a health plan and health care claim status. Notwithstanding OESS’ discretionary application of its enforcement authority, the compliance date for using the operating rules remains January 1, 2013.

Industry feedback suggests that HIPAA covered entities have not reached a threshold whereby a majority of covered entities would be able to be in compliance with the operating rules by January 1, 2013. This enforcement discretion period does not prevent applicable HIPAA covered entities that are prepared to conduct transactions using the adopted operating rules from doing so, and all applicable covered entities are encouraged to determine their readiness to use the operating rules as of January 1, 2013 and expeditiously become compliant. Although enforcement action will not be taken, OESS will accept complaints associated with compliance with the operating rules beginning January 1, 2013. If requested by OESS, covered entities that are the subject of complaints (known as "filed-against entities") must produce evidence of either compliance or a good faith effort to become compliant with the operating rules during the 90-day period. HHS will continue to work to align the requirements under Section 1104 of the Affordable Care Act to optimize industry’s ability to achieve timely compliance.

OESS is the U.S. Department of Health and Human Services’ (HHS) component that enforces compliance with HIPAA transaction and code set standards, including operating rules, identifiers and other standards required under HIPAA by the Affordable Care Act.

For copies of the operating rules for the eligibility for a health plan and health care claim status transactions, visit the Council for Affordable Quality Healthcare (CAQH) CORE website at http://www.caqh.org. Links to information on the operating rules for eligibility for a health plan and health care claim status are available at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/OperatingRulesforEligibilityandClaimsStatus.html

CMS issues final rule on ACOs

On October 20, 2011, CMS published the final rule on Accountable Care Organizations (ACOs) or, as it is formally known, the Medicare Shared Savings Program (the "Program"), enacted as part of the Patient Protection and Affordable Care Act (ACA) of 2010. According to CMS chief Don Berwick, MD, the Program represents an "opportunity to coordinate care among providers," which could "greatly improve the quality of care Medicare beneficiaries receive," and produce substantial savings for the federal government. The Program creates incentives for providers to collaborate in treating an individual patient across care settings, in order to receive a portion of the savings generated from providing such care. 

CMS has substantially relaxed the requirements for ACOs originally provided in the proposed rule. Some of the key changes include (among many others):

  • Adding a "one-side" risk model, allowing providers to participate in the program without risking a loss in the event their ACO did not produce savings
  • "Preliminary perspective assignment" of Medicare beneficiaries, giving ACOs more control over their Medicare beneficiary population
  • Reducing the number of performance measures from 65 to 33
  • Eliminating the two percent threshold for being eligible for shared savings

CMS will begin taking applications for the program on January 1, 2012, with start dates of April 1 and July 1, 2012.

 Important links via HHS press release:

The Shared Savings Program final rule can be found at: http://www.HealthCare.gov/law/resources/regulations/index.html. (See Final Rule on Shared Savings Program: Accountable Care Organizations)

The Advanced Payment solicitation is posted at: http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/advance-payment/.

For more information, fact sheets are posted at: http://www.HealthCare.gov/news/factsheets/2011/10/accountable-care10202011a.html and http://www.cms.gov/ACO/.

The joint CMS and Department of Health and Human Services Office of Inspector General (OIG) Interim Final Rule with Comment Period addressing waivers of certain fraud and abuse laws in connection with the Shared Savings Program can be found at: http://www.HealthCare.gov/law/resources/regulations/index.html. (See Request for Public Comment on Final Waivers in Connection with the Shared Savings Program).

The Antitrust Policy Statement is posted at: www.ftc.gov/opp/aco/ andhttp://www.justice.gov/atr/public/health_care/aco.html.

The Internal Revenue Service (IRS) Fact Sheet, Tax-Exempt Organizations Participating in the Medicare Shared Savings Program through Accountable Care (FS-2001-11), is posted at: http://www.irs.gov/newsroom/article/0,,id=248490,00.html.

Breaking: HHS releases proposed rule on ACO's

Earlier today, HHS has released the highly anticipated proposed rule on Accountable Care Organizations (ACOs). The rules will guide healthcare providers in setting up exchanges of healthcare data to improve care and reduce costs, as mandated under the Patient Protection and Accountable Care Act of 2010.

HHS will host a call today, March 31, 2011 on the new regulations, expected to be released prior to the call. The call will take place a noon EDT today and can be accessed by calling 800-475-8413 Code: HHS.

You can find a copy of the proposed rule by clicking here.

Via Healthcare IT News:

Accountable care organizations are pivotal to the federal government's plan to reduce healthcare costs and improve quality. Some providers, such as Intermountain Health in Utah, have been using an approach that's something similar to ACOs for years. Collaborations between doctors and other providers make care more uniform, based on the best outcomes. Often, this care is also the most cost-effective. Some have called ACOs the HMOs of today.

Wednesday afternoon, CMS Administrator Donald Berwick and other federal officials hosted a pre-regulation release call on the pending ACO rule. According to Barnes, who was on the call, Berwick said that ACOs will not simply be the status quo repackaged – and that this will not be a one-size-fits-all approach.

According to Barnes, Berwick said the rule would put patients and families at the center of care, make ACOs particularly sensitive to care transitions and promote innovative care.

 

Enrollment standards recommendations released

We dedicate much of our time to the implications of and regulations stemming out of the American Recovery and Reinvestment Act of 2009 (ARRA).  However, this year's historic health reform legislation ("Affordable Care Act" or "ACA") also contains a number of significant provisions affecting the health IT industry.  (We discussed ACA's health IT provisions in a recent guide to the health reform legislation crafted by the American Health Lawyers Association, which you can fine here.) 

In particular, Section 1561 of the Affordable Care Act tasks the HIT Policy and Standards Committees (established last year pursuant to ARRA) to develop a set of standards which would facilitate enrollment in federal and state health and human services programs, including drafting "standards for electronic matching across state and federal data; retrieval and submission of electronic documentation for verification; reuse of eligibility information; capability for individuals to maintain eligibility information online; and notification of eligibility."

On July 19, 2010, the Enrollment workgroup of these advisory committees issued their recommendations with respect to minimum enrollment standards.  Their recommendations will be the subject of a rule the agency must issue by September 30, 2010.  The workgroup's recommendations include the use of web-based services, easing enrollment procedures for patients, and creating "business rules" (sets of policies and procedures aimed at promoting "the use of standard data elements and verification and help to deal with ambiguity of information and differences in data so program officers can make decisions about eligibility.")

You can learn more about the Enrollment workgroup's recommendations via Healthcare IT News or, in greater detail, via ONC's web site.

"Health IT panel offers first enrollment standards details," Healthcare IT News (July 20, 2010).