Government requirements for certifying compliance with HIPAA’s transaction standards would impose a significant, unwarranted burden on self-funded group health plans that do not perform these transactions directly, employer groups warned in written comments to the U.S. Department of Health and Human Services.
The proposed rules would lay “significant costs” on self-insured plans that hire vendors to perform covered transactions without doing any good, according to April 3 comments from by the ERISA Industry Committee. The vendors themselves should send the kinds of attestations or certifications required by the proposed regulations, ERIC said.
The American Benefits Council agreed: A self-insured plan would be able to certify compliance “only through its arrangement with those third parties that actually carry out standard transactions in the administration of the plan, and the multiplicity of such arrangements could make the effort both time-consuming and burdensome.”
Section 1104 of the Patient Protection and Affordable Care Act requires health plans to certify compliance with the transaction standards and related “operating rules,” or face potentially substantial penalties. The rules proposed Jan. 2 (79 Fed. Reg. 298) set the certification deadline for the first round of transactions at Dec. 31, 2015 (a two-year extension from the statutory deadline), but also specified that health plans must obtain third-party accreditation.
The proposed rules would require all “controlling health plans,” meaning all health plans not controlled by another plan, to obtain either a Phase III certification or an alternative “HIPAA credential” from the Council for Affordable Quality Healthcare’s Committee on Operating Rules. Either alternative involves significant testing requirements, and the proposed rules seem to place this obligation directly on the plan.
“For the majority of self-insured plans, the Proposed Rule’s requirements are impossible to satisfy,” warned the U.S. Chamber of Commerce. Read the full story on Thompson Information Services’ website here.