Delay of HPID Regulations Announced by CMS

With the November 5th deadline looming, the Centers for Medicare & Medicaid Services (“CMS”) announced that effective October 31, 2014, the enforcement of the regulations pertaining to the use of the Health Plan Identifier (“HPID”) is delayed until further notice.  This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.  As a result, HIPAA covered entities will not be penalized for failing to obtain an HPID number.

The stated reason for the delay is to give CMS time to review recommendations from the National Committee on Vital and Health Statistics (“NCVHS”), an advisory board to the U.S. Department of Health and Human Services.  In a September 23, 2014 letter, NCVHS outlined some of the committee’s concerns regarding the lack of benefit and value in the use of reporting of HPIDs in health care transactions. Some of the concerns expressed by NCVHS in the September 23rd letter include the following:

  • Lack of clear business need and purpose for using HPID and Other Entity Identifier (“OEID”) in health care administrative transactions;
  • Confusion about how the HPID and OEID would be used in administrative transactions, including strong concerns that HPID might replace the current Payer ID;
  • Challenges faced by health plans with respect to the definitions of controlling health plan and sub-health plan;
  • Use of HPID for group health plans that do not conduct HIPAA standard transactions; and
  • Cost to health plans, clearinghouses, and providers if software has to be modified to account for the HPID.

The NCVHS offered two recommendations.  First, that all covered entities will not use HPID in administrative transactions and that the current Payer ID will not be replaced with HPID.  Second, that HHS should further clarify when and how the HPID would be used in health plan compliance certification and if there will be a connection with the Federally-facilitated Marketplace.  The enforcement delay will allow time for HHS to review NCVHS’s recommendations and consider any next steps.  Text of the CMS announcement can be found here.

About Bose McKinney & Evans LLP

Bose McKinney & Evans LLP is a business law firm, headquartered in Indianapolis, Indiana, serving both publicly held and privately held businesses, governmental entities and high-growth industries. Our clients include Fortune 100 companies, international manufacturers, national and regional financial institutions, agribusinesses, sports teams, university-incubated start-ups, media, utilities, cities and schools, to name a few. We strive to build strong relationships with our clients as key business advisors, to exceed expectations in the quality of our work, to be knowledgeable about our clients’ businesses and sectors, to be responsive to service needs and to continually seek to improve the delivery of client services. Our ultimate focus is on our clients.
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