Health Care Law Blog

Health Plans Take Notice: Compliance with HIPAA Administrative Simplification Rules is still Required

On Jan. 2, 2014, the Department of Health and Human Services (“HHS”) issued a proposed rule related to the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  Specifically, it delayed the date by which health plans must certify compliance with certain operating rules imposed by the Affordable Care Act (“ACA”).   

The ACA required the Secretary of HHS to adopt operating rules related to claims status, eligibility, electronic funds transfers ("EFT") and health care payment and remittance advice transactions ("ERA").  Health plans (and other covered entities) were required to comply with the claims status and eligibility operating rules by Jan. 1, 2013 and the EFT and ERA operating rules by Jan. 1, 2014.  Additionally, health plans were required to file a statement with HHS certifying that the health plan is in compliance with the operating rules.  This certification statement was due by Dec. 31, 2013. 

The recently published proposed rule delayed the deadline for submission of this certification statement until Dec. 31, 2015. This delay is intended to provide more time for health plans to gather data that is required as part of the certification. The proposed rule makes it very clear that the deadlines for compliance with the operating rules were not affected.  Therefore, despite the reprieve from the certification deadline, a health plan is still required to comply with the operating rules.  If it fails to do so, it runs the risk of being assessed penalties.

If you have any questions about how the HIPAA Administrative Simplification rules may affect your health plan, please contact Mindi Johnson at mjohnson@fosterswift.com or 616.726.2252.

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