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Administrative Simplification CORBAmed January 12, 1999 Bill Braithwaite Senior Advisor on Health Information Policy U.S. Department of Health and Human Services Administrative Simplification Law Title II - Subtitle F of H.R. 3103 (the Kassebaum/Kennedy Bill)

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Administrative

Simplification

CORBAmedJanuary 12, 1999

Bill Braithwaite

Senior Advisor on Health Information Policy

U.S. Department of Health and Human Services


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Administrative Simplification Law

Title II - Subtitle F of H.R. 3103(the Kassebaum/Kennedy Bill)

“The Health Insurance Portability and Accountability Act of 1996” AKA “HIPAA”

Signed August 21, 1996 to become

P.L. 104-191

Part C of Title XI of the Social Security Act


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Purpose of Provisions

  • Improve the efficiency and effectiveness of the health care system by standardizing the electronic data interchange of certain administrative and financial transactions.

  • Protect the security and privacy of transmitted information.

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Overview of Provisions

  • HHS must adopt national standards necessary for efficient, electronic, administrative and financial health care transactions.

  • All health plans, all clearinghouses, and those providers who choose to conduct these transactions electronically, are required to implement these standards.

  • Recommendations for privacy legislation.

  • Recommendations for electronic medical records.


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Mandated Standards

  • 9 EDI transaction standards (claims, encounters, enrollment, etc.) including code sets.

  • Coordination of benefits information.

  • Unique identifiers (including allowed uses) for individuals, employers, health plans, and health care providers.

  • Security, confidentiality, and electronic signatures.


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Standards Adoption Process

  • HHS looks to industry for consensus standard:

    • developed by ANSI accredited standards setting organization (SDO).

    • HHS works with industry to develop and confirm consensus at implementation guide level.

  • Secretary relies on recommendations of the NCVHS, which holds public meetings and hearings as required to get public input.

  • HHS publishes proposed rules and then final rules which have the force of federal law.


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Satisfaction of Requirements

  • Directly transmitting and receiving data using adopted standards

  • Submitting non-standard data to a health care clearinghouse for transmission using adopted standards.

  • Receiving non-standard data from a health care clearinghouse after conversion from data received using adopted standards.


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Penalties

  • Penalty for Non-compliance with Standards:

    • $100 each violation; maximum $25,000 per year per violation of identical requirement or prohibition.

  • Penalty for Wrongful Disclosure:

    • Maximum $250,000 and 10 years imprisonment.


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Publications in 1998

  • Federal Register - Notices of Proposed Rule Making (NPRMs) and their public comment periods:

    • Transactions and Medical Coding (5/7/98 - 7/6/98)

    • National Provider ID (5/7/98 - 7/6/98)

    • Employer ID (6/16/98 - 8/17/98)

    • Security (8/12/98 - 10/13/98)


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Expected 1999 Publications

  • Final rules for transactions, security, provider identifier, and employer identifier.

  • NPRM for Health Plan Identifier

  • NPRM for Claims Attachment

  • NPRM for First Report of Injury

  • Possible standard for Health Number for Individuals?


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Expected 2000 Publications

  • Standards for Privacy of Individually Identifiable Health Information (whether or not Congress passes privacy law by August 1999).

  • NCVHS Recommendations for standards for patient medical record information and the electronic exchange of such information.

  • Possible other financial and administrative transactions that improve the operation of the health care system and reduce administrative costs.


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Criteria for Standards

  • Improve efficiency and effectiveness

    • by leading to cost reductions for or improvements in benefits from electronic health care transactions.

  • Meet needs of user community

  • Data element definitions and codes consistent and uniform with other standards.

  • Low development and implementation costs relative to benefits of using the standard.

  • Supported by ANSI-accredited SDO or other organization to ensure continuity and updating.


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Criteria for Standards

  • Timely development, testing, implementation, and updating procedures.

  • Technologically independent of computer platforms and transmission protocols, except when explicitly part of the standard.

  • Precise and unambiguous, but simple as possible.

  • Low data collection and paperwork burdens.

  • Flexibility to adapt to changes in infrastructure.


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New Technology

  • Proposed process to introduce new technology:

    • Request waiver for testing showing

      • clear improvement over the current standard.

      • cost-benefit analysis.

    • Test new standard or revision of current standard.

    • Report on test results.

    • HHS will adopt new or revised standard if

      • benefits of the proposed revision or new standard significantly outweigh the disadvantages of implementing it.


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Philosophy

  • One standard for the data (definitions + conditions)

  • Potential for multiple transport standards

  • Open standards (over proprietary)

  • Due process for consideration of all input (ANSI)

  • Standards at implementation guide level

  • Consider cost of supporting multiple standards

  • Limit transition requirements as standards evolve


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Resources

  • Web Sites:

    • http://aspe.os.dhhs.gov/admnsimp/

      • posting of law, process, regulations, and comments.

    • http://www.wpc-edi.com/hipaa/

      • posting of X12N implementation guides

  • Listserv:

    • receive e-mail notification on publication of documents related to HIPAA regulations

    • send e-mail to: [email protected]

    • include in body of message:

      subscribe HIPAA-REGS first-name last-name


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