Yes. HHS is accepting public comments on the NPRM through April 3, 2014. CAQH CORE developed a timeline to collect industry input and submit a comment letter on the NPRM to HHS. On February 21, 2014 CAQH CORE issued a Final Model Comment Letter that both CORE and non-CORE Participants may customize and use as they deem appropriate in submitting comments on the NPRM to HHS.

On January 2, 2014, HHS issued an NPRM proposing requirements for the ACA-mandated HHS Certification of Compliance program addressing the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions. The HHS NPRM, RIN 0938–AQ85, is available online in the Federal Register HERE. To date, the NPRM for these four transaction is still only proposed, and a final rule has not been published on the ACA-mandated HHS Certification of Compliance program.

ACA Section 1104 requires all HIPAA-covered entities to comply with the HIPAA-mandated transaction standards and associated operating rules. Beyond general HIPAA compliance, ACA Section 1104 requires health plans to certify their compliance with HHS.

Under the HIPAA Administrative Simplification provisions, health plans are “required to have the capacity to accept and/or send (either itself, or by hiring a health care clearinghouse to accept and/or send on its behalf) a standard transaction that it otherwise conducts but does not currently support electronically” (see CMS FAQ #8121).

No. To date, HHS has only issued proposed regulations for the first certification of ACA-mandated health plan certification addressing the eligibility, claim status, electronic funds transfers, and healthcare payment and remittance advice transactions. The HHS Notice of Proposed Rulemaking (NPRM) on the first certification specifies that HHS will adopt certification requirements for the remaining five transactions in subsequent rulemaking.

ACA Section 1104 requires health plans to file a statement with HHS certifying that their data and information systems are in compliance with the HIPAA-mandated transaction standards and associated operating rules for nine healthcare administrative and financial electronic transactions.

Yes. ACA Section 1104 directs the HHS Secretary to conduct periodic audits to ensure that health plans, including entities that have service contracts with health plans, are in compliance with any HIPAA-mandated standards and associated operating rules. Additionally, ACA Subsection 1104(b)(2) mandates the following requirements regarding penalties to be against health plans that fail to certify compliance with HHS:

The Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification provisions include a requirement for the Secretary of the Department of Health and Human Services (HHS) to establish an HPID for the purpose of identifying health plans in HIPAA-mandated transactions .

On January 2, 2014, the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking (NPRM or “proposed rule”)  that would require a controlling health plan (CHP) to submit information and documentation demonstrating that it is compliant with certain standards and operating rules adopted by the Secretary of HHS under the Health Insurance Portability and Accountability Act (H

Yes. On January 2, 2014, HHS issued a Notice of Proposed Rulemaking (NPRM) on the ACA-mandated health plan certification. The NPRM (RIN 0938–AQ85) addresses certification requirements for: eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA).