[Federal Register Volume 80, Number 103 (Friday, May 29, 2015)]
[Proposed Rules]
[Pages 30646-30647]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-13047]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

45 CFR Part 162

[CMS-0026-NC]


Request for Information Regarding the Requirements for the Health 
Plan Identifier

AGENCY: Office of the Secretary (HHS).

ACTION: Request for information.

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SUMMARY: This request for information seeks public comment regarding 
the health plan identifier (HPID) including the requirements regarding 
health plan enumeration and the requirement, to use the HPID in 
electronic health care transactions.

DATES: To be assured consideration, written or electronic comments must 
be received at one of the addresses provided below, no later than 5 
p.m. on July 28, 2015.

ADDRESSES: In commenting, refer to file code CMS-0026-NC. Because of 
staff and resource limitations, we cannot accept comments by facsimile 
(FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-0026-NC, P.O. Box 8013, 
Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-0026-NC, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. Alternatively, you may deliver (by hand or 
courier) your written comments ONLY to the following addresses: a. For 
delivery in

[[Page 30647]]

Washington, DC--Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 
Independence Avenue SW., Washington, DC 20201.
    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping in and retaining an extra copy of the comments being 
filed.)
    b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    If you intend to deliver your comments to the Baltimore address, 
call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    Comments erroneously mailed to the addresses indicated as 
appropriate for hand or courier delivery may be delayed and received 
after the comment period.

FOR FURTHER INFORMATION CONTACT: Geanelle G. Herring, (410) 786-4466. 
Chevell Thomas, (410) 786-1387.

SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments 
received before the close of the comment period are available for 
viewing by the public, including any personally identifiable or 
confidential business information that is included in a comment. We 
post all comments received before the close of the comment period on 
the following Web site as soon as possible after they have been 
received: http://www.regulations.gov. Follow the search instructions on 
that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

I. Background

    Section 262 of the Health Insurance Portability and Accountability 
Act of 1996, Public Law 104-191, added section 1173 to the Social 
Security Act (the Act) and required, among other things, the Secretary 
of the Department of Health and Human Services (HHS) (the Secretary) to 
adopt standards providing for a standard unique health identifier for 
each health plan. The Congress renewed that requirement in 2010 in 
section 1104 of the Patient Protection and Affordable Care Act (Pub. L. 
111-148), as amended by the Health Care and Education Reconciliation 
Act of 2010 (Pub. L. 111-152) (collectively known as the Affordable 
Care Act), requiring the Secretary to promulgate a final rule to 
establish a unique health plan identifier based on the input of the 
National Committee on Vital and Health Statistics, with such rulemaking 
to be effective not later than October 1, 2012.
    In the September 5, 2012 Federal Register (77 FR 54664), the 
Secretary issued the Administrative Simplification: Adoption of a 
Standard for a Unique Health Plan Identifier; Addition to the National 
Provider Identifier Requirements; and a Change to the Compliance Date 
for the International Classification of Diseases, 10th Edition (ICD-CM 
and ICD-10-PCS) Medical Data Code Sets final rule (hereinafter referred 
to as the ``HPID final rule'') adopting a standard for a unique health 
plan identifier (HPID) and established requirements for its 
implementation. The final rule was effective November 5, 2012. With the 
exception of small health plans, plans were required to obtain an HPID 
by November 5, 2014 (small plans have until November 5, 2015). In 
recognition of the fact that health plans have many different business 
structures and arrangements, the HPID final rule created an enumeration 
structure that distinguishes between controlling health plans (CHPs) 
and subhealth plans (SHPs) and enables health plans to obtain HPIDs to 
reflect those arrangements and be identified appropriately in HIPAA 
transactions. CHPs are required to obtain HPIDs while SHPs are not. The 
HPID final rule also created an optional other entity identifier (OEID) 
to facilitate the identification in HIPAA transactions of entities that 
are not health plans, health care providers, or individuals, yet need 
to be identified in such transactions.
    The HPID final rule does not require covered entities to identify a 
health plan in a HIPAA transaction. But, where a covered entity does 
identify a health plan in a HIPAA transaction, the final rule specifies 
that, on or after November 7, 2016, it must use an HPID to do so.
    In early 2014, the National Committee on Vital and Health 
Statistics (NCVHS) conducted a number of hearings regarding the HPID. 
Those hearings yielded testimony from various segments of the industry 
expressing concerns about the HPID and the need for additional 
clarification and led the NCVHS, on September 23, 2014, to recommend 
that the Secretary specify that the HPID not be used in HIPAA 
transactions and clarify the HPID's use. On October 31, 2014, HHS 
exercised enforcement discretion and advised the public of a delay, 
until further notice, in enforcement of 45 CFR 162, Subpart E (the 
regulations pertaining to HPID enumeration and use) so that HHS could 
review the NCVHS's recommendations and consider next steps. (See http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/Health-Plan-Identifier.html).

II. Solicitation of Comments

    We are soliciting public input to assess the NCVHS's 
recommendations to determine whether policy changes may be warranted. 
We also note that, since the publication of the HPID final rule, the 
nation's health care system has experienced sweeping changes, including 
implementation of the Affordable Care Act's marketplaces. Therefore, we 
are requesting information regarding the following:
     The HPID enumeration structure outlined in the HPID final 
rule, including the use of the CHP/SHP and OEID concepts.
     The use of the HPID in HIPAA transactions in conjunction 
with the Payer ID.
     Whether changes to the nation's health care system, since 
the issuance of the HPID final rule published September 5, 2012, have 
altered your perspectives about the function of the HPID.

III. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble; 
and, when we issue a subsequent document, we will respond to the 
comments in the preamble to that document.

    Approved May 25, 2015.
Sylvia M. Burwell,
Secretary, Department of Health and Human Services.
[FR Doc. 2015-13047 Filed 5-28-15; 8:45 am]
 BILLING CODE 4120-01-P