Health Plan Identifier Final Rule Released

November 2019 ~

The Department of Health & Human Services (HHS) announced, on October 28, the Federal Register publication of the Final Rule CMS-0054-F pertaining to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The final rule rescinds the adopted standard unique health plan identifier (HPID) and the implementation specifications and requirements for its use and the other entity identifier (OEID) and implementation specifications for its use. This final rule also removes the definitions for the ‘‘Controlling health plan’’ (CHP) and ‘‘Subhealth plan’’ (SHP).

The HPID and OEID were adopted in the September 2012 final rule under the statutory authorities of HIPAA and the Affordable Care Act (ACA). In a proposed rule issued in December 2018, HHS described how it came to understand, based on recommendations from the NCVHS and overwhelming industry input, that the HPID and OEID do not meet the need for which they were adopted. In turn, the agency proposed to remove Subpart E- Standard Unique Health Identifier for Health Plans at 45 CFR part 162. HHS also proposed to remove the definitions of ‘‘Controlling health plan’’ (CHP) and ‘‘Subhealth plan’’ (SHP) at 45 CFR 162.103 as those terms are integrally related to the HPID requirements, noting, without which they would have no application (83 FR 65123).

HHS also proposed that if the proposal to rescind the HPID and OEID was finalized, the agency would deactivate each HPID and OEID record in the Health Plan and Other Entity Enumeration System (HPOES) on behalf of each enumerated entity, as opposed to each entity having to do so itself, and would notify the manager of record at the current email address in the system (83 FR 65123). In addition, the agency proposed to store the identifiers for 7 years in accordance with federal recordkeeping requirements, and proposed that HHS would not regulate any actions entities may take with their existing HPID and OEID identifiers, such that they would be free to retain and use these identifiers at their own discretion (83 FR 65123).

HHS notes that in response to its December 19, 2018 proposed rule, 19 timely commenters, including major health plan and provider associations and vendors, all supported rescinding the HPID and OEID.

HHS states that it will continue to “explore options for a more effective standard unique health plan identifier,” as required by statute. In the meantime, HHS will deactivate each HPID and OEID record in the Health Plan and Other Entity Enumeration System (HPOES) on behalf of each enumerated entity and will communicate to affected organizations and stakeholders about the deactivation process.

The final rule is scheduled to take effect on December 27, 2019.

Source(s): CMS; HIPAA Administrative Simplification Information Bulletin; Lexology; Reed Smith; American Hospital Association;