Related Links

Web Seminars

Sen. Max Baucus' proposal to mandate use of "operating rules" that would make HIPAA transactions more uniform remains in the version of the Senate Finance Committee health reform bill that soon will have a vote.

The bill also would add the electronic funds transfer (EFT) of health claims payments as a HIPAA transaction. It further would require release of a final rule within two years of enactment to establish unique health plan identifiers, to be effective by Oct. 1, 2012. The identifiers were mandated under HIPAA when enacted in 1996 but never implemented.

Baucus (D-Mont.), chair of the finance committee, first proposed the operating rules, EFT transaction and health plan identifiers in his first "Chairman's Mark," issued on September 16. The mark is a detailed explanation of provisions for health care reform. It is not yet formal legislation written in legislative language; the amended version is a 262-page plain-English document. The amended version of the bill explains the operating rules and EFT proposals in considerable more detail and includes compliance dates.

The "operating rules" referenced in the plan are those developed under the voluntary CORE initiative, which has been under way for several years. CORE is the Committee on Operating Rules for Information Exchange within CAQH, a Washington-based payer advocacy group. The initiative seeks to build industry consensus on tightening of the HIPAA standards to facilitate health care financial/administrative transactions and offer more information to providers.

The amended proposal would require the Secretary of Health and Human Services to initially adopt a single set of operating rules for eligibility verification, claims status, remittance/payment and EFT. "The goal would be to create as much uniformity in the implementation of the electronic standards as possible," according to the proposal.

Under the proposal, HHS would adopt operating rules for eligibility and claims status transactions by July 1, 2011, to be effective by Jan. 1, 2013. "Such operating rules would be allowed to include rules for the use of a machine readable identification card."

HHS would adopt operating rules for EFT and remittance/payment transactions by July 1, 2012, to be effective by Jan. 1, 2014. HHS would adopt operating rules for claims, enrollment/disenrollment, health plan premium payments and referral certification/authorization transactions by July 1, 2014, to be effective by Jan. 1, 2016.

The amended Chairman's Mark, dated Oct. 2 and 262 pages in PDF format, is available at congress.gov. Click on Senate on the left, then Committees, then Finance, then Legislation. The language on operating rules starts on page 207.

--Joseph Goedert