Following the recommendations of the Implementation Teams and the NCVHS, Notices of Proposed Rule Making (NPRMs) are being prepared for three of the four identifiers required by the statute: the National Provider Identifier (NPI), the PAYERID for health plans, and the Employer ID.
Because of the controversy and lack of consensus surrounding the selection of a unique health identifier for individuals, the Data Council recommended that the Secretary not go forward with a NPRM on the individual identifier at this time. Instead, the Data Council recommended publication of a Notice of Intent (NOI) to maximize public involvement in the selection process. The purpose of the NOI is to seek public input on a variety of options and approaches for individual health identifiers without presenting a specific option as the preferred direction, and to invite comment on privacy issues. Comments will be due 60 days after publication of the NOI. Once the public comments have been received and analyzed, the Secretary will decide whether and how to proceed with the selection of the identifier.
This means that the selection of the unique identifier for individuals will be delayed relative to the deadline established by the statute. The NCVHS strongly believes that the delay is warranted and that additional public involvement in this very sensitive area is imperative.
Based on the results of the analyses performed by the Implementation Teams, the input received from the Committee, and the public testimony provided at the NCVHS hearings during the past year, a Notice of Proposed Rulemaking is being prepared for the HIPAA transaction standards and data content and code set standards. Publication of the NPRM will be followed by a 60-day comment period.
HHS has taken a step in the right direction toward a rational framework for coding procedures and associated products. The improvement involves deleting a section of HCPCS codes and using NDC codes for drugs in the place of the deleted codes.
The First Report of Injury transaction has been removed from the HIPAA transaction standards regulation at this time because there is neither a millennium-compliant version of an implementation guide nor a complete data dictionary for the ASC X12N 148 - Report of Injury, Illness, or Incident transaction. The Secretary will issue a separate Notice of Proposed Rulemaking at a later date after the implementation guide and data dictionary have been completed.
Based on the results of the analyses performed by the Implementation Teams, the input received from the Committee, and the public testimony provided at the NCVHS hearings during the past year, a Notice of Proposed Rulemaking is being prepared for the security standards. Publication of the NPRM will be followed by a 60-day comment period.
As noted above, the statute gave an additional 12 months for the adoption of standards for claims attachments. The Implementation Team for claims attachments was formed in October 1997. NCVHS hearings on claims attachment issues began in November 1997. The Notice of Proposed Rulemaking is due in August 1998, and the Final Rule is scheduled to be published by February 21, 1999.
On September 11, 1997, Secretary Shalala delivered to Congress her recommendations for Federal privacy legislation to protect individually identifiable health information. In her recommendations, she urged Congress to pass without delay privacy legislation that would be based on five key principles:
1. Boundaries - An individual’s health care information should be used for health purposes and only those purposes, subject to a few carefully defined exceptions.
2. Security - Organizations to which we entrust health information ought to protect it against deliberate or inadvertent misuse or disclosure. Federal law should require such security measures.
3. Consumer Control - Patients should be able to see what is in their records, get a copy, correct errors, and find out who else has seen them.
4. Accountability - Those who misuse personal health information should be punished, and those who are harmed by its misuse should have legal recourse.
5. Public Responsibility - Federal law should identify those limited arenas in which our public responsibilities warrant authorization of access to our medical information, and should sharply limit the uses and disclosure of information in those contexts.
In addition, the Secretary recommended that Federal privacy legislation not preempt or supersede other State or Federal laws that are more protective of individual privacy. The full text of the Secretary's privacy recommendations is available in the HHS administrative simplification website: http://aspe.os.dhhs.gov/admnsimp/.
The Department has taken very seriously its responsibilities to ensure that the industry will be able to receive all of the information and assistance it will need to implement the standards. The statute requires that the Department provide a low-cost distribution method for the implementation guides for these standards.
The X12N standards committee has a long-standing agreement with the Washington Publishing Company (WPC) to develop and maintain official implementation guides for the X12N transaction sets that are being recommended for adoption in the NPRMs. In order to meet its low-cost distribution requirement, HHS has established a contract with the WPC, and implementation guides will be available for downloading from the WPC web site at no charge. Paper copies will be available for purchase from WPC. Guides for the retail drug claim standards will be available from the NCPDP web site.
In addition, HHS and the NCVHS have recognized the importance of developing a comprehensive communication strategy to increase the quantity and availability of information on administrative simplification. On July 9, 1997, HHS sponsored a public meeting at the National Institutes of Health at which members of the Implementation Teams presented their recommendations for standards to be adopted and answered questions posed by the audience. This meeting, which was open to the public, drew an audience of about 200 individuals. For those who could not attend, the meeting was broadcast live on the Internet. Those who listened to the broadcast were able also to view the presentation materials being displayed at the meeting. This was one of the Department's first attempts at using the Internet in this manner. Because of the success of this Internet broadcast, the NCVHS now broadcasts its public meetings on the Internet as well.
Despite our many efforts, discussions with the health care industry about administrative simplification continue to reveal that many in the health care industry do not realize how these standards will affect them. To address this problem, the NCVHS has formed a work group and the Department has established a public education group to develop a coordinated and comprehensive outreach and communication strategy. The strategy includes the development of print materials for publication in periodicals and for distribution to the press and the public, direct mailings to affected groups, the coordinated scheduling of presentations to interested groups, press interviews, and the development and distribution of videotaped products.
In addition, information on the current status of these standards is available on the HHS Administrative Simplification web site:
http://aspe.os.dhhs.gov/admnsimp/
Information on the web site is updated frequently. For example, the Secretary's privacy recommendations and her testimony to the Congress were available from the web site the same morning that she delivered them to the Congress.
Agendas and transcripts of the Committee’s hearings and copies of its recommendations to the Secretary are available on the NCVHS web site:
These sites will be continue to be maintained and updated throughout the implementation of administrative simplification. The Department is also exploring the possibility of using a web site to receive comments on the NPRMs.