Baucus’ proposal for use of ‘operating rules’ to go for voting soon

by | Oct 8, 2009

There will soon be a voting for Sen. Max Baucus’ proposal to mandate use of “operating rules” that would make HIPAA transactions more uniform. The proposal, at present, remains in the version of the Senate Finance Committee health reform bill.

The bill also would add the electronic funds transfer (EFT) of health claims payments as a HIPAA transaction besides requiring the 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.

When Baucus (D-Mont.), chair of the finance committee, issued his first “Chairman’s Mark,” on September 16, he proposed the operating rules, EFT transaction and health plan identifiers. The mark, which is a detailed explanation of provisions for health care reform, 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 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.

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.

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