HHS Withdrew Proposed Rule for Certification of Compliance for CHPs

The HHS wanted to simplify the administrative process for getting certification of compliance for all controlling health plans (CHPs) and promote consistent testing processes for CHPs. However, their proposal for a new rule has been withdrawn.

With the proposed new rule, the CHPs would have been required to submit documentations that show their compliance to three electronic transaction standards that HHS set following HIPAA Rules. The three electronic transactions standards are:

  • Eligibility for a health plan
  • Health care claim status
  • Health care electronic fund transfers (EFT) and remittance advice

If the CHP fails to comply with the required documentation or the new rule, there would be financial penalties. Employer’s health plans handled by insurance carriers won’t be affected by the proposed rule, but self-funded employers would have to bear a significant burden.

After they published the proposed rule in January 2014, HHS got over 72 public comments, which upon examination made the HHS decide to withdraw the proposal. The HHS will still continue to study the issues raised by the commenters and think of alternative options that will comply with statutory regulations.

The regulations are already set for CHPs to comply with HIPAA administration simplification standards. HHS is also ready to enforce compliance to those standards. Although HHS withdrew the proposed rule, covered entities still need to comply with 45 CFR parts 160 and 162.

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Christine Garcia is the staff writer on Calculated HIPAA. Christine has several years experience in writing about healthcare sector issues with a focus on the compliance and cybersecurity issues. Christine has developed in-depth knowledge of HIPAA regulations. You can contact Christine at [email protected]. You can follow Christine on Twitter at https://twitter.com/ChrisCalHIPAA