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HHS delays enforcement for HIPAA standards operating rules

January 3, 2013

The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services will not enforce until April the first two operating rules for Health Insurance Portability and Accountability Act (HIPAA) transaction standards, the agency announced yesterday. Operating rules are intended to make the application of the HIPAA standards more consistent and efficient. The operating rules for the HIPAA standards for health plan eligibility and health care claim status took effect Jan. 1 for health plans, health care clearinghouses and certain health care providers. "Industry feedback suggests that HIPAA covered entities have not reached a threshold whereby a majority of covered entities would be able to be in compliance with the operating rules by Jan. 1, 2013," CMS said. While enforcement action will not be taken before April, OESS will accept complaints associated with compliance. "If requested by OESS, covered entities that are the subject of complaints…must produce evidence of either compliance or a good faith effort to become compliant with the operating rules during the 90-day period," the agency said. The Patient Protection and Affordable Care Act's administrative simplification provisions require the Department of Health and Human Services to adopt a single set of operating rules for each HIPAA transaction standard to improve its utility and reduce administrative costs.