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Life Health > Health Insurance > Health Insurance

Self-funded health plans slow tech rules

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Federal regulators are giving benefits groups more time to react to a proposal that could make some self-insured health plans with data standards problems pay fines of up to $40 per covered life per year.

The U.S. Department of Health and Human Services is extending the comment period for the proposal to April 3, from March 3.

The proposal, which appeared in the Federal Register on Jan. 2, would require “controlling health plans” to show they comply with the Health Insurance Portability and Accountability Act standards for three types of electronic plan communications.

The HIPAA transaction standards apply to health plan eligibility information, claim status information and electronic funds transfers and remittance advice.

The normal cap on data standards-related fines would be $1 per day per covered life, up to $20 per year. The $40 cap would apply only when a plan was guilty of misrepresentation of whether or not it was in compliance with the standards.

Carriers already have had to comply with similar regulations. The new regs are different because they also would apply to many self-insured plans that haven’t had to comply with earlier HIPAA data standards regulations, officials wrote in a new notice.

Many of the plans, including self-insureds, haven’t been affected by the earlier regs because they don’t directly conduct HIPAA-covered transactions, officials say.

HHS is extending the proposal comment period to give benefits groups more time to understand the proposal and solicit feedback from their members, officials say.

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