NYSACRA

During a Special Open Door Forum o­n HIPAA o­n July 24, 2003, the Centers for Medicare and Medicaid Services (CMS) presented guidance o­n compliance with the October 16 transactions and code sets (TCS) deadline. In response to inquiries received expressing concern over the health care industry's state of readiness, the Department of Health and Human Services (HHS) issued the guidance outlining its approach to enforcement of the TCS provisions. The guidance reiterates what CMS officials have been saying all along: "The law is clear: October 16, 2003 is the deadline... after that date, covered entities, including health plans, may not conduct noncompliant transactions" and "CMS will focus o­n obtaining voluntary compliance and use a complaint-driven approach for enforcement."  (CMS Guidance Document: http://www.cms.gov/hipaa/hipaa2/guidance-final.pdf (pdf 82KB)

During the question and answer part of the teleconference, CMS stated the following:

1.  October 16 remains the legal deadline for transaction and code set compliance. After that date, covered entities may not conduct noncompliant transactions.

2.  Federal CMS will focus o­n voluntary compliance and use a complaint driven approach to enforce the transactions and code sets rule.

3.  CMS will consider good faith efforts, especially outreach and testing activities, when determining, o­n a case-by-case basis, whether or not to impose fines based o­n complaints about non-compliant transactions.

4.  CMS will not impose penalties o­n covered entities that use contingency plans to ensure the smooth flow of payments if the entities have made reasonable and diligent efforts to become compliant. Specifically, as long as a health plan (such as Medicaid) can demonstrate to CMS its active outreach/testing efforts, it can continue processing payments to providers.

During the teleconference CMS didn't address concerns about potential non-payment of claims after October 16 because of implementation problems with either a HIPAA-compliant transaction system, or a contingency system.  CMS also acknowledged that, despite o­ngoing testing of Medicare claims, the majority of Medicare payors were still not ready to submit HIPAA-compliant claims.

NYSACRA continues to work in collaboration with other associations and groups to make sure that claims will not be interrupted.  A letter to Senators Schumer and Clinton, as well as meetings with the Governor’s office, NYS DOH and NYS DOB have happened or will happen in the next 10 days, to address the concern that although NYS DOH and Computer Sciences Corporation are making progress, not enough providers/vendors will have been able to “test” their entire claims process (end-to-end testing) before October 16, 2003 (the compliance date).