The new electronic process for self-funded non-federal governmental plans to opt out of certain HIPAA-related coverage requirements was detailed in guidance from the Centers for Medicare and Medicaid Services.
Opt-out elections must be submitted through the Non-Federal Governmental Plans Module in the Health Insurance Oversight System, according to the July 21 memorandum from Mandy Cohen, acting director of CMS’ Center for Consumer Information and Insurance Oversight.
These exemption elections will not be accepted by U.S. Mail or fax after this Dec. 31, under recent opt-out rule changes that CMS included in the health care reform “market standards” finalized May 27.
Self-funded state or local government plan sponsors may opt out of the Mental Health Parity and Addiction Equity Act, the Newborns’ and Mothers’ Health Protection Act, the Women’s Health and Cancer Rights Act and “Michelle’s Law.”
HIPAA’s provisions on pre-existing condition exclusions, special enrollment and nondiscrimination were removed from this list by the Patient Protection and Affordable Care Act. However, group health plans maintained under a collective bargaining agreement that was ratified before March 23, 2010, and had been exempted from those three rules, do not have to comply with them until the first year that begins after the CBA expires.
HIOS Registration Required
To be able to file exemption elections, a plan sponsor first must register for access to HIOS, request access to the Non-Fed Module and choose the user role for its submittal: as a “submitter” that completes the application and submits the documents or a “role approver administrator” that confirms submitter role requests. Becoming a HIOS user requires registering in the Enterprise Identity Management system at https://portal.cms.gov.
Plan sponsors first should register as a role approver administrator in HIOS, so they then can register the submitter role in the Non-Fed Module, CMS indicated. The guidance and a recently issued user manual include more detailed instructions.
To certify the electronic submittal, plan sponsors should enter their electronic signature, including title, first name and last name. The individual signing the certification should be the Non-Fed Module submitter for the online HIOS submission.
Under the recent rule changes, plan sponsors may not submit a single opt-out election for more than one group health plan, unless the plans are subject to a common collective bargaining agreement — in which case the election must list each group health plan subject to the agreement.
A complete election consists of the election document, a signed certification and — unless the filing is for renewal of an existing exemption — a copy of the required notice to plan enrollees, in Word or .pdf format.