With the HIPAA deadline for obtaining a health plan identifier less than two months away, plan sponsors have encountered major problems trying to get one — if they’ve started at all, according to a poll conducted by the ERISA Industry Committee.
“ERIC’s members are really struggling with the requirements for health plan identifiers,” said Gretchen Young, ERIC senior vice president for health policy. “Regulations issued by HHS were clearly not written with self-insured group health plans in mind.”
Most ERIC members who responded to the survey have not even tried to obtain an HPID yet. Of these, 45 percent said they are waiting until the U.S. Department of Health and Human Services “publishes relevant guidance,” according to the poll results reported Sept. 8. Of members that have attempted to obtain an identifier, 83 percent found the process “very difficult.” Problems cited included a lack of guidance on calculating the number of plans that need an HPID.
“Many plan sponsors use a single document that includes a variety of different benefit programs and they treat all of the benefit programs as a single plan for reporting purposes under ERISA,” Young said. It is unclear whether each benefit must be treated as a separate “controlling health plan” that needs its own HPID, she explained, “even if they use a single document and their benefits are treated as a single plan for ERISA purposes.”
Most health plans must obtain an HPID by this Nov. 5, under final rules that HHS issued in 2012. Controlling health plans — defined as any health plan whose activities are not directed by another plan — must obtain HPIDs for themselves, and may obtain them for their “subhealth plans” as well. Non-HIPAA-covered entities such as third-party administrators may, but are not required to, obtain an “other entity identifier.”
“It is critical that HHS act quickly to address the deficiencies in the current guidance,” Young added. “Given the lack of guidance and difficulties using their system, ERIC hopes that HHS will delay the deadline for self-insured health plans to obtain HPIDs.”
The survey asked members how many CHPs and SHPs they thought they had. Estimated numbers of CHPs ranged from “no plans” to “hundreds of plans,” and the SHP count ranged from zero to 16. “We have approximately 70 distinct medical plans and dozens of various other plans under our ERISA plan,” commented one respondent. “Not even sure where to start.”
Besides determining the number of plans that needed an HPID, other enumeration problems included not having the information requested to complete the application (such as National Association of Insurance Commissioners numbers or Payer Identification Numbers), and not being able to register more than one plan.
HIPAA privacy, transactions and identifiers are discussed in the Employer’s Guide to HIPAA Privacy Requirements.