The CMS Division of National Standards, on behalf of HHS, is launching the Compliance Review Program (the “Program”) to ensure compliance among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions. HHS will randomly select health plans and clearinghouses to assess compliance with: (1) transaction formats; (2) code sets; and (3) unique […]
As a follow-up to our recent blog Count Down to Open Enrollment – Some Quick Thoughts, below is a little more detail on how seemingly simple wellness program design changes can have significant legal consequences. HIPAA – Employers feeling extra generous this plan year may want to increase their wellness program’s financial incentive. It is […]
To state the obvious, there has been some uncertainty regarding how the Trump Administration will affect federal agency enforcement efforts. However, at least, in regard to HIPAA Privacy and Security, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”), appears to be unchanging in its previous course. In the first […]
Although it is not a new requirement, it is important and therefore worth a reminder: HIPAA requires covered entities to establish and implement written policies and procedures that are consistent with its Privacy and Security Rules. As discussed in an earlier blog, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”) […]
DOL health and welfare plan investigations are on the rise. There are best practices for plans chosen for investigation: 1. Get Employee Benefits Counsel Involved Early. The DOL investigation process generally starts with a letter from DOL requesting a long list of documents that range from plan documents and disclosures to financial documents (e.g., trust […]
In our April 21 blog, Wellness Programs: Agencies Issue Helpful Guidance but Look Before You Leap, Nancy Campbell wrote about the release of the much-anticipated EEOC proposed regulations concerning wellness programs. In her blog, Nancy briefly touched upon some of the differences between the EEOC proposed regulations and the final HIPAA wellness regulations issued by […]
The Civil Rights Office of the Department of Health and Human Services announced a “Phase 2” audit program in the Fall of 2014. That audit program was delayed due to funding issues, but appears to be back on schedule for 2015. These Phase 2 audits are expected to be more in depth and focused on […]
Recent studies indicate that wellness programs significantly improve the health of workers. If only it were so easy to implement a wellness program . . . As explained in our July 17, 2013 Benefits Update – Final Wellness Rules May Require Review of Existing Wellness Programs, final HIPAA wellness regulations were issued by the Departments […]
On October 31, 2014, HHS announced a delay, “until further notice,” in the enforcement of the regulations pertaining to Health Plan Identifiers (HPIDs) and their use in HIPAA standard electronic transactions. For more information on the HPID requirements, please see our October 1, 2014 SW Benefits Update, “HIPAA Requires Many Health Plans to Obtain a […]
On January 17, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule under HIPAA making substantial changes to the rules for vendors that provide services to HIPAA-covered plans, such as third-party administrators, pharmacy benefit managers and certain brokers – known in the HIPAA world as “Business Associates.” Under this final […]
