HIPAA Administrative Simplification: Electronic Health Care Claims Attachment Proposed Rule Issued September 23, 2005

This in from Stanley Nachimson, Senior Technical Advisor, Office of Electronic Health Standards and Services at Centers for Medicare and Medicaid Services (CMS):

On September 23, 2005, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) adopts two new X12 transaction standards, an HL7 messaging standard to carry clinical information in the response transaction, and HL7 specifications for the content or “questions” that may be asked in each of the six attachment types. This proposed rule also adopts the Logical Observation Identifiers Names and Codes (LOINC) as a new HIPAA code set to be used to identify the questions and answers (attachment information). The standards allow for the transmission of structured or coded data, as well as images and text.

The proposed rule solicits comments from the affected industries on several key issues, including the adoption of LOINC and its use for the HIPAA transactions, the appropriateness of the six proposed attachment types, business requirements for attachments that would accompany the original claim (unsolicited attachments), and the cost-benefit implications of adopting this transaction set.

The public comment period is open until November 22, 2005.

Google Blog Search

If you are into blogs be sure to check out the new Google blog search which is now out in beta.

More Katrina Resource Information for Health Care Providers

The American Health Lawyers Assocation has created a special section on its website featuring additional Hurricane Katrina resource materials and links for health care providers, including federal and state government announcements and actions and insurer information.

Katrina Relief Effort: Information for Health Care Providers

Garlo Ward, a Texas health care law firm, has posted information about how Texas is handling some of the initial health care legal questions that have come up as a result of the number of individuals leaving Louisiana due to Katrina. Many of those individauls displaced by the hurricane are in need of community based health care related services, such as intermediate care facilities, home and community care, etc.

The post includes a copy of any email issued by the Private Providers Association of Texas (PPAT), the association representing for-profit and non-profit health care providers who provide community based services to those with mental retardation and other developmental disability.

Over the last week I have been impressed by the prompt response of Texas. However, Texas appears to be nearing capacity after having accepted over 220,000 hurricane victims.

Tonight's news in West Virginia reported the first arrival of displaced Louisiana residents via the West Virginia's 130th Airlift Wing. Other states are sure to follow and receive residents from Louisiana, many who will need continuing health care services. Many providers, associations, patients, etc. will have transfer of service and reimbursement related questions over the coming days and weeks.

Over the last few days I have had a number of conversations about how the transfer of hospital, nursing home, intermediate care and other types of health services will be handled from a reimbursement standard. CMS and Medicare have a Hurricane Katrina Information page, including a Q&A section that should be a starting point for information. It appears that CMS has issued a general waiver under Section 1135 of the SSA allowing HHS to waive Medicare, Medicaid and State CHIP requirements in time of national crisis. Following is a summary from the CMS information page:

Signed Waiver Under Section 1135 of the Social Security Act 9/1/2005
Section 1135 of the Social Security Act allows the Secretary of Health and Human Services to waive or modify certain Medicare, Medicaid, or State Children's Health Insurance Program requirements in order to protect the public health and welfare in times of national crisis. On Wednesday August 31, 2005 Secretary Levitt notified the Congress that he was invoking this authority, as a consequence of Hurricane Katrina, in order to protect the health and welfare of the public in areas impacted by this crisis. CMS is taking action consistent with this authority to ensure that the people in these areas receive all necessary health care services.

EMTALA, HIPAA and Katrina

Interesting discussion about whether or not claims and potential violations of the Emergency Medical Treatment and Labor Act (EMTALA) have occurred in the wake of Hurricane Katrina. I haven't looked into the legal aspects of a potential violations under the actual regulations and whether there is an exemption for disaster situations.

Also I received a special Hurricane Katrina Bulletin from CMS that discussed how health care providers can disclose medical and health information in medical emergencies without violating the HIPAA privacy regulations.

New Health Care Blog: HealthcareTomorrow

A new health care blog came across my screen today thanks to a post by Hospital Impact. The blog is called Healthcare Tomorrow and is authored by Andrew Barna, a young healthcare executive who is currently Director of Strategic Development for a Catholic hospital in the Bay Area.



According to Andrew, "the purpose of this blog is to discuss U.S. healthcare today and what we should be doing to create the healthcare delivery system we want for tomorrow. I am writing for healthcare professionals, commentators, and interested citizens. The posts are my own and do not represent the views of my employer."



I especially liked Andrew's description of himself as a "young healthcare executive with at least 30 years of healthcare experience ahead of me." It's great to see someone young recognizing the value of looking forward. All too often we only look to (and value) those with experience from the past and don't always recognize those looking to create something better for the future.



I was intrigued by Andrew's first post on July 27 regarding the Sorry Works! Coalition. I recently spent some time advising a health care client on the impact a new "I'm Sorry" bill that passed the West Virginia legislation during the 2005 Legislative Session iwll have on malpractice in our state. This particular health care provider was interested in the scope of what could and should not be said during the apology after an adverse event or medical error.