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Back  RFI # 1723: State Regs. Contradict Guide

Formal vs. Informal Help Informal Formal

Submitter

Description

In some instances, trading partners have stated that they must implement specific aspects of HIPAA transactions differently than is stated in the guide, or include/require information that is not documented in the guide (or for locations like the K3 segment and Portal approved uses). In those cases, the trading partner is stating the the state regulation superceeds the Federal HIPAA requirement.

Can you provide guidance on the validity of this statement, and what actions can be taken if this is invalid?

Submitter Assigned Keywords

State Mandate

Response

This is a policy issue that must be handled by the Department of Health and Human Services. The original Federal rule published August 17, 2000 (45 CFR Parts 160 and 162 - Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice) provided the following in I. Background B. Statutory Background:

"Under section 1178 of the Act, the provisions of part C of title XI of the Act, as well as any standards or implementation specifications adopted under them, generally supersede contrary provisions of State law. However, the Secretary may make exceptions to this general rule if she determines that the provision of State law is necessary to prevent fraud and abuse, ensure appropriate State regulation of insurance and health plans, or for State reporting on health care delivery or costs, among other things. In addition, contrary State laws relating to the privacy of individually identifiable health information are not preempted if more stringent than the related federal requirements. Finally, contrary State laws relating to certain activities with respect to public health and regulation of health plans are not preempted by the standards adopted under Part C or section 264 of Public Law 104–191." (p. 50313)

Each situation may vary as to compliance based upon the details.

Beyond this, suspected violations that can't be resolved between trading partners or with the related state agency should be submitted as complaints to the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS). To file a complaint, go to the CMS website.
Submission 12/19/2012
Status Date 5/30/2013
Status F - Final
Primary References
Document 005010XALL
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