Deadline Delayed for Group Health Plan Identifiers

‘HPIDs’ were required for large plans by Nov. 5, 2014; small plans had another year

By Stephen Miller, CEBS Nov 3, 2014

updated 11/6/2014

Deadline for ‘HPID’ Identifier Delayed

The requirement for large plans to acquire health plan identifiers (HPIDs) by Nov. 5, 2014, has now been delayed indefinitely, the government announcedin an online update posted on Oct. 31:

Effective Oct. 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of e-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F).

This enforcement delay applies to all HIPAA covered entities, including health care providers, health plans, and health care clearinghouses.

“This last-minute reprieve comes as good news, particularly to self-insured plan sponsors,” according to an alert from consultancy PwC. “Many self-insured health plan sponsors limit the role of their internal benefits administration staff to transmitting enrollment information to the plan’s third party administrators(TPAs). … Those plan sponsors should identify which of their external vendors transmits electronic standard transactions on behalf of the plan, and ask whether one of those vendors can assist responsible staff to obtain an HPID for the plan once HHS announces a new effective date for these provisions.”​

But Groom Law Group advised in a benefits brief, “In light of this announcement and pending further guidance from the agencies, health plans that have not yet obtained an HPID should not need to do so until further notice from HHS. Health plans that have obtained an HPID also do not need to take any further action at this time.”

Law firm Quarles & Brady went further, stating: “The NCVHS [National Committee on Vital and Health Statistics] findings—from May, June and September of this year—are essentially that the HPID requirement is unnecessary and that the HPID will not be used for HIPAA standard transactions. The HPID may still be used for other purposes, but this is speculative. Unless CMS finds that there really are other justifications for an HPID, we may have just witnessed the end of the HPID requirement.”



Original story posted in October 2014 follows below:

Deadline Looms to Obtain Group Health Plan Identifiers

Self-insured employers should take note of approaching deadlines under a Department of Health and Human Services (HHS) final rule that requires large health plans to obtain health plan identifiers (HPIDs) by Nov. 5, 2014; for small plans, the deadline is Nov. 5, 2015.

An HPID is intended to serves as a unique identifier for health plans involved in transactions subject to the Health Insurance Portability and Accountability Act (HIPAA). HIPAA defines a small health plan as one with annual receipts of $5 million or less.

Employers “are really struggling with the requirements for health plan identifiers,” said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee (ERIC), in a news release. “Regulations issued by HHS were clearly not written with self-insured group health plans in mind.”

Clarification Sought

ERIC recently polled its members, who are large employers that sponsor benefit plans for their workers, and found that the vast majority of these companies had not tried to obtain an HPID as of September 2014. The poll indicated that nearly half of the respondents (45 percent) were still waiting, with hopes that HHS would publish relevant guidance.

For those members who have attempted to obtain an HPID, 100 percent found the process to be “very difficult” or “difficult,” Young said. Common problems included the lack of guidance from HHS regarding the manner in which self-insured plans should calculate 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. It is unclear whether companies would need to treat each type of benefit as a separate [controlling health plan] that needs its own HPID, even if they use a single document and their benefits are treated as a single plan for ERISA purposes,” explained Young.

“It is critical that HHS act quickly to address the deficiencies in the current guidance...given the lack of guidance and difficulties using their system,” she said.

Other Self-Funded Arrangements

“While it is the insurer that is responsible to obtain an HPID on behalf of fully insured health plans, plan sponsors of fully insured health plans should be aware that an HPID may be required for other self-funded arrangements,” cautioned Tripp Vander Wal, an attorney with law firm Miller Johnson, in an online article.

Examples of these self-funded arrangements include health reimbursement arrangements (HRAs) or medical flexible spending accounts (FSAs). “The good news is that HRAs and FSAs are likely to qualify as small health plans and have an additional year to obtain an HPID,” he noted.

In a subsequently issued set of FAQs, the Centers for Medicaid and Medicare Service stated that neither health FSAs nor HSAs are required to obtain an HPID because they are “individual accounts directed by the consumer to pay health care costs.” In addition, CMS stated that whether an HRA needs an HPID depends on what it reimburses. HRAs that cover only deductibles or out-of-pocket costs do not require HPIDs; however, HRAs that pay for other costs (e.g., health insurance premiums) still need HPIDs.

Commented law firm Alston & Bird LLP in an Advisory Update, “We note that, while this guidance may appear to be welcome news for employers with only fully insured plans and health FSAs or HRAs (whose only potential HPID enumeration responsibility would be because of the health FSA or HRA), it is not consistent with HIPAA’s definition of health plan, under which both health FSAs and HRAs are health plans, as CMS has previously recognized. Employers should be able to rely on CMS’s clear statement in this guidance that FSAs and certain HRAs do not require HPIDs, but we advise caution. Given the inconsistency with previous guidance on FSAs and HRAs and the manner in which CMS has phrased the FAQ, the guidance may not create as broad an exception as it first appears.” ​

CMS Clarifies HPID Requirement for Wrap Plans

The Centers for Medicare and Medicaid Services (CMS) has revised its Health Plan ID (HPID) FAQs to provide clearer guidance for employers who wrap multiple self-funded benefit programs into a single ERISA plan for purposes of the annual Form 5500 filing. The updated guidance confirms that a plan sponsor may obtain a single HPID for all self-funded “controlling health plans” (CHP) offered through a wrapped ERISA plan.

“While this clarification may be good news for many employers, remember that CHPs that do not qualify for the ‘small controlling health plan’ exception are required to obtain HPIDs no later than Nov. 5, 2014,” comments an alert from law firm Littler Mendelson P.C..



Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter @SHRMsmiller.​

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