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Psychiatric News   |   January 17, 2003 
Volume 38 Number 2 page 5-5
Government News
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CMS System to Gather Noncompliance Complaints
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The Centers for Medicare and Medicaid Services, charged with enforcing the HIPAA electronic transactions and code-set standards, posts a new online complaint form to monitor whether health care entities have complied or submitted plans.
The Centers for Medicare and Medicaid Services (CMS) has posted a complaint submission form on its Web site to identify health care entities that are not compliant with the federal electronic transactions and code-set standards.
CMS is responsible for enforcing the standards mandated by the 1996 Health Insurance Portability and Accountability Act (HIPAA).
The online complaint form will alert CMS about health care entities, defined as health care professionals, insurance plans, and information companies, that have not met the October 15, 2002, compliance deadline or filed for the one-year compliance extension (Psychiatric News, March 15, 2002).
Health care entities have until October 16 to be compliant with the federal standards, but the law required them to file their compliance plans with CMS by October 15, 2002.
CMS estimates that more than a million health care entities missed the October 15 filing deadline, according to a November 1 article in Modern Physician.
CMS officials have stated they will enforce the law through complaints filed against health care entities. If that occurs, the entity will have to demonstrate compliance or be prepared to submit a corrective action plan, according to CMS.
Fines for noncompliance can be up to $100 for each offense, with a maximum of $25,000 a year.
According to CMS, the form should not be used to file complaints regarding the privacy of health information.
One of the over 500,000 groups that applied for a one-year extension was CMS, according to a December 1 article in Modern Physician. CMS applied for an extension in August to give the agency "the time to space out the implementation" because of the "enormous complexity" of ensuring compliance for both CMS and its numerous private subcontractors overseeing Medicare. CMS is allowing complaints regarding compliance with the electronic transactions and code-set standards to be submitted in paper form.
The Online Complaint Submission Form and the paper form are posted on the CMS Web site at www.cms.hhs.gov/hipaa/hipaa2/support/correspondence/complaint/default.asp?. Additional information about HIPAA administrative simplification regulations (including the privacy rule) is posted at www.cms.hhs.gov/hipaa/hipaa2/default.asp. ▪

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