Statutes and Regulations
Guidance for statutes and regulations as it relates to HIPAA.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 02, 2020
CMS Timeline
View the 20-year history of key Administrative Simplification laws and regulations (PDF)
Key Compliance Dates for Adopted Standards
- March 24, 2020 – D.0 Modification to Identify Partial Fills for Schedule II Drugs in the Quantity Prescribed (460-ET) Field (PDF)
- Oct 1, 2015 – ICD-10
- Jan 1, 2014 – Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) Standards and Operating Rules
- Jan 1, 2013 – Eligibility and Claims Status Operating Rules
- Jan 1, 2012 – Version 5010, D.0 and 3.0
Statutes
The primary statutes that introduced Administrative Simplification provisions are the:
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- The Patient Protection and Affordable Care Act (ACA)
- The Administrative Simplification Compliance Act (ASCA)
HIPAA
- The Health Insurance Portability and Accountability Act of 1996, or HIPAA, enacted to improve the efficiency and effectiveness of the nation’s health care system, includes Administrative Simplification provisions to establish national standards for:
HIPAA also defines privacy and security requirements for protected health information.
ACA
The Patient Protection and Affordable Care Act, or ACA expanded on the HIPAA provisions, including by requiring operating rules for transactions.
In a separate provision, the ACA directs HHS to conduct outreach to advisory bodies, including the National Committee for Vital and Health Statistics (NCVHS), for input on potential improvements to Administrative Simplification such as:
- Use of a uniform enrollment for health care providers
- Expanding scope of standards and operating rules to apply to health-related transactions conducted by organizations like auto insurers
- Standardized forms for financial audits required by health plans and others
- More transparent and consistent approach to claims edits by health plans
ASCA
- The Administrative Simplification Compliance Act (ASCA) requires all claims be submitted to Medicare electronically except in certain circumstances. To learn more:
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.