SDOs & Operating Rules Updates

WEDI Sends NSA Letter to Ways and Means Outlining Challenges with AEOBs. WEDI sent to the House Committee on Ways and Means its letter on the No Surprises Act (NSA) that it sent on September 8 to the Secretaries of the Departments of Health and Human Services (HHS), Labor, and Treasury and Director of the…

WEDI Urges Action on No Surprises Act GFE and AEOB Provisions. WEDI sent a letter to the Departments of Health and Human Services (HHS), Labor, Treasury, and the Office of Personnel Management (OPM) outlining critical data exchange issues related to the Good Faith Estimation (GFE) and Advanced Explanation of Benefits (AEOB). Both the GFE and…

X12 Publishes 008060 Versions of HIPAA-Mandated Implementation Guides. Standards Development Organization X12 has published the first of the 008060 versions of the HIPAA-mandated implementation guides. The rest of those 008060 versions will be published over the next few weeks. These updated implementation guides can be viewed in X12’s online viewer, Glass, at  products.x12.org and navigate to…

HHS Delegates Authority to OCR to Administer and Enforce Confidentiality of Substance Use Disorder Records. The U.S. Department of Health and Human Services (HHS) Secretary issued a Statement of Delegation of Authority allowing the Office for Civil Rights (OCR) to administer and enforce the “Confidentiality of Substance Use Disorder Patient Records” regulations at 42 CFR…

HHS Publishes Interim Final Rule Updating Compliance Dates for NCPDP Retail Pharmacy Standards. The U.S. Department of Health and Human Services (HHS) published an Interim Final Rule (IFR) updating the compliance and other dates for the National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards and the Medicaid Pharmacy Subrogation Standard. This IFR is…

CMS Innovation Center Posts FAQs on New WISeR Model. The Centers for Medicare & Medicaid Services (CMS) Innovation Center posted new frequently asked questions (FAQs) for the recently-released Wasteful and Inappropriate Service Reduction (WISeR) model. Questions include whether the WISeR model changes Medicare coverage policy, whether it applies to all Medicare items and services, how…

Health Plans Commit to Improving Prior Authorization. Following a roundtable meeting hosted by the U.S. Department of Health and Human Services (HHS), approximately 50 health plans nationwide announced their commitment to six key actions to improve the prior authorization (PA) process for commercial plans, Medicare Advantage, Medicaid Managed Care, and Health Insurance Marketplace. The participating…

Dr. Thomas Keane Named New Assistant Secretary/National Coordinator. Thomas Keane, MD, MBA, has been named by the U.S. Department of Health and Human Services (HHS) as the new Assistant Secretary for Technology Policy (ASTP) and National Coordinator for Health Information Technology (National Coordinator). Prior to this appointment, Dr. Keane held previous roles within HHS since…

Federal Agencies Called on to Identify Anticompetitive Regulations. In response to Executive Order No. 14267, a letter was sent from the Department of Justice (DOJ) and Federal Trade Commission (FTC) to heads of federal agencies requesting they identify regulations that reduce competition. Regulations asked to be reviewed include ones that limit competition, create or facilitate…