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RULES AND REGULATIONS

Federal

The final rules and regulations associated with Administrative Simplification are maintained in the Code of Federal Regulations, parts 160, 162 and 164 of title 45. They are available through the Center for Medicare and Medicaid Services (CMS) website and include:

Transactions: Published in the Federal Register January 16, 2009, with an implementation date of January 1, 2012. The rule adopts a new Point of Sale standard and eight electronic X12 transactions including code sets to be used in the transactions. By updating the formats, it is anticipated health care providers and payers can realize efficiencies and savings. Standardization will allow for exchange of healthcare information for purposes such as third-party liability administration and fraud and abuse detection, and for simplified record keeping.

Privacy: Published in the Federal Register on December 28, 2000, with an implementation date of April 14, 2003. This regulation will protect medical records and other personal health information maintained by health care providers, hospitals, health plans, health insurers, and health care clearinghouses. It limits the non-consensual use and release of private health information, gives patients new rights to access their medical records and to know who has accessed them, and restricts most disclosure of health information to the minimum needed for the intended purpose. The regulation provides protection for paper, oral and electronic information, creating a privacy system that covers all personal health information created or held by covered entities.

Security: Published in the Federal Register on February 20, 2003, with an implementation date of April 21, 2005. The final rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information.

Utah

The State of Utah Insurance Commissioner’s Office, incorporates billing standards into State rule. The Department of Health participates with a coalition of health care insurers, providers and other interested parties in developing these standards. The coalition, known as the Utah Health Information Network (UHIN), is a not-for-profit organization that is reducing the cost of Administrative Health Care through electronic transactions, electronic transaction standards, and education. Participants in the coalition are active members of many national standard setting organizations. Visit the UHIN website for more information regarding electronic commerce agreements, State standards and specifications, and HIPAA links including links to transaction guides and code sets.