DOL Releases Proposed Rule on Administrative Simplification Modifications to the HIPAA Privacy Rule for Retail Pharmacy Transactions; Comments Due January 9

​The Health and Human Services Department (HHS) published a proposed rule seeking comments on adopting modifications to standards for electronic retail pharmacy transactions and a subrogation standard adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and to broaden the applicability of the HIPAA subrogation transaction.

This proposed rule includes modifications to the currently adopted standards for the following retail pharmacy transactions:

• health care claims or equivalent encounter information,
• eligibility for a health plan,
• referral certification and authorization, and
• coordination of benefits.

The proposed rule would also broaden the applicability of the Medicaid pharmacy subrogation transaction to all health plans and would rename and revise the definition of the transaction and adopt an updated standard, which would be a modification for state Medicaid agencies and an initial standard for all other health plans.

Should these proposals be adopted as proposed, it would require covered entities to comply 24 months after the effective date of the final rule. Small health plans would have 36 months after the effective date of the final rule to comply.

Comments are due January 9, 2023.