The U.S. Department of Health and Human Services (HHS) has extended the effective date of its final rule updating electronic transaction standards for retail pharmacy transactions under the Health Insurance Portability and Accountability Act (HIPAA). The final rule also modifies the Medicaid pharmacy subrogation standard. These final rules were scheduled to go into effect on February 11, 2025. The new effective date is April 14, 2025.
The purpose of the 60-day delay is to allow the Trump administrative to review the new rule, as per the January 2025 presidential memorandum. That memorandum instructed all federal agencies to consider postponing the effective date of certain regulations not already in effect to review any questions of fact, law, or policy. HHS stated that the delay also would give it time to correct a technical error concerning the dates of a permitted transaction period before fully implementing the rule. According to the memorandum, HHS and other federal agencies also are to consider reopening any comment period and reevaluating any pending petitions that involve the regulation.
If not amended by the Trump administration, the final rule will adopt updated National Council for Prescription Drug Programs (NCPDP) electronic retail pharmacy transaction standards. These transactions include health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of benefits, as well as the Medicaid pharmacy subrogation standards. These standards include:
- NCPDP Telecommunications Standard Implementation Guide Version F6 (to replace Version D.0);
- NCPDP Batch Standard Implementation Guide Version 15 (to replace Version 1.2); and
- NCPDP Batch Standard Subrogation Implementation Guide Version 10 (to replace Version 3.0).
Under the Affordable Care Act (ACA), all covered entities must utilize regularly updated electronic exchange of information standards. The final rule is a part of the HIPAA administrative simplification rules. Using standardized electronic data interchange (EDI) reduces health costs by eliminating any need for different propriety codes and formats.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.
Hall Benefits Law, LLC
