[This Transcript is Unedited]

Department of Health and Human Services

National Committee on Vital and Health Statistics

Standards Subcommittee

February 21, 2014

Hubert H. Humphrey Building
200 Independence Avenue, SW
Washington, D.C. 20024

Proceedings by:
CASET Associates, Ltd.
caset@caset.net

P R O C E E D I N G S (8:05 a.m.)

Agenda Item: Welcome

DR. SUAREZ: I think we are going to go ahead and get started. Welcome and good morning everyone. This is the meeting of the Standards Subcommittee of the National Committee of Vital and Health Statistics. I’m Walter Suarez and co-chair of the subcommittee. I am a member of the full committee as well, and I don’t have any conflicts. And so we’re going to go around and do introductions and then we’ll go through the agenda.

(Introductions around table)

DR. SUAREZ: This is very exciting to come out of these last couple of days actually. We had an incredible hearing on Wednesday, and also very good discussion yesterday at the full committee on the activities of the committee.

I think the agenda right now, basically, and our intent right now for this meeting was to – basically three things, work through the timeline of the HIPAA report and make sure that we have all the things that we need between now and June to complete the process of developing the report.

Secondly, just briefly talk about and I don’t think we’re going to spend a full amount of time really on the public health data standards themes. We discussed yesterday with the full committee this area so I think we got enough to finalize our letter and be able to prepare it and send it out and have it ready for action.

Really, I don’t know if we are going to have to wait, or we could wait potentially, to a full in-person committee. That would be until June, and it would be potentially fine. I think that is really part of the question that we always have is how much do we have to wait until in-person meetings or do we have an ability to convene the full committee to discuss some of these action items that have been discussed already in full committee. So we’ll see. At least we have really a very good basis on the letter itself.

We discussed it yesterday. We got very good feedback and so I think we have pretty much the essence of that. We already actually have a draft of the letter itself, but have not really incorporated all this new feedback from the committee into the draft letter. So I’m hoping that we will be able to finish that up very quickly.

And then really spend more time on the Administrative Simplification Hearing that we just had and reserve some time for public comments.

So basically, going back to the – and I know we had a slide deck yesterday, that we presented and I might actually have to go to the other table to display it because it’s not in that computer. So I’ll just do that and show the slides as we go along. So people on the phone are not going to be able to see this.

So as we mentioned yesterday, the HIPAA report is fairly complete in terms of most of its components. Really, we’re going to be refining and just adding some more context to some of the sections, particularly section six, and then we’ll be able to share it with the entire committee for review.

There are a couple of important items to mention. First of all, the timeline that we have set is we’re going to be working – so the timeline basically points to being able to complete roughly between February and March, the subsections, basically subsections with the Privacy and Security Subcommittee and the Population Health Subcommittee. And then complete a full draft for vetting with the full committee between March and April. Then finalize the report in May basically for presentation to NCVHS in June. So that’s the basic timeline.

We know that, again, within the context of the sections, the vast majority of the report has been already drafted and we just need to make a few adjustments to it. I think one was really the executive summary, of where we’re going to try to beef it up or actually draft it in a way that will simplify the identification of the key messages and really summarize the report.

And ultimately see the report as kind of a two part. One is the executive summary itself that can be pulled out and read if people wanted. And then the full report that has all the richness into it, with all the details. That will be part of the development work.

And then the other big part is section six that we discussed yesterday, and we had quite a bit of good input from the full committee. So that’s going to also be shaped up. We already have quite a bit of draft on that section done. So I think for those members of the other subcommittees here we’ll just be working with you on those sections.

I think that’s the main element of discussion. I don’t think we need to go and rehash all the items we discussed yesterday with the full committee. Let me stop there and see if there’s any questions or comments about the actual report and the process that we have to finish it up?

MS. KLOSS: Walter, it might be helpful to just set a target date where we’ve got – for finishing up, let’s say, the privacy and the population section. If those can be to Terri first week in March or something, that might be very helpful. I know most people do better to have a firm date.

DR. SUAREZ: We will do that. Yes, I think it would be ideal if we can try to wrap up sections by no later than the end of the first week of March – that will be really good. So we will probably send out that note. I will be working with the co-chairs of the Population Health Subcommittee to develop the section on population health and we’ll have that as well. So, yes, the goal will be to based on the timeline, roughly by the end of the first week of March or some time around that, have the sections completed.

We’ll probably take a little more time as a subcommittee developing section six, or realigning a little bit the section six which is the one that talks about the future and next stages. As it was discussed yesterday, the idea of within the framework of Administration Simplification, where are we today and what are the gaps. What are the things that we see need to happen into the future and then sort of also give a little larger perspective on the future of eHealth. So we’ll do that.

Larry, I think you have some comments.

DR. GREEN: Walter, I am wondering where you are in terms of the health plan ID and where it fits in the work planning. Does it go in this particular HIPAA report? And where I’m really headed, given that it’s 18 years later and we’re getting around to this, is the intention or direction, the thrust of this going to be this needs to be rethought or is it going to be well, here’s the way to do a health plan ID?

DR. SUAREZ: Well, the report itself is describing in the Administrative Simplification section, the developments that happened through the last couple years. So it will describe, it has described the description –

DR. GREEN: And then the remaining things that need to be addressed.

DR. SUAREZ: Yes, I think the discussion about the issues around the health plan ID can be included probably in the section about where are we today, what are some of the gaps, what are the issues that we have. We don’t want to preempt the letter that we will be putting out on the Administrative Simplification hearing that we just had two days ago with anything that we write into the report itself about the plan idea. It will take some more discussion about what would happen there.

Of course, the reality is this is a report to Congress and, as I mentioned when we had the discussion at the hearing, this is part of the Affordable Care Act that calls for the establishment of this plan ID, so it’s coded into law. So in some respects it takes an act of Congress to really dismantle that, if that’s the case, or change that. So I think this whole discussion takes a little more than what we would necessarily include in the report, in my mind, I think.

DR. GREEN: So Terri let me direct the question to you. Is it your view that this HIPAA report pretty much just bypasses that and leaves it for later and/or other things or does it forecast it or does it identify it as an issue?

MS. DEUTSCH: I think that is part of what has to be discussed and looked at when we talk about the future. It looks like the way it is right now that it’s more on a global perspective as opposed to going into specific areas that need to be addressed in the future. But we need to look at and evolve it.

One of the things that we have in that future section or section six is a roadmap, and so when we start developing that roadmap, seeing what falls in there, we may refer to the fact that we are looking to the HP ID or in a very global effect.

The one thing that we don’t want to put into this report is anything that hasn’t been vetted up to the Secretary. And so if there is anything that you want to be able to get changes in, that would not go in the report. That would be a recommendation in your letter.

DR. SUAREZ: Any other questions about the report?

MS. KLOSS: I don’t think when we did the 10th report to Congress, we did put some recommendations in about staying the course and accelerating forward movement and I think some of that can speak to the point of some of these provisions lagging without being too specific.

DR. SUAREZ: It is going to be interesting to see that as we progress with the report as well as with the letter from the hearing, at the same time in June we’re going to have a discussion to the full committee about the report itself, and then the letter that talks about the health plan ID section among the other four sections in the hearing.

So that’s why I was trying to balance, and we’ll have to figure out how to better do it as we get closer to the final report and the letter itself, from Wednesday’s hearing, how do we not preempt one of the other. We have to make sure that if the committee feels we can include some things from the letter into the report, we can do it actually in situ at the meeting in June.

So we’ll have to play it that way because at this point we need to formulate what is it that we want to discuss about the health plan ID based on the hearing itself. Any other questions on the report?

Okay, so the next one is the Public Health Standards hearing letter. Again, the slides that we presented yesterday just actually were a pretty nice summary of the themes and the areas for recommendation and I think we got also very good feedback and a good discussion.

So what we will be doing – and again, I want to emphasize a couple points here. One is this set of – this hearing itself was actually, as I mentioned a joint hearing formed by the three subcommittees. So the letter itself is going to describe it in that way. It’s not coming out of a hearing from the Standards Subcommittee. It’s really a joint hearing from the three subcommittees.

And indeed that theme that I mentioned yesterday about looking at all our products ultimately, reflecting perspectives from the three main domains or dimensions that we bring up, I think it’s going to be important to present that as well in that letter. And then the letter itself is going to incorporate recommendations.

So we will be, in terms of next steps, we will be finalizing the draft of the letter, discussing it within the Standards Subcommittee and then discussing it with each of the other two subcommittees.

And we will certainly hope that we will have a chance to come to one of your upcoming sessions, the other respective subcommittees, to talk about this. So if you could add this as a part of the workflow between now and June of your subcommittee, that would be really good.

My expectation, again, in terms of timeline is by probably around mid-March we will hope to have a final draft to discuss with the subcommittee on standards and so we’ll again schedule our monthly call so basically, we’ll probably maybe need a couple extra calls in between too.

But we’ll have a chance to really discuss it with the subcommittee, sort of refine the letter and then discuss it with the other two subcommittees towards the end of March. And then go from there and refine it, finalize it, present it to the executive committee and then bring it to the full committee.

So that’s the letter of Public Health Standards hearing. Any comments or questions about that one?

MS. WILLIAMSON: So Walter, are we planning after the Standards Subcommittee finalizes the draft, are we going to need to schedule calls that will include all three subcommittees?

DR. SUAREZ: No. I think what we will do is – and that’s what I was suggesting – we will come to a call schedule for the subcommittees to talk about this. So each of the subcommittees – I don’t think we need three subcommittee call for this. Otherwise that would be like a full committee meeting, in many respects.

What we need is to talk to each of the subcommittees and whenever a call is being scheduled in late March or early April. That’s my thought, I guess, at this point.

DR. FRANCIS: I am happy to try to login to any calls as a Privacy person.

DR. SUAREZ: That would be another possibility is really as we discuss this it in the Standards Subcommittee, we invite the co-chairs of the other subcommittees to get involved. But I’m just making sure that if the other subcommittees want to have an internal discussion, if you will, within the subcommittee of this letter, that would be also really helpful.

MS. KLOSS: And you expect it will be ready to circulate about mid-March would you think?

DR. SUAREZ: In the middle of March I think we will have a draft that we would be discussing within the Subcommittee of Standards. And then towards the end of March I think is when we will have a chance to share it and have it discussed with the other subcommittees.

DR. COHEN: I think Leslie is right. It might be more efficient if we came in on the subcommittee call that you’re having and then we can circulate amongst our group.

Also, it would be helpful, I think, if you could highlight the specific areas that you would like us to be particularly responsive to in the letter. It will make it easier for me, Walter. Make it easier for me. It won’t preclude us addressing anything but if there are particular areas that you want us to focus on, that would be helpful. Thanks.

DR. SUAREZ: Any other comments or questions about the Public Health letter. Okay, moving on.

So yesterday’s hearing really, I mean Wednesday’s hearing really wanted to go back to some of the key elements. And so we’re going to take a few minutes on each of the different points that we talked about, each of the topics that we covered.

So starting with the status of the EFT and ERA and the development of operating rules, a couple of thoughts there I guess and you all heard Ob’s review yesterday of the main themes that we have captured so I’m not rehash that.

But I think from a perspective of areas to focus on, I think on the EFT and ERA certainly – and this applies actually across the board – I think the entire session, as is true with many other hearings that we have had, highlighted a need to continue to press on themes like education, outreach, communication, clarification, guidance, developing different vehicles and mechanisms to help clarify and facilitate things.

On the EFT and ERA, I think it was exciting to see that this is truly one area where there are very definite opportunities for return on investment and what we need to see is a lot more adoption and a lot more embracement of this by primarily providers. I think health plans, of course, are required to be ready and to be able to conduct EFT and ERAs. The providers are the ones that decide whether they want or not to do it. And so we need to really try to create and foster that adoption.

I think we do have a very concrete area to talk about and discuss and that is this area of the virtual credit card concept and the implications, the costs for providers. The issue that we heard, which maybe it didn’t come through quite clearly yesterday, but it was about the actions that some health plans are taking in forcing in some respects, using certain ways to force providers to accept the use of these types of cards, virtual credit cards.

And so in some ways, and we heard even that in some cases payers are using strategies to perhaps discourage organiza providers from using the standard by saying, well, if we pay you with this credit card, it will be faster. But if you use the EFT and ERA it takes 60 days to get paid.

We heard that actually in the hearing and there are concerns about the implications of that in terms of the legal ability to do it, really. And there were calls even for closing the loophole that people refer to in the regulation about the ability for entities not to use the vehicle that has been built to route these type of EFT transactions that opens the opportunity for all these other alternatives, mechanisms.

At the same time, we have to balance, as Ob mentioned yesterday, the ability to consistently use a standard to make sure that that achieves the goals of the simplification versus creating situations where it impedes the innovation and the use of alternative means. So that’s a really tricky balancing area.

But I think we heard consistently that this is an area, number one EFT and ERA are areas that are truly beneficial to everybody, to the industry. Standardizing is really an important goal and addressing this issue of the virtual credit card is going to be important. So that was the EFT and ERA part.

The operating rule I think we heard basically that there is already work underway to develop operating rules for the remaining transactions. We expect to hear from the operating rule authoring entity later this year about the development so we will certainly be holding appropriate hearings and other vehicles to bring that operating rule author and entity to present the proposed operating rules for these new transactions.

One of the goals, and it’s important too, is that we are expecting to see really a lot more convergence across operating rules that apply to the entire transaction set, not just transaction by transaction operating rules. So we’re hoping to see a lot more of that operating rule applicability across the board and then some certainly special operating rules for specific transactions.

So we will have to schedule this in to the quarter three and four of our work plan to ensure that we hear this at outset of this year and are able to recommend to the Secretary the adoption of operating rules.

So let me stop there and see if there are any questions or comments about this. Steve.

DR. LAZARUS: Thank you. Steve Lazarus, Boundary Information Group, representing CAQH Corp. The slide accurately reflects what was said during the session but there’s something not on the slide that I think needs to be recorded. You sort of alluded to it in your words and it probably ought to be documented in the letter, the results from this.

And that is, this is one of those hearing sessions where there was no conflict among the people giving the testimony. In fact, almost everyone was reiterating the same points. So we not only have the points of the summary but very strong consensus across the industry about what these points are. And I think that’s something we don’t always have. And we should just emphasize that as we report this out to the Secretary, whatever the recommendations are.

DR. SUAREZ: Absolutely, I think that’s very –

MS. KLOSS: Walter, this is Linda, and I think that is a really good point, Steve. I’ve been toying with whether the comments that we might have on the ICD-10 issue should be pulled out from the others. Because of the urgency of that to approve a letter and dealing with any kind of new insights on the ICD-10 seems like – I don’t know if there was anything that came out of that that’s compelling enough to include in a separate letter.

I think what was most disturbing to me was how many providers have been passive in terms of really getting an accounting of where their technology vendors and their clearinghouse and small health plan partners are at with this. And whatever could be done to mobilize the industry to be more transparent I think could help a lot.

Now, maybe we wait until a lot of organizations supporting the VMGMA survey seem to suggest they were going to do software upgrades at the end of first quarter. So whether they’re on track come April may have a lot to do with how well this whole cutover works, especially within the more vulnerable, smaller providers.

But, I did think the timing track on that is so much different than the other letter so at least I’d like to throw that out for some discussion before we finalize the plan.

DR. SUAREZ: Thanks Linda. Yes, absolutely. I think that’s an important point and I was actually going to mention something about when we talk about the ICD-10 in the next part of this. Yes, very important point.

DR. GREEN: Walter, I want to intersect some of the discussion yesterday with the full committee. One of the first points you make about the EFT ERA significant ROI. And in yesterday’s discussion, I forget who but someone asked, is anyone actually making estimates of what that ROI might be?

This is not particular to this hearing, I realize, but my sense was that the full committee thought that was a good idea. And I’m wondering if it’s possible to create rough estimates about the ROI and – to this point I’m just representing an issue raised by the full committee that makes sense to me here. Personally, I think that if there’s any way to do something like that it will really give bite to the letter.

DR. SUAREZ: I know Steve has some comments on it. But I want to mention in several of the testimonies, particularly from providers, we actually heard exactly how much amount in dollars and cents using EFT saves, per claim, per transaction. So I think we do have the basis for understanding the benefit, the ROI, from a purely cost and financial perspective, we did hear it. We didn’t report it yesterday. But it is in the testimony from a number of providers. Steve, I don’t know if you want to add to some of that too or –

DR. LAZARUS: Just two things. One is I had reason last week for another purpose to look at some of the historical letters the Committee has sent to the Secretary and in 2011 after your hearings on this issue, you actually reported what the dollar savings were estimated to be for the EFT versus checks, so summarizing some of the testimony. So you’ve already reported – you can also look at that information in following up on this issue.

The second thing is that every one of the operating rules that Core develops, we try to drive the decision-making process about what’s a priority based on the potential ROI. And gather the best pre-operating rule information available for the participants to use in their vetting process.

So there is prior work that’s been done as well as Core does it’s best to do metrics measurement after implementation and we did see the notch of volume issue, that doesn’t get to the ROI, but the volume – they can track the volume increase as it goes through their system. So that will be part of the Core ongoing effort to report to you down the road as to what the actual metrics are moving forward. We’ve got a year or two before we get there because it’s just started, but that’s cooked and baked into every operating rule that’s developed and presented to the Committee.

DR. SUAREZ: Thank you. That is a great point, Larry, I think it will be very valuable to, in a letter, document this to highlight concretely the benefits.

Any other comments on this particular one?

The next one was ICD-10. So as someone said at the hearing yesterday, they were glad that we started with EFT and ERA because that was a really good way to put a very positive spin to the hearing. Then we got into ICD-10.

So, yes, I mean we heard a lot of things. We heard significant concerns across the board about the degree to which the industry is really marching, if you will, towards compliance. We heard good things about the fact that there’s a lot of people using the actual transaction standard that is capable of carrying the ICD-10, 50-10, version 50-10.

We heard that a number of organizations are certainly ahead and moving along. We heard that a number of surveys have shown that even though there are organizations moving along, they are not moving along as quickly or as fast through the process, that a number of them are not in the remediation stage. They are still sort of in the assessment stage.

And then we also heard about the risk that we have with delivery of the actual products that are capable of carrying ICD-10, not in terms of the transaction itself but inside the practice management systems that have the ability to really codify this.

It was interesting that we also talked about how in the meaningful use world and the EHR world, this is already a requirement, that EHRs are, as of now, capable of having ICD-10 in it among other vocabulary and terminologies. So it already embedded into the stage of EHR development.

We also heard, and this is important to point out, somewhat of two sides. One group of entities representing of course a large segment of the industry including hospitals, the Hospital Association including the health plans, including the coders, HIMA and others, strongly pointing to recommendations to staying the course, ensuring that there’s no more delays, ensuring that there is no dismantling or pushing or modifying what everybody’s working towards now.

And then we did hear from the provider organizations represented by AMA and by the Medical Group Management Association, concerns about the ability to achieve these, the impact to care delivery, the impact to the practices themselves in terms of their financial ability to bear a risk of not getting paid or delayed for a month or 2 and the impact on operations and cash flows and other things.

And certainly to be reflective of what we also heard, we heard from the provider side questions about the benefits and utility and actual why are we doing this kind of questions.

So I think we’re going to be – it’s going to be important to reflect that in our letters, of course, and our comments and observations because that was really a reflection of the hearing.

But we heard also important things that we need to emphasize. I think a few points were now focusing – we only have 8 months remaining so now we really need to be focused on the big priority groups so payers, focusing on the priority providers that are way behind, HHS, CMS, Medicare, same thing.

And then continuing to press on that testing basically and it was very good to have CMS, Medicare use the hearing to kind of officially announce their plans to do end-to-end testing.

It’s also important this point about the Medicare advance payment and this is a concept that is really going to be valuable to point to, and perhaps even mention this for other segments of the industry, the insurance industry. So not just Medicare advance payment but certainly other payer, private payer advance payment policies and considerations to really avoid a situation where there are going to be risks for providers to continue to operate, literally, in terms of not getting paid or getting pay delays because of not meeting the appropriate coding standards.

So there is a lot of discussion we had, very intense and extensive testimony and discussion about this so I think this is all going to be reflected in our letter, so we will work through those issues as we go along in the drafting of it.

So let me stop there and see if there are any comments based on ICD-10 or questions. Yes, Bruce.

DR. COHEN: I think Linda raised a really excellent point. Of all the things we’re doing right now this might be the most time sensitive. So the question is do we want to break out our specific observations and recommendations to the Secretary in a separate ICD-10 letter and get this out more quickly than this larger letter that will take, I think, more refinement.

The bottom line is do we want to weigh in as a committee on not only the observations but a strong recommendation to the Secretary. So I would like us to, by the end of today, decide whether we want to do a separate letter sooner rather than later, to the Secretary with our recommendations about ICD-10.

DR. SUAREZ: Great suggestion and I really strongly support that. In fact, I was going to suggest that we’re going to have a separate letter on another topic within the – because there is some time pressure on some of this – so I think we might end up having not just two – well, certainly not necessarily one letter and not even just two letters. Maybe three letters or something like that that can help us move things quickly.

MS. KLOSS: I do think it would help certainly reinforce again, as Steve mentioned, on the EFT issue. There was strong consensus about going forward and there was really only testifier that was still saying this isn’t worth it. So I think that putting forward emphasis on the issues that are pointed out here as observations and turning that around very quickly would be helpful.

DR. SUAREZ: Yes, great. Bill, do you –

DR. STEAD: I just was wanting to see if you could clarify how CMS is using the term end-to-end. In particular, I think there are still people that are thinking about ICD-10 as all of the very difficult end-to-end, if you will, plumbing reworking. How we actually make the transactions work and flow.

I live in concern about the frontend and the documentation workflows and in particular the provider’s space. And I wonder if that is in fact included in the idea of end-to-end. I know it couldn’t be done globally but what seemed to me we could actually do the same kind of onsite, visual audits that they’re beginning to talk about with attestation.

And so you could actually do that to test key examples of our ability to get the frontend right connected to the backend. And I didn’t know if they were thinking that broadly. If not, I would advocate that we at least get that hook in there.

DR. SUAREZ: Yes, great point. I think I was looking for the actual term that they used with respect to end-to-end testing. And I think it was really testing the generation of a transaction and then the return of the transaction. So it was testing that part.

Some people refer to end-to-end testing as going even beyond inside the walls, if you will, rather than between two walls, testing that. So that other end-to-end portion is sort of like doing end-to-end testing tests my ability to internally generate something than externally exchange it and then the recipient and the ability to receive it, internally process it and then return it to me.

But I think they were talking – I forgot the term they used and it was an interesting, like sent to return – I forgot exactly. But that was the concept they are doing and they are doing certainly a targeted end-to-end testing.

DR. STEAD: I would advocate that we suggest that the concept needs to be extended. Because I think that’s where we get in most trouble. That’s where – when we think of this from the perspective of a transaction, even if it’s end-to-end of that transaction and we don’t include what it takes in the workflow to properly load that transaction to create the right pay load.

MS. KLOSS: The closest we came to discussing that I believe was some of the best practices that some of the payers are using to do case-based testing to really look at whether the documentation is producing the right codes. And so we heard a touch of that but not to the extent that you’re describing it, Bill.

MS. GOSS: And it sounded to me yesterday that they were already tweaking their approach to testing. They were first going to do sort of a cursory, knocking on the doors, being able to take it in the first round for a week in March and then they’re going to do a more robust testing in the summer time, I think. And that it was going to enable them to prove that the claim could get processed but not necessarily provide the payment reimbursement rates because of the fee schedule dynamics in the fall. So I think that they’re – my sense is they’re getting closer to what you want.

MS. KLOSS: But in a very sampled way, was my understanding, which will also make –

DR. SUAREZ: So we will definitely include these concepts in our letter and make sure that we cover that. I know we have only like 7 or so minutes more before the full committee starts.

So rather than really going the rest of the section one by one, very briefly, I think the other important topic is the one about prior authorization between prescribers and processors. We heard a general consensus about it and this is one area that I was going to suggest.

We have actually another separate, very short, probably would be one of the shortest letters actually on record from our subcommittee – maybe a page and a half at the most – but anyway, it will be a very short letter that provides a recommendation to the Secretary and CMS and OASS about this. I think there was a lot of consensus around this. And I think we can move this very quickly.

And then the last one is the big topic of plan ID so we will certainly have a lot more discussion about this. There is the challenge of what are we trying to do with respect to using this.

And one point I wanted to, I think Alex, you wanted to clarify, what this bullet that we have hear that said definition – so basically the regs as it was explained, the regulations require two different separate things.

One is requires entities like all health plans to enumerate and obtain a number. That’s the requirement number one. Health plans need to enumerate and obtain a number. And there are a number of descriptions about controlling health plan and a sub health plan and who can and who is eligible. And then there’s also the other entity identifier and all those things. So that’s one area.

And then the second one is the concept of when the number – well, basically the regulation requires that the number be used whenever it’s needed in a transaction, whenever it’s needed in a transaction. So those are the two separate requirements.

MS. GOSS: So let’s pause there for a second because I think you just hit the nail on the head. And I just wanted to make sure that the language that we had in there was really tracking with what X12 did and I took the time last night to clarify with Margaret Weiker just to make sure we had the right concept and I think your language on the slide probably is just fine.

The distinction is that there’s the policy comes out of the regulations once that regulation then can be interpreted and applied within the appropriate workflows and business purposes that correlate to the transaction. So I think we’re fine.

DR. SUAREZ: Okay, great. So yes, exactly. The other point was really once the policy is defined in the regulation then the standards development organization takes that and defines when and where it’s used exactly. So that’s the point. So this is a major topic we will be also discussing.

And so just to finish up, I think what we want to do here is probably work off three different letters, if you will. One is a letter that deals with the EFT ERA, we might even have separate letters for each of the topics but what we will do – how about we work the topics independently, and then decide which ones can go into a common letter and which ones can be done separately. But I think we need to deal with them separately and individually and then define it. So we will work on that and move very quickly with a couple of the priority topics, ICD-10 and the prescriber standard. And then look at what we need to do with the other two.

So, in the next two or three minutes I think we are opening this for public comments, any public comments? Steve?

DR. LAZARUS: Thank you. This time it’s Steve Lazarus without CAQH. As I commented on Wednesday, the e-prescribing proposal that you’re talking about fast tracking, there was no testimony from health plans heard by the Committee directly. And the recipient of the scripts transaction often will be a health plan. Currently health plans don’t receive scripts transactions, they don’t deal with them.

So, it’s still my strong recommendation this committee hear testimony from health plans prior to writing a letter to the Secretary or if you want to write a letter to the Secretary note carefully in the letter that no testimony was heard from health plans in this –

DR. SUAREZ: It is a good point and there are two groups of health plans. I think one is the pharmacy benefit managers which I think are doing this and the other one is non-pharmacy venders managing health plans and so yes, one of the things I was going to do was reach out to AHIP specifically to get some written comment about it to be able to – even though we didn’t hear it at the hearing, we can at least get a perspective from them. Yes, it’s a great point. So that’s something we will definitely do. Thank you.

Any other public comments? All right. Hearing none and the time being 9:01, we are going to finish our meeting. Thank you everyone. I want to thank our staff specifically for the tremendous work that has been done over the last 3 months particularly.

And I want to welcome, and I will also take the opportunity to say this at the full committee, but want to welcome Terri Deutsch as our new staff, lead staff from CMS assigned to our subcommittee.

It’s been just an amazing opportunity to bring in Terri. Terri has been the person leading the development of our HIPAA report and now is not only involved in that but actually in the entire task of the subcommittee. So I want to welcome Terri. Thank you for all the work. It was an amazing way to inaugurate you, I guess, or bring you into the subcommittee with the organization of this incredible hearing. So thank you, Terri.

And thanks to Marietta and to the rest of the staff for all the work on the hearing and on our subcommittee’s report. So thank you very much.

All right, we can adjourn and we’ll turn it to our Chair who will be coming in any time now.

(Whereupon, the subcommittee adjourned at 9:02 a.m.)