June 29, 2001

The Honorable Tommy Thompson
Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Thompson:

As part of its responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the National Committee on Vital and Health Statistics (NCVHS) provides advice to you regarding the standard electronic transactions and code sets adopted under HIPAA. NCVHS has recently reviewed the first recommended set of changes to these standards, as recommended by the Designated Standards Maintenance Organizations (DSMOs). The DSMOs are a group of six organizations that have been designated by the Department to modify the standards based on industry input. These organizations include the National Uniform Billing Committee, the National Uniform Claim Committee, the Dental Content Committee, Health Level 7, the National Council for Prescription Drug Programs, and ASC X12N.

The first set of changes was produced by the DSMOs under a “fast-track” process that the NCVHS requested to expedite changes that are necessary to facilitate successful implementation. This process required the DSMOs to do their review and analysis work in a compressed time frame, so that changes could be made to the standards during the first year after adoption and in time to assist with initial industry implementation. The DSMO representatives, especially chair Margaret Weiker and vice-chair Maria Ward, responded to the NCVHS’s request in extraordinary fashion, devoting substantial time and effort to meeting our deadlines and achieving industry consensus. All of the participants are to be highly commended. Their success bodes well for the ability of the HIPAA change management process to be responsive to future health industry needs.

The NCVHS has reviewed the DSMO recommendations for changes to the standards. We recommend that you accept all of these changes subject to technical corrections, and begin the regulatory process to adopt these changes as part of the standards. In addition, we urge you to expedite the process, so that health plans, providers, and clearinghouses can adopt these necessary changes as soon as possible. We recommend that the final rule implementing these changes be published no later than January 31, 2002.

It is clear that the current HIPAA code sets do not cover all procedures and diagnoses. This will always be a problem due to the evolving nature of health care. Where gaps have been identified, we endorse the DSMOs position that requesters work with the maintainers of the currently designated code sets to address these gaps before new code sets are considered. We are planning to address these and broader issues related to code sets and terminology gaps at hearings some time in the late fall or winter. One topic we are likely to address is the extent to which this process is responsive to requesters’ needs.

We appreciate the opportunity to provide these recommendations to you.



John Lumpkin, M.D., M.P.H.
Chair, National Committee on Vital and Health Statistics

c.c. Data Council Co-chairs