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E. Requirements

[Please label written and e-mailed comments about this section with the subject: REQUIREMENTS.]

We note that the law does not bind employers to use the standard. However, providers, health plans, and health care clearinghouses are bound to use the standard in electronic health transactions. Any individual or other entity that needs to know an employer’s EIN for use in electronic health transactions would obtain it directly from the employer. The EIN is not considered confidential and it may be freely used and exchanged by employers and others.

1. Health plans.

In § 142.604, Requirements: Health plans, we would require health plans to accept the EIN on all electronic transactions and transmit the EIN on all electronic transactions that require an employer identifier. Federal agencies and States may place additional requirements on their health plans.

2. Health care clearinghouses.

We would require in § 142.606 that each health care clearinghouse use the EIN on all electronic transactions that require an employer identifier.

3. Health care providers.

In § 142.608, Requirements: Health care providers, we would require each health care provider to use the EIN on all transactions, wherever required, that are electronically transmitted.

4. Employers.

In § 142.610, Requirements: Employers, we would require each employer to disclose its EIN, when requested, to any entity that conducts standard electronic transactions that require that employer’s identifier.

We believe the authority to require employers to disclose their EINs to entities that are required to use these numbers in electronic health care transactions is implicit in the statutory directive to the Secretary to adopt an employer identification number for use in the health care system. We note that we have been unable to identify any reason for an employer to refuse to furnish the number to an entity that conducts electronic health care transactions since the EIN, unlike the social security number, is not information about a person. We note too that access to the EIN does not give access to specific tax information.

F. Effective Dates of the Employer Identifier

Health plans would be required to comply with our requirements as follows:

1. Each health plan that is not a small health plan would have to comply with the requirements of §§ 142.104 and 142.604 no later than 24 months after publication of the final rule.
2. Each small health plan would have to comply with the requirements of §§ 142.104 and 142.604 no later than 36 months after the date of publication of the final rule.
3. If HHS adopts a modification to a standard or implementation specification, the implementation date of the modification would be no earlier than the 180th day following the adoption of the modification. HHS would determine the actual date, taking into account the time needed to comply due to the nature and extent of the modification. HHS would be able to extend the time for compliance for small health plans.

Failure to comply with standards may well result in monetary penalties. The Secretary is required by statute to impose penalties of not more than $100 per violation on any person who fails to comply with a standard, except that the total amount imposed on any one person in each calendar year may not exceed $25,000 for violations of one requirement. We will propose enforcement procedures in a future Federal Register document once the industry has more experience with using the standards.

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