In response to the publication in the Federal Register of the proposed rule on May 7, 1998, we received approximately 17,000 timely public comments. The comments came from a wide variety of correspondents including professional associations and societies, health care workers, law firms, third party health insurers, hospitals, and private individuals. We reviewed each commenter’s letter and grouped like or related comments. Some comments were identical, indicating that the commenters had submitted form letters. After associating like comments, we placed them in categories based on subject matter or based on the section(s) of the regulations affected and then reviewed the comments. All comments relating to general subjects, such as the format of the regulations were similarly reviewed.
This process identified areas of the proposed regulation that required review in terms of their effect on policy, consistency, or clarity of the rules.
We present comments and responses generally in the order in which the issues appeared in the May 1998 proposed rule.
General - Comment Period
Comment: We received several comments that stated the 60-day comment period was too short. It was stated that the period did not take into account the highly detailed, technical review of the thousands of pages in the implementation specifications that was required in order to comment in a meaningful way.
Response: We disagree. We understand the difficulty in reviewing a rule of this complexity. However, we met our notice requirements for the length of the comment period and made every effort to ensure that the proposed rule was readily accessible to the public (for example, the proposed rule was published in the Federal Register and available over the Internet). In addition, we received many comments requesting changes to the implementation specifications, which indicates that the majority of interested parties were able to review all implementation specifications in the 60-day period. If additional changes are necessary, revisions may be made to the standards on an annual basis.
D. Data Content
Proposal Summary: We proposed standard data content for each adopted standard. Information that would facilitate data content standardization, while also facilitating identical implementations, would consist of implementation specifications, data conditions, data dictionaries, and the standard code sets for medical data that are part of this rule. Data conditions are rules that define the situations when a particular data element or segment can or must be used.
It is important to note that all data elements would be governed by the principle of a maximum defined data set. No one would be able to exceed the maximum defined data set in this rule. This principle applies to the data elements of all transactions.
F. Proposed Requirements Stated in Each Subpart
In each subpart setting forth a standard or standards, we stated which entities had to use the standard(s), the effective dates for implementation, and that we are incorporating implementation specifications (where applicable) by reference.
Comments and Responses on Provisions Appearing in Each Subpart