Comment: One respondent indicated that the development, collection, and data entry of all the authorizations will create a new transaction type for employers, health plans, and providers, and result in duplicated efforts among them. This commenter estimates that the costs of mailing, re-mailing, answering inquiries, making outbound calls and performing data entry in newly created authorization computer systems could result in expenses of close to $2.0 billion nationally. Another commenter indicated that authorization costs will be at least double the notice dissemination costs due to the cost of both outbound and return postage.
Response: Public commenters and subsequent factfinding clearly indicate that most providers with patient contact already obtain authorizations for release of records, so for them there is virtually no new cost. Further, this comment does not reflect the actual regulatory requirement. For example, there is no need to engage in mailing and re-mailing of forms, and we do not foresee any reason why there should be any significant calls involved.
Comment: A commenter criticized the percentage (1%) that we used to calculate the number of health care encounters expected to result in requests to withhold the release of protected information. This respondent postulates that even if one in six patients who encounter the U.S. health care system opt to restrict access to their records, the total expected national cost per year could rise to $900 million.
Response: The final regulation requirements regarding the release of protected health information has been substantially changed, thereby greatly reducing the potential cost burden. A fuller explanation of the cost is provided below in the regulatory impact analysis.
Comment: An additional issue raised by commenters was the added cost of seeking authorizations for health promotion and disease management activities, health care operations that traditionally did not require such action.
Response: In the final regulation, a covered entity can use medical information collected for treatment or operations for its own health promotion and disease management efforts without obtaining additional authorization. Therefore, there is no additional cost incurred.