Comment: Many of the commenters believe that the Department used unrealistic assumptions in the development of the estimated cost of the training provisions and they provided their own estimates.
Response: The commenters' estimates varied widely, and could not be used by the Department in revising its analysis because there was inadequate explanation of how the estimates were made.
Comment: Several commenters argued that if even an hour of time of each of the entity's employees is spent on training instead of "work" and they are paid the minimum wage, an entity would incur $100 of cost for training no more than 20 employees. The commenters noted that the provision of health care services is a labor-intensive enterprise, and many covered entities have thousands of employees, most of whom make well in excess of minimum wage. They questioned whether the estimates include time taken from the employee's actual duties (opportunity cost) and the cost of a trainer and materials.
Response: As explained in more detail below, the Department made extensive revisions in its training estimate, including the number of workers in the health care sector, the cost of workers in training based on average industry wages, and training costs (instructors and materials). The revised estimate is a more complete and accurate estimate of the costs likely to be borne as a result of the final regulation.
Comment: One commenter estimated that simply training an employee could have a burdensome impact on his company. He argued, for example, a 10-hour annual requirement takes 0.5% of an employee's time if they work a 2000-hour year, but factoring in sick and vacation leave, the effects of industry turnover could significantly increase the effect.
Response: In the analysis below, the Department has factored in turnover rates, employment growth and greater utilization based on data obtained from broad-based surveys and a public comment.
Comment: Some commenters felt that the regulatory training provisions are overly burdensome. Specific concerns centered around the requirement to train all individuals who may come in contact with protected health information and the requirement to have such individuals sign a new certifying statement at least every three years. Some commenters felt that the content of the training program should be left to the discretion of the covered entity.
Response: Changes and clarifications in the training requirements are made in the final regulation, explained below. For example, the certification requirement has been eliminated. As in the NPRM, the content of the training program is left to the discretion of the covered entity. These changes are expected to lessen the training burden and are reflected in the final cost estimates.