FBO_Appendix_2.pdf

REQUEST FOR INFORMATION

APPENDIX 2

Specific Technical Questions

Health Insurance Portability and Accountability Act (HIPAA) Electronic Standards Program Coordination and Analysis

RFI Focus: The Government is interested in determining the availability of potential sources that have the capabilities to provide services and furnish assistance to the Defense Health Agency (DHA) for analysis and coordination of the tasks and activities required to functionally prepare for, achieve, and maintain compliance with the electronic standards requirements of HIPAA to achieve business process improvements and simplification as described in Appendix 1.

Background: The (HIPAA of 1996, Public Law 104-191 was enacted on August 21, 1996. The Act required the Department of Health and Human Services (HHS) to issue several Final Rules establishing health industry standards for a number of health care administrative transactions, code sets and identifiers. So far HHS has issued regulations specifying standards for several transactions (HIPAA X12 versions 4010 and 5010, as well as National Council on Prescription Drug Programs (NCPDP) versions) and , code sets (e.g., ICD-10), and identifiers (e.g., Employer Identifier, and a National Provider Identifier (NPI)). HHS plans to issue regulations for other electronic standards to include Claims Attachments, new versions of existing HIPAA electronic transactions, use of Device Identifiers (DI), and transactions compliance certification. There will also be updates to existing and future electronic standards. In addition to the HIPAA standards, HHS continues to identify additional electronic standards that will be mandated and employed for federal agencies toward U.S. healthcare interoperability.

The Military Health System (MHS) is required as a HIPAA covered health plan and/or payer entity to comply with all the HIPAA adopted electronic standards. As a HIPAA covered provider entity, the MHS has implemented many of the electronic transaction standards but work continues to implement others and make improvements in the use of the electronic standards based on applicability to associated business processes.

The following are need to be addressed under this RFI:

1. Please provide your relevant performance-based experience in providing program coordination for all aspects of a HIPAA Electronics Standards Program. Program Coordination experience shall include, but not be limited to: project and requirements budgeting; developing functional capability requirements; facilitating and contributing to HIPAA related integrated project team (IPT) or workgroup efforts; developing and tracking annual goals and performance measures; developing and coordinating functional requirements and agency manual changes; tracking correspondence;

providing meeting and workgroup support; tracking and resolving risks and issues; and tracking implementation and compliance through the requirements lifecycle.

2. Please provide your relevant performance-based experience in providing support through functional analysis, interpretation, applied understanding, and implementation of HIPAA electronic standards and their potential use in the various agency programs. In addition to HIPAA mandated standards, similar analysis may be required for other federally mandated electronic transaction standards. This analysis shall include, but not be limited to: developing new business practices and identifying issues (business, technical and policy) that may impact the use of the standards.

3. Please provide your relevant performance-based experience in providing assistance to clients with functional participation in industry Standards Development Organizations (SDO). The primary SDO developing the HIPAA electronic standards is the Accredited Standards Committee (ASC) X12N and you should provide example of your company’s experience in this area.

4. Please provide your relevant performance-based experience in drafting and managing content for your clients’ HIPAA related web site.

5. Please provide your relevant performance-based experience in providing subject matter support to your clients’ mission as it relates to support for HIPAA Electronic Transactions, Code Sets, and Identifier Standards, or other legislatively directed data or information interoperability standards.

6. Please provide your relevant experience with providing functional subject matter expert (SME) knowledge of HIPAA adopted implementation guides (both X12N and NCPDP).

This functional SME knowledge includes being able to collaborate with related stakeholders and explain and educate about concepts and content in plain English.

7. Please provide your relevant experience with providing coordination, collaboration, and communication with entities external to the MHS, such as counterparts from Veterans Administration; Centers for Medicare & Medicaid Services (CMS); National Committee on Vital and Health Statistics (NCVHS) Standards Subcommittee; and X12N leaders.

8. Please provide your relevant experience with receipt, assessment, coordination, and adjudication (as necessary) of HIPAA transactions, code sets, and identifiers questions posed to DHA (or similar Government Healthcare organization) by U.S. healthcare entities (providers, clearinghouses, health plans/payers) through a HIPAA email system.