12. The Rule Making Process for Administrative Simplification: What Takes So Long?

The goal is simplification, but the process is far from simple. It is a deliberate process designed to achieve consensus within HHS and across other Federal departments. The process is important because the final rules will have the force of Federal law.

HHS Implementation Teams have drafted Notices of Proposed Rule Making (NPRMs) for the:

1. Administrative and Financial Transaction Standards and Code Sets;
2. National Provider Identifier for health care providers;
3. Identifier for Health Plans;
4. Identifier for Employers;
5. Security Standards to protect health care information.

Before an NPRM can be published in the Federal Register, it must be reviewed and approved within the Federal government. Questions and concerns from within the government must be answered and resolved before the NPRMs can be published for public comment.

This within-government review is a 3-stage process. The NPRMs must be approved by:

1. The HHS Data Council's Committee on Health Data Standards. This Committee is responsible for overseeing the entire AS implementation process for the Secretary of HHS. This Committee, composed of members from many Federal agencies, must approve the content of the NPRMs before they go to the next review step.
2. Advisors to the Secretary within HHS. HHS consists of several divisions that may be affected by the proposed standards or that are responsible for particular issues, such as the impact of the standards on the Federal budget. Agency heads also act as formal advisors to the Secretary of HHS in the rule making process. Agreement among the Secretary's advisors must be reached before the NPRMs go to the next review step.
3. The Office of Management and Budget. OMB reviews the NPRMs from a government-wide perspective and circulates the NPRMs for review by Federal departments other than HHS. These departments, which will also be affected by the proposed standards, include the Departments of Defense and Veterans Affairs. In addition, OMB reviews the NPRMs for their potential impacts -- e.g., on the Federal budget, on intergovernmental relations, and on small business -- and for their compliance with the principles of regulation set out in Executive Order 12866.

When published in the Federal Register, the NPRMs will be available directly from the Administrative Simplification homepage.

Delays in adoption of the standards will not shorten the period for implementation. The standards will become effective 24 months after adoption for most organizations; 36 months after adoption for small health plans.

Updated 6/11/98.