National Plan and Provider Enumeration System (NPPES) Data Changes, 15581-15584 [2024-04517]
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[FR Doc. 2024–04431 Filed 3–1–24; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–0059–N]
RIN 0938–ZB82
National Plan and Provider
Enumeration System (NPPES) Data
Changes
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services (HHS).
ACTION: Notice.
AGENCY:
This notice provides
information on changes to data elements
that providers are required to submit to
the National Plan and Provider
Enumeration System (NPPES) to obtain
and maintain a National Provider
Identifier (NPI). The changes to the
required data elements affect the data
that is made available to the public from
NPPES in downloadable files and in a
query-only database on the internet.
DATES: This notice is applicable on
April 3, 2024.
FOR FURTHER INFORMATION CONTACT:
Christopher S. Wilson, (410) 786–3178
or Beth A. Karpiak, (312) 353–1351.
SUPPLEMENTARY INFORMATION:
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SUMMARY:
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I. Background
A. Legislative and Regulatory
Background
Through subtitle F of title II of the
Health Insurance Portability and
Accountability Act of 1996 (HIPAA),
Congress added Part C, ‘‘Administrative
Simplification’’ to title XI of the Social
Security Act (the Act). (Pub. L. 104–
191). Part C of title XI consists of
sections 1171 through 1179 of the Act.
These sections define various terms and
impose requirements on the Secretary of
the Department of Health and Human
Services (HHS) (hereinafter referred to
as the Secretary), health plans, health
care clearinghouses, and certain health
care providers concerning the adoption
of standards and implementation
specifications relating to health
information. The Secretary delegated
authority for administering and
enforcing HIPAA Administrative
Simplification provisions related to
transactions, code sets, unique
identifiers, and operating rules,
implemented in 45 CFR parts 160 and
162, to the Centers for Medicare &
Medicaid Services (CMS) (see 68 FR
60694).
Section 1173(b) of the Act requires the
Secretary to adopt a standard unique
health identifier for each individual,
employer, health plan, and health care
provider for use in the health care
system and to specify the purposes for
which the identifiers may be used. On
May 7, 1998 (63 FR 25320), HHS
proposed a standard unique health
identifier for health care providers and
requirements concerning its
implementation (hereinafter referred to
as the National Provider Identifier (NPI)
proposed rule). On January 23, 2004 (69
FR 3434), HHS published a final rule
that adopted the NPI as the standard
unique health identifier for health care
providers (hereinafter referred to as the
NPI final rule). The NPI final rule
established that HIPAA covered entities
must use NPIs to identify health care
providers in electronic transactions for
which the Secretary has adopted a
standard. Covered entities include
health plans, health care clearinghouses,
and health care providers who transmit
any health information in electronic
form in connection with a transaction
for which the Secretary has adopted a
standard.
B. Operational and System Background
The NPI final rule established that
NPIs are assigned to health care
providers through the National Provider
System (NPS). The preamble to the NPI
final rule included an ‘‘NPS Data
Elements Table’’ (69 FR 3457) that listed
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15581
the data elements HHS expected to
collect about a health care provider and
include in the NPS. The NPS, now
called the National Plan and Provider
Enumeration System (NPPES),1
uniquely identifies health care
providers through an application
process and assigns NPIs. NPPES creates
a record for each health care provider to
whom it assigns an NPI. The records are
updated when health care providers
furnish updates to NPPES.
Health care providers are categorized
by NPPES into two types: Individuals,
such as physicians; and organizations,
such as hospitals. A health care
provider may apply for an NPI in one
of three ways, by: (1) completing form
CMS–10114 (NPI Application/Update
Form) and mailing it to NPPES; (2)
applying online at https://NPPES.cms.
hhs.gov/; or (3) having an approved
Electronic File Interchange Organization
(EFIO) submit its NPI application data
to NPPES in an electronic format
defined by HHS.2 3 Health care
providers who apply online have
electronic access to the information in
their own NPPES records by using user
identifiers and passwords they select.
This access allows those health care
providers to submit updates to their
NPPES data electronically via the
internet.
The NPI final rule requires that the
NPS (now NPPES) disseminate data in
response to approved requests.
Following publication of the NPI final
rule, CMS, as the administrator of
NPPES, published a notice in the May
30, 2007 Federal Register (72 FR 30011)
describing the data dissemination
strategy for NPI data maintained in
NPPES and the process by which CMS
would carry out the strategy (hereinafter
referred to as the NPPES Data
Dissemination notice). The NPPES Data
Dissemination notice included a list of
data elements that CMS determined are
required to be disclosed under the
Freedom of Information Act (FOIA) (see
72 FR 30012).
The health care industry needs
NPPES health care provider data to
know the NPIs of health care providers
to be able to submit HIPAA-compliant
health care transactions. In anticipation
1 https://nppes.cms.hhs.gov/#/.
2 The information collection request is currently
approved under OMB control number 0938–0931.
(https://www.reginfo.gov/public/do/
DownloadNOA?requestID=311118).
3 The Electronic File Interchange (EFI), also
referred to as ‘‘bulk enumeration,’’ is a process by
which a provider or group of providers can have an
EFIO apply for NPIs on their behalf. EFIOs are
approved by CMS through a certification process
and submit information in a format designated by
CMS; https://www.cms.gov/medicare/regulationsguidance/administrative-simplification/efi.
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Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices
of an extraordinary demand from the
health care industry for FOIAdisclosable NPPES health care provider
data, in September 2007, CMS began
making this information available to the
public, in accordance with the
Electronic Freedom of Information Act
Amendments of 1996 (Pub. L. 104–231),
via the internet in two forms:
• NPI Registry: The NPI Registry is a
query-only database that is updated
daily to enable users to query NPPES
(for example, search by NPI, provider
name, etc.) and retrieve the FOIAdisclosable data from the search results.
There is no charge to view the data.
• NPI Downloadable File: Full
Replacement Monthly NPI File, Weekly
Incremental NPI File, and Full
Replacement NPI Deactivation File.
There is no charge to download the
data.
II. Provisions of the Notice
A. Changes to NPPES Data Elements
The NPI final rule acknowledged that
the data elements and information
presented in the data elements table
were not intended to be used for data
design purposes and that during the
NPS design and development, the
names and attributes of the data
elements could be revised.4 The table
was included to show the kind of
information that CMS expected to
collect about health care providers and
that could be disseminated by the NPS
(69 FR 3455).
The data elements table in the NPI
final rule included the following health
care provider data elements addressed
by this notice: provider first line address
location, provider second line address
location, and provider gender code.
Thirty days after publication of this
notice in the Federal Register, the
NPPES system, NPPES Registry, paper
form, and associated data files will be
updated to begin collecting and
disseminating for these health care
provider data elements: (1) amend the
description of the provider first line
location address and second line
location address data elements to permit
a provider that does not have a physical
location other than their home address
to enter a United States Postal Service
(USPS) post office box or personal
mailbox provided by private delivery
services as their provider location
address; and (2) add additional choices
for provider gender codes. All other
attributes assigned to these data
elements remain unchanged.
The data elements relevant to this
notice are listed in Table 1. Description
of the information contained in each
column of this table is as follows:
• Data Element Name: The name of
the data element residing in the NPPES.
• Description: The definition of the
data element and related information.
• Data Status: The instruction for
furnishing the information being
requested in the data element. The
abbreviations used in this column are as
follows:
++ Required (R): Required for NPI
assignment.
++ NPPES-generated (NG): Generated
or assigned by the NPPES.
++ Optional (O): Not required for NPI
assignment.
++ Situational (S): If a certain
condition exists, the data element is
required. Otherwise, it is not required.
++ Repeat (RPT): Indicates that the
data element is a repeating field. A
repeating field is one that can
accommodate more than one separate
entry. Each separate entry must meet the
edits, if any, designated for that data
element.
• Data Condition: Describes the
condition(s) under which a
‘‘Situational’’ data element must be
furnished. NOTE: The abbreviation NA
means ‘‘not applicable.’’
• Entity Types: The ‘‘Entity type
codes’’ to which the data element
applies. Code describing the type of
health care provider that is being
assigned an NPI. Codes are as follows:
++ 1 = (Person): individual human
being who furnishes health care.
++ 2 = (Non-person): entity other
than an individual human being that
furnishes health care (for example,
hospital, SNF, hospital subunit,
pharmacy, or HMO).
• Use: The purpose for which the
information is being collected or will be
used. The abbreviations used in this
column are as follows:
++ I: The data element supports the
unique identification of a health care
provider.
++ A: The data element supports
administrative implementation
specification.
TABLE A—NPPES DATA ELEMENTS AT ISSUE IN THIS NOTICE
Data element name
Provider first line location address.
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Provider second line location address.
Provider gender code ...
The first line location address of the provider being identified. For providers with more than one physical location,
this is the primary location. This address can only include
the USPS post office box location or personal mailbox offered by a private delivery service if the provider’s NPI is
Entity type code = 1 and the provider does not have a
physical location other than their home address (for example, a provider that exclusively provides telehealth
services from their home).
The second line location address of the provider being
identified. For providers with more than one physical location, this is the primary location. This address can only
include a USPS post office box location or personal mailbox offered by a private delivery service if the provider’s
NPI is Entity type code = 1 and the provider does not
have a physical location other than their home address
(for example a provider that exclusively provides telehealth services from their home).
The code designating the provider’s gender if the provider
is a person.
4 HIPAA Administrative Simplification: Standard
Unique Health Identifier for Health Care Providers
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Data
status
Description
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Data condition
(situational status only)
Entity
types
R
NA ..........................................
1, 2 .....
A
S
Required if it exists ................
1, 2 .....
A
S
Required if the provider’s NPI
is Entity type code = 1.
1 .........
I
(NPI final rule) (69 FR 3455) https://www.federal
register.gov/documents/2004/01/23/04-1149/hipaa-
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administrative-simplification-standard-uniquehealth-identifier-for-health-care-providers#p-394.
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Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices
1. Allowing Provider Address Location
To Include Post Office Boxes
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The NPI final rule acknowledged that
many comments to the NPI proposed
rule noted that health care provider
practice addresses change frequently,
will be burdensome and expensive to
maintain, and will be unlikely to be
maintained accurately.5 In response to
these comments, we concluded in the
NPI final rule that, due to how
frequently provider location addresses
change, the data element is of limited
use in electronic matching of health care
providers (69 FR 3450). However, the
rule did recognize that capturing one
provider location address in NPPES
could serve the administrative purpose
of providing an address where a health
care provider can be contacted in
situations when a mailing address is
insufficient. For example, a mailing
address containing a USPS post office
box number cannot be used for mail
delivery by entities other than the
USPS. The rule concluded that NPPES
should collect a provider mailing
address and one provider location
address as required elements. To
support this administrative purpose,
both the provider first line location
address and provider second line
location address data element
descriptions included a note indicating,
‘‘This address cannot include a post
office box’’ (69 FR 3458).
Since the publication of the NPI final
rule, health plans, Medicare, and
Medicaid programs, have expanded
coverage for telehealth services.6 As
such, there are now a number of
individual (Entity type code = 1)
providers, such as behavioral health
service providers, who exclusively
furnish telehealth services from the
providers’ homes. In some instances,
providers who exclusively furnish
telehealth services from their own
homes may not have a provider address
location other than their home address.
We understand that providers who
furnish telehealth services exclusively
from their homes often enter a post
office box as their provider mailing
address into NPPES when applying for
an NPI. Given the prohibition on
including a post office box for the
5 HIPAA Administrative Simplification: Standard
Unique Health Identifier for Health Care Providers
(NPI final rule)(69 FR 3455) https://www.federal
register.gov/documents/2004/01/23/04-1149/hipaaadministrative-simplification-standard-uniquehealth-identifier-for-health-care-providers#p-394.
6 https://telehealth.hhs.gov/; https://
data.cms.gov/summary-statistics-on-use-andpayments/medicare-service-type-reports/medicaretelehealth-trends; https://www.ama-assn.org/
practice-management/digital/new-survey-datashows-doctors-steadfast-commitment-telehealth.
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provider location address data elements,
they enter their home addresses into
NPPES to satisfy the provider location
address data elements and obtain an
NPI.
In accordance with FOIA, NPPES
address data, including provider
mailing address and provider location
address, is publicly available on the
internet. Internet posting of provider
home address information as a provider
location may cause confusion,
potentially leading patients and others
who may access NPPES data to think
that the provider can be accessed for
treatment or administrative purposes at
the listed home address. We have heard
from providers that posting the
information also poses privacy and
potential safety concerns for themselves
and their families.
To address these concerns, while still
maintaining the administrative purpose
of providing a provider location address
that can be accessed by methods other
than the USPS when such a location
exists outside of the provider’s own
home, NPPES will keep the provider
location address data element status as
required, but will allow for submission
of a post office box or personal mailbox
offered by a private delivery service
when a provider’s NPI is Entity type
code = 1 and the provider does not have
a physical location other than their
home address (for example, a provider
that exclusively furnishes telehealth
services from their home). This change
is accomplished by removing the
language ‘‘This address cannot include
a post office box’’ from the data element
descriptions for both the provider first
line location address and provider
second line location address and
replacing it with ‘‘This address can
include a post office box or personal
mailbox offered by a private delivery
service only if the provider’s NPI is
Entity type code = 1 and the provider
does not have a physical location other
than their home address (for example, a
provider that exclusively provides
telehealth services from their home).’’
The change in the data element
descriptions allows providers that are
persons that do not currently have an
NPI, and exclusively furnish telehealth
services or other services out of their
homes, to obtain an NPI without
including their home address in NPPES.
Should a provider with Entity type code
= 1 that has as an existing NPI, and
exclusively furnishes telehealth services
or other services out of their homes,
wish to remove their home address from
NPPES and replace it with a post office
box, they may do so by updating their
NPPES records, either themselves or
through the EFIO that submitted their
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15583
NPI application data to NPPES. The
change in the data element descriptions
does not require providers that already
have an NPI assigned through NPPES,
including telehealth providers that do
not have a physical location address
other than their home address, from
changing any existing information in
NPPES. Should a provider who
furnishes telehealth services or other
services exclusively from their home
address wish to maintain their home
address as their provider location
address within their NPPES record, they
may do so.
2. Adding Additional Provider Gender
Code Choices
The NPI final rule identified provider
gender code as a required data element
if the provider’s NPI is Entity type code
= 1. While neither the NPI final rule nor
the NPPES Data Dissemination notice
identified the gender codes that NPPES
would collect and disseminate when
applying for an NPI, providers are given
the option to click on a box that
captures gender as either male or
female. NPPES stores that selection as
code (F) should an individual select
female and (M) should an individual
select male. The NPI Registry queryonly database displays the descriptions
‘‘Male’’ and ‘‘Female’’ to disseminate
provider gender and NPI downloadable
files display the information using the
codes (M) and (F).
NPPES will permit selection of, and
disseminate, gender code options
beyond M and F to promote improved
accuracy in publicly available data and
support unique identification and
enumeration of health care providers.
The NPPES system, NPPES Registry,
paper form, and associated data files
will be updated to begin collecting and
disseminating these new values 30 days
after publication of this notice in the
Federal Register. NPPES will provide
additional guidance on the new codes
and instructions for selecting gender
codes when applying for an NPI and
maintaining NPI data.
Adding gender codes aligns with HHS
efforts, as described in E.O. 14075 (87
FR 37189), to advance equity and full
inclusion of lesbian, gay, bisexual,
transgender, queer, and intersex
(LGBTQI+) individuals through
inclusive federal data collection
practices.
Providers with Entity type code = 1
who previously furnished a provider
gender code to NPPES may update or
change their selection in NPPES, or
have the EFIO that submitted their NPI
application data to NPPES cause them
to be changed in NPPES, at any time.
HHS encourages providers who have
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Federal Register / Vol. 89, No. 43 / Monday, March 4, 2024 / Notices
obtained NPIs to review their NPPES
records to ensure that the information
they furnished when applying for their
NPIs is up-to-date and accurate.
B. Impact on FOIA-Releasable NPPES
Data
The NPPES Data Dissemination notice
identified both the provider location
address and provider gender code as
NPPES data elements that must be
released under FOIA. The changes to
these data elements described in section
II. of this notice do not affect HHS’s
assessment of their releasability under
FOIA and the data elements will
continue to be made available to the
public through the NPI registry and the
NPI downloadable files.
III. Collection of Information
Requirements
This document imposes new
information for collection and
recordkeeping requirements. It makes
reference to an existing information
collection request that will be revised as
a result of the revised data elements
discussed in this notice. Specifically,
we will submit a non-substantive
change request to OMB for review and
approval of the data element revisions
associated with the information
collection request currently approved
under 0938–0931.
Chiquita Brooks-LaSure,
Administrator of the Centers for
Medicare & Medicaid Services,
approved this document on February
27, 2024.
Xavier Becerra,
Secretary, Department of Health and Human
Services.
[FR Doc. 2024–04517 Filed 3–1–24; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Head Start REACH:
Strengthening Outreach, Recruitment,
and Engagement Approaches With
Families—Mixed Methods Study (New
Collection)
Office of Planning, Research,
and Evaluation, Administration for
Children and Families, U.S. Department
of Health and Human Services.
ACTION: Request for public comments.
AGENCY:
The Administration for
Children and Families (ACF) within the
U.S. Department of Health and Human
Services (HHS) is proposing to collect
data on different approaches that Head
Start programs use to recruit, select, and
enroll families, and the ways in which
such practices reflect programs’
community contexts. We are not
attempting to recruit a nationally
representative sample. Instead, the
study will aim to obtain a variety of
eligibility, recruitment, selection,
enrollment, and attendance (ERSEA)
practices and experiences to explore
how these practices and experiences
intersect with different adversities,
demographic characteristics, and
community contexts.
DATES: Comments due within 60 days of
publication. In compliance with the
requirements of the Paperwork
Reduction Act of 1995, ACF is soliciting
public comment on the specific aspects
of the information collection described
above.
ADDRESSES: You can obtain copies of the
proposed collection of information and
submit comments by emailing OPREinfo
collection@acf.hhs.gov. Identify all
requests by the title of the information
collection.
SUPPLEMENTARY INFORMATION:
Description: Building on information
collected previously through case
studies (OMB #0970–0580), the Head
Start REACH: Strengthening Outreach,
Recruitment, and Engagement
SUMMARY:
Approaches with Families Project is
proposing to conduct a mixed-methods
study to expand understanding of (1)
how Head Start programs implement
recruitment, selection, and enrollment
practices; and (2) the ways in which
practices reflect programs’ community
contexts. The mixed-methods study
would achieve several goals including
(1) providing in-depth contextual
information about recruitment,
selection, and enrollment practices and
experiences; (2) identifying promising
recruitment, selection, and enrollment
practices and experiences; and (3)
informing training and technical
assistance regarding recruitment,
selection, and enrollment challenges
and needs. We will aim to collect
information from 60 Head Start and
Early Head Start programs in 15
geographic areas in states, from Head
Start regions I–X, located in census
tracts where the rate of deep poverty is
high.
We will collect information about the
characteristics of families in Head Start
programs and their communities;
programs’ enrollment numbers and
goals; programs’ use and perceived
effectiveness of and challenges with
recruitment, selection, and enrollment
practices; promising recruitment,
selection, and enrollment practices for
potential future replication; families’
reasons for choosing Head Start and
experiences with and perceptions of
recruitment, selection, and enrollment
practices; and how community partner
staff support recruitment, selection, and
enrollment of families into Head Start.
The findings are intended to help Head
Start programs understand how to
support the needs of families facing
adversities. We will disseminate
findings in a report, research brief, and
presentations or briefings.
Respondents: Head Start program
directors (one per program), ERSEA lead
staff (one per program), Head Start
parents/caregivers (up to 10 per
program), and staff from community
organizations with which Head Start
programs partner for ERSEA activities
(four in each geographic area).
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ANNUAL BURDEN ESTIMATES
Number of
respondents
(total over
request period)
Instrument
Program director survey (Instrument 1) ..........................................................
ERSEA lead staff survey (Instrument 2) .........................................................
Onsite coordination a ........................................................................................
Head Start parent/caregiver survey (Instrument 3) .........................................
Community partner survey (Instrument 4) .......................................................
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Number of
responses per
respondent
(total over
request period)
60
60
60
600
60
E:\FR\FM\04MRN1.SGM
1
1
1
1
1
04MRN1
Average
burden per
response
(in hours)
0.17
0.75
1.5
0.5
0.25
Total/annual
burden
(in hours)
10.2
45
90
300
15
]]>Agencies
[Federal Register Volume 89, Number 43 (Monday, March 4, 2024)]
[Notices]
[Pages 15581-15584]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-04517]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-0059-N]
RIN 0938-ZB82
National Plan and Provider Enumeration System (NPPES) Data
Changes
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice provides information on changes to data elements
that providers are required to submit to the National Plan and Provider
Enumeration System (NPPES) to obtain and maintain a National Provider
Identifier (NPI). The changes to the required data elements affect the
data that is made available to the public from NPPES in downloadable
files and in a query-only database on the internet.
DATES: This notice is applicable on April 3, 2024.
FOR FURTHER INFORMATION CONTACT: Christopher S. Wilson, (410) 786-3178
or Beth A. Karpiak, (312) 353-1351.
SUPPLEMENTARY INFORMATION:
I. Background
A. Legislative and Regulatory Background
Through subtitle F of title II of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), Congress added Part C,
``Administrative Simplification'' to title XI of the Social Security
Act (the Act). (Pub. L. 104-191). Part C of title XI consists of
sections 1171 through 1179 of the Act. These sections define various
terms and impose requirements on the Secretary of the Department of
Health and Human Services (HHS) (hereinafter referred to as the
Secretary), health plans, health care clearinghouses, and certain
health care providers concerning the adoption of standards and
implementation specifications relating to health information. The
Secretary delegated authority for administering and enforcing HIPAA
Administrative Simplification provisions related to transactions, code
sets, unique identifiers, and operating rules, implemented in 45 CFR
parts 160 and 162, to the Centers for Medicare & Medicaid Services
(CMS) (see 68 FR 60694).
Section 1173(b) of the Act requires the Secretary to adopt a
standard unique health identifier for each individual, employer, health
plan, and health care provider for use in the health care system and to
specify the purposes for which the identifiers may be used. On May 7,
1998 (63 FR 25320), HHS proposed a standard unique health identifier
for health care providers and requirements concerning its
implementation (hereinafter referred to as the National Provider
Identifier (NPI) proposed rule). On January 23, 2004 (69 FR 3434), HHS
published a final rule that adopted the NPI as the standard unique
health identifier for health care providers (hereinafter referred to as
the NPI final rule). The NPI final rule established that HIPAA covered
entities must use NPIs to identify health care providers in electronic
transactions for which the Secretary has adopted a standard. Covered
entities include health plans, health care clearinghouses, and health
care providers who transmit any health information in electronic form
in connection with a transaction for which the Secretary has adopted a
standard.
B. Operational and System Background
The NPI final rule established that NPIs are assigned to health
care providers through the National Provider System (NPS). The preamble
to the NPI final rule included an ``NPS Data Elements Table'' (69 FR
3457) that listed the data elements HHS expected to collect about a
health care provider and include in the NPS. The NPS, now called the
National Plan and Provider Enumeration System (NPPES),\1\ uniquely
identifies health care providers through an application process and
assigns NPIs. NPPES creates a record for each health care provider to
whom it assigns an NPI. The records are updated when health care
providers furnish updates to NPPES.
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\1\ https://nppes.cms.hhs.gov/#/.
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Health care providers are categorized by NPPES into two types:
Individuals, such as physicians; and organizations, such as hospitals.
A health care provider may apply for an NPI in one of three ways, by:
(1) completing form CMS-10114 (NPI Application/Update Form) and mailing
it to NPPES; (2) applying online at https://NPPES.cms.hhs.gov/; or (3)
having an approved Electronic File Interchange Organization (EFIO)
submit its NPI application data to NPPES in an electronic format
defined by HHS.2 3 Health care providers who apply online
have electronic access to the information in their own NPPES records by
using user identifiers and passwords they select. This access allows
those health care providers to submit updates to their NPPES data
electronically via the internet.
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\2\ The information collection request is currently approved
under OMB control number 0938-0931. (https://www.reginfo.gov/public/do/DownloadNOA?requestID=311118).
\3\ The Electronic File Interchange (EFI), also referred to as
``bulk enumeration,'' is a process by which a provider or group of
providers can have an EFIO apply for NPIs on their behalf. EFIOs are
approved by CMS through a certification process and submit
information in a format designated by CMS; https://www.cms.gov/medicare/regulations-guidance/administrative-simplification/efi.
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The NPI final rule requires that the NPS (now NPPES) disseminate
data in response to approved requests. Following publication of the NPI
final rule, CMS, as the administrator of NPPES, published a notice in
the May 30, 2007 Federal Register (72 FR 30011) describing the data
dissemination strategy for NPI data maintained in NPPES and the process
by which CMS would carry out the strategy (hereinafter referred to as
the NPPES Data Dissemination notice). The NPPES Data Dissemination
notice included a list of data elements that CMS determined are
required to be disclosed under the Freedom of Information Act (FOIA)
(see 72 FR 30012).
The health care industry needs NPPES health care provider data to
know the NPIs of health care providers to be able to submit HIPAA-
compliant health care transactions. In anticipation
[[Page 15582]]
of an extraordinary demand from the health care industry for FOIA-
disclosable NPPES health care provider data, in September 2007, CMS
began making this information available to the public, in accordance
with the Electronic Freedom of Information Act Amendments of 1996 (Pub.
L. 104-231), via the internet in two forms:
NPI Registry: The NPI Registry is a query-only database
that is updated daily to enable users to query NPPES (for example,
search by NPI, provider name, etc.) and retrieve the FOIA-disclosable
data from the search results. There is no charge to view the data.
NPI Downloadable File: Full Replacement Monthly NPI File,
Weekly Incremental NPI File, and Full Replacement NPI Deactivation
File. There is no charge to download the data.
II. Provisions of the Notice
A. Changes to NPPES Data Elements
The NPI final rule acknowledged that the data elements and
information presented in the data elements table were not intended to
be used for data design purposes and that during the NPS design and
development, the names and attributes of the data elements could be
revised.\4\ The table was included to show the kind of information that
CMS expected to collect about health care providers and that could be
disseminated by the NPS (69 FR 3455).
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\4\ HIPAA Administrative Simplification: Standard Unique Health
Identifier for Health Care Providers (NPI final rule) (69 FR 3455)
https://www.federalregister.gov/documents/2004/01/23/04-1149/hipaa-administrative-simplification-standard-unique-health-identifier-for-health-care-providers#p-394.
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The data elements table in the NPI final rule included the
following health care provider data elements addressed by this notice:
provider first line address location, provider second line address
location, and provider gender code. Thirty days after publication of
this notice in the Federal Register, the NPPES system, NPPES Registry,
paper form, and associated data files will be updated to begin
collecting and disseminating for these health care provider data
elements: (1) amend the description of the provider first line location
address and second line location address data elements to permit a
provider that does not have a physical location other than their home
address to enter a United States Postal Service (USPS) post office box
or personal mailbox provided by private delivery services as their
provider location address; and (2) add additional choices for provider
gender codes. All other attributes assigned to these data elements
remain unchanged.
The data elements relevant to this notice are listed in Table 1.
Description of the information contained in each column of this table
is as follows:
Data Element Name: The name of the data element residing
in the NPPES.
Description: The definition of the data element and
related information.
Data Status: The instruction for furnishing the
information being requested in the data element. The abbreviations used
in this column are as follows:
++ Required (R): Required for NPI assignment.
++ NPPES-generated (NG): Generated or assigned by the NPPES.
++ Optional (O): Not required for NPI assignment.
++ Situational (S): If a certain condition exists, the data element
is required. Otherwise, it is not required.
++ Repeat (RPT): Indicates that the data element is a repeating
field. A repeating field is one that can accommodate more than one
separate entry. Each separate entry must meet the edits, if any,
designated for that data element.
Data Condition: Describes the condition(s) under which a
``Situational'' data element must be furnished. NOTE: The abbreviation
NA means ``not applicable.''
Entity Types: The ``Entity type codes'' to which the data
element applies. Code describing the type of health care provider that
is being assigned an NPI. Codes are as follows:
++ 1 = (Person): individual human being who furnishes health care.
++ 2 = (Non-person): entity other than an individual human being
that furnishes health care (for example, hospital, SNF, hospital
subunit, pharmacy, or HMO).
Use: The purpose for which the information is being
collected or will be used. The abbreviations used in this column are as
follows:
++ I: The data element supports the unique identification of a
health care provider.
++ A: The data element supports administrative implementation
specification.
Table A--NPPES Data Elements at Issue in This Notice
----------------------------------------------------------------------------------------------------------------
Data condition
Data element name Description Data status (situational Entity types Use
status only)
----------------------------------------------------------------------------------------------------------------
Provider first line location The first line location R NA................ 1, 2........ A
address. address of the
provider being
identified. For
providers with more
than one physical
location, this is the
primary location. This
address can only
include the USPS post
office box location or
personal mailbox
offered by a private
delivery service if
the provider's NPI is
Entity type code = 1
and the provider does
not have a physical
location other than
their home address
(for example, a
provider that
exclusively provides
telehealth services
from their home).
Provider second line location The second line S Required if it 1, 2........ A
address. location address of exists.
the provider being
identified. For
providers with more
than one physical
location, this is the
primary location. This
address can only
include a USPS post
office box location or
personal mailbox
offered by a private
delivery service if
the provider's NPI is
Entity type code = 1
and the provider does
not have a physical
location other than
their home address
(for example a
provider that
exclusively provides
telehealth services
from their home).
Provider gender code........... The code designating S Required if the 1........... I
the provider's gender provider's NPI is
if the provider is a Entity type code
person. = 1.
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[[Page 15583]]
1. Allowing Provider Address Location To Include Post Office Boxes
The NPI final rule acknowledged that many comments to the NPI
proposed rule noted that health care provider practice addresses change
frequently, will be burdensome and expensive to maintain, and will be
unlikely to be maintained accurately.\5\ In response to these comments,
we concluded in the NPI final rule that, due to how frequently provider
location addresses change, the data element is of limited use in
electronic matching of health care providers (69 FR 3450). However, the
rule did recognize that capturing one provider location address in
NPPES could serve the administrative purpose of providing an address
where a health care provider can be contacted in situations when a
mailing address is insufficient. For example, a mailing address
containing a USPS post office box number cannot be used for mail
delivery by entities other than the USPS. The rule concluded that NPPES
should collect a provider mailing address and one provider location
address as required elements. To support this administrative purpose,
both the provider first line location address and provider second line
location address data element descriptions included a note indicating,
``This address cannot include a post office box'' (69 FR 3458).
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\5\ HIPAA Administrative Simplification: Standard Unique Health
Identifier for Health Care Providers (NPI final rule)(69 FR 3455)
https://www.federalregister.gov/documents/2004/01/23/04-1149/hipaa-administrative-simplification-standard-unique-health-identifier-for-health-care-providers#p-394.
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Since the publication of the NPI final rule, health plans,
Medicare, and Medicaid programs, have expanded coverage for telehealth
services.\6\ As such, there are now a number of individual (Entity type
code = 1) providers, such as behavioral health service providers, who
exclusively furnish telehealth services from the providers' homes. In
some instances, providers who exclusively furnish telehealth services
from their own homes may not have a provider address location other
than their home address. We understand that providers who furnish
telehealth services exclusively from their homes often enter a post
office box as their provider mailing address into NPPES when applying
for an NPI. Given the prohibition on including a post office box for
the provider location address data elements, they enter their home
addresses into NPPES to satisfy the provider location address data
elements and obtain an NPI.
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\6\ https://telehealth.hhs.gov/; https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-service-type-reports/medicare-telehealth-trends; https://www.ama-assn.org/practice-management/digital/new-survey-data-shows-doctors-steadfast-commitment-telehealth.
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In accordance with FOIA, NPPES address data, including provider
mailing address and provider location address, is publicly available on
the internet. Internet posting of provider home address information as
a provider location may cause confusion, potentially leading patients
and others who may access NPPES data to think that the provider can be
accessed for treatment or administrative purposes at the listed home
address. We have heard from providers that posting the information also
poses privacy and potential safety concerns for themselves and their
families.
To address these concerns, while still maintaining the
administrative purpose of providing a provider location address that
can be accessed by methods other than the USPS when such a location
exists outside of the provider's own home, NPPES will keep the provider
location address data element status as required, but will allow for
submission of a post office box or personal mailbox offered by a
private delivery service when a provider's NPI is Entity type code = 1
and the provider does not have a physical location other than their
home address (for example, a provider that exclusively furnishes
telehealth services from their home). This change is accomplished by
removing the language ``This address cannot include a post office box''
from the data element descriptions for both the provider first line
location address and provider second line location address and
replacing it with ``This address can include a post office box or
personal mailbox offered by a private delivery service only if the
provider's NPI is Entity type code = 1 and the provider does not have a
physical location other than their home address (for example, a
provider that exclusively provides telehealth services from their
home).''
The change in the data element descriptions allows providers that
are persons that do not currently have an NPI, and exclusively furnish
telehealth services or other services out of their homes, to obtain an
NPI without including their home address in NPPES. Should a provider
with Entity type code = 1 that has as an existing NPI, and exclusively
furnishes telehealth services or other services out of their homes,
wish to remove their home address from NPPES and replace it with a post
office box, they may do so by updating their NPPES records, either
themselves or through the EFIO that submitted their NPI application
data to NPPES. The change in the data element descriptions does not
require providers that already have an NPI assigned through NPPES,
including telehealth providers that do not have a physical location
address other than their home address, from changing any existing
information in NPPES. Should a provider who furnishes telehealth
services or other services exclusively from their home address wish to
maintain their home address as their provider location address within
their NPPES record, they may do so.
2. Adding Additional Provider Gender Code Choices
The NPI final rule identified provider gender code as a required
data element if the provider's NPI is Entity type code = 1. While
neither the NPI final rule nor the NPPES Data Dissemination notice
identified the gender codes that NPPES would collect and disseminate
when applying for an NPI, providers are given the option to click on a
box that captures gender as either male or female. NPPES stores that
selection as code (F) should an individual select female and (M) should
an individual select male. The NPI Registry query-only database
displays the descriptions ``Male'' and ``Female'' to disseminate
provider gender and NPI downloadable files display the information
using the codes (M) and (F).
NPPES will permit selection of, and disseminate, gender code
options beyond M and F to promote improved accuracy in publicly
available data and support unique identification and enumeration of
health care providers. The NPPES system, NPPES Registry, paper form,
and associated data files will be updated to begin collecting and
disseminating these new values 30 days after publication of this notice
in the Federal Register. NPPES will provide additional guidance on the
new codes and instructions for selecting gender codes when applying for
an NPI and maintaining NPI data.
Adding gender codes aligns with HHS efforts, as described in E.O.
14075 (87 FR 37189), to advance equity and full inclusion of lesbian,
gay, bisexual, transgender, queer, and intersex (LGBTQI+) individuals
through inclusive federal data collection practices.
Providers with Entity type code = 1 who previously furnished a
provider gender code to NPPES may update or change their selection in
NPPES, or have the EFIO that submitted their NPI application data to
NPPES cause them to be changed in NPPES, at any time. HHS encourages
providers who have
[[Page 15584]]
obtained NPIs to review their NPPES records to ensure that the
information they furnished when applying for their NPIs is up-to-date
and accurate.
B. Impact on FOIA-Releasable NPPES Data
The NPPES Data Dissemination notice identified both the provider
location address and provider gender code as NPPES data elements that
must be released under FOIA. The changes to these data elements
described in section II. of this notice do not affect HHS's assessment
of their releasability under FOIA and the data elements will continue
to be made available to the public through the NPI registry and the NPI
downloadable files.
III. Collection of Information Requirements
This document imposes new information for collection and
recordkeeping requirements. It makes reference to an existing
information collection request that will be revised as a result of the
revised data elements discussed in this notice. Specifically, we will
submit a non-substantive change request to OMB for review and approval
of the data element revisions associated with the information
collection request currently approved under 0938-0931.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &
Medicaid Services, approved this document on February 27, 2024.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2024-04517 Filed 3-1-24; 8:45 am]
BILLING CODE 4120-01-P
