House Votes to Lift HHS Funding Ban on National Patient Identifier

In its Fiscal Year 2021 minibus package passed this week, the House of Representatives once again voted to remove a provision that effectively bans providing federal funds to the Department of Health and Human Services for the development of a national patient identifier.

HHS was initially called on to adopt standards for a distinct, unique patient ID, which would be used to identify the medical records of individuals, employers, providers, and health plans under HIPAA regulations. But in 1998, former Congressman Rep. Ron Paul, R-Texas introduced the funding ban, and it has been written into every Congressional budget proposal since 1999. 

Advocates for a national patient identifier, such as CHIME, argue that a unique identifier would help to improve patient privacy and patient safety, while supporting interoperability. CHIME and 55 other health groups urged Congress to remove the funding ban or at least adopt a unique patient identifier in August 2019. 

In June 2019, House members made a similar vote to lift the ban, but the Senate opted not to remove the the funding ban language in its own draft federal appropriations bill. Sen. Rand Paul, MD, R-Kentucky, took it a step further in September 2019, moving to remove the national patient identifier language from HIPAA altogether. The viewpoint was largely rejected.

But in December, Congress directed the Office of the National Coordinator to work with private sector stakeholders to develop a national strategy for improving patient identification. 

The latest effort spearheaded by Reps. Bill Foster, D-Illinois, and Mike Kelly, R-Pennsylvania, was unanimously adopted by the House. Foster argued that the unique patient identifier would help in slowing the spread of COVID-19 and prevent “doctor shopping” when it comes to opioids, while reducing medical errors and costs. 

“Removing this archaic ban is more important than ever as we face the COVID-19 pandemic,” Foster said in a statement. “Our ability to accurately identify patients across the care continuum is critical to addressing this public health emergency and removing this ban will alleviate difficult and avoidable operational issues, which will save money and, most importantly, save lives.” 

HIMSS signaled support of the amendment, launching Patient ID now with other healthcare stakeholders to address patient identification though legislative and regulatory advocacy. 

However, the American Civil Liberties Union rejected the effort, citing privacy cocnerns. 

“Absent strong privacy protections, use of unique health identifiers could empower HHS and potentially other federal agencies, including law enforcement, to gain unprecedented access to sensitive medical information,” ACLU leaders argued. 

“For this reason, it is critical that any use of unique health identifiers be subject to strict privacy and security protections, which are approved by Congress and subject to public debate,” they added. “Historically, we have seen examples of inadequate health privacy regulations, underscoring the importance of requiring Congressional approval of health privacy standards in this arena.” 

The privacy arguments have been previously made by ACLU and other groups. But industry stakeholders believe the risk to privacy is no different than that posed by Social Security numbers, which are tied to a patient’s financial information. Thus, a national patient identifier is seen as an improvement to privacy. 

“Use of a national identifier instead of SSN should lessen the burden of security breaches because the ability to steal an identity is limited without a SSN,” Corinne Smith, a healthcare attorney with Clark Hill Strasburger, told HealthITSecurity.com amid the Congressional patient ID discussions in 2019. “I fail to see how use of the national identifier would pose an increased risk over use of a SSN.” 

“The ban has prohibited effective conversations,” Leslie Krigstein, vice president of Congressional Affairs for CHIME, told HealthITSecurity.com during the same timeframe. “How can we have a dialogue if we’re prohibiting HHS from coming to the table with how they would like to identify patients? Or work with private partnerships to move forward on this? Without HHS at the table, we’re not going to see any change.” 

The Senate will be the next deciding factor on lifting the HHS funding ban from the appropriations bill, scheduled for next month.