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What Happens Based on the Categorization of the Change Request
Once the DSMO consensus recommendation is achieved, a categorization is applied to the change request. The categories and the DSMO step after categorizing are explained below.

A. Modifications necessary to permit compliance with the standard/law (available only for the initial implementation of the standards).
According to DHHS, necessary items include
    1. Something in the adopted standard or implementation specification conflicts with the regulation.
    2. A non-existent data element or code set is required by the standard. (removal of data content that is not supported by the healthcare industry any longer)
    3. A data element or code set that is critical to the industry's business process has been left out.
    4. There is a conflict among different adopted standards
    5. There is an internal conflict within a standard (implementation guide).
According to DHHS, necessary items include
    1. Something in the adopted standard or implementation specification conflicts with the regulation.
    2. A non-existent data element or code set is required by the standard. (removal of data content that is not supported by the healthcare industry any longer)
    3. A data element or code set that is critical to the industry's business process has been left out.
    4. There is a conflict among different adopted standards
    5. There is an internal conflict within a standard (implementation guide).
If the DSMO categorize a Change Request as Category A, a letter is sent from the DSMO to the National Committee on Vital and Health Statistics recommending immediate action. NCVHS may have public hearings on the items. After the hearings, NCVHS will recommend the changes to HHS in a letter. HHS will issue a Notice of Proposed Rule Making (NPRM) requesting public comment, then make a determination based on comments received and publish a Final Rule. This categorization is no longer applicable because the initially adopted standards have become effective.

B. Modifications.
Classified as additions or deletions of data elements, internal code list values, segments, loops; changes in usage of segments, data elements, internal code list values; changes in usage notes;anges in repeat counts; changes in formatting notes or explanatory language that do not fall into Category A.

If the DSMO categorize a Change Request as Category B, the appropriate Standards Development Organization or Data Content Committee will process the request and make the necessary modifications to a future version or release. This category may not be appealed, since collaboration should be made during the SDO or DCC deliberations of the request. The Change Request is done and is archived.

C. Maintenance.
Classified as items that do not impact the implementation of the transaction. Items classified as "Maintenance" will require no further DSMO action. Items are to follow the SDO process.

If the DSMO categorize a Change Request as Category C, the item will be considered as part of the appropriate Standards Development Organization or Data Content Committee change process for a future version or release. This category may not be appealed, since collaboration should be made during the SDO or DCC deliberations of the request. The Change Request is done and is archived.

D. No Change.
Classified as items that the implementation guides do meet the needs requested, or did go through the consensus building process originally to meet need. The DSMO may request follow up by the submitter for further action.

If the DSMO categorize a Change Request as Category D, the Change Request has been denied. The submitter has the right to appeal. If no appeal is made, the Change Request is done and is archived.

E. DHHS Policy.
Classified as items that require follow up by the Department of Health and Human Services in regards to the Final Rule.

If the DSMO categorize a Change Request as Category E, the change request is completed by the DSMO. The request is forwarded to HHS for final determination.

F. Withdrawn by Submitter.
Classified as items that have been removed from Change Request System consideration.

If the DSMO categorize a Change Request as Category F, the submitter has agreed that the Change Request will not be processed. An appeal is not valid for this category. The Change Request is done and is archived.

G. Appeal.
Classified as items where the DSMO did not reach consensus on response and will follow the appeal process.

If the DSMO categorize a Change Request as Category G, see the steps under "Change Request System Flow".

H. Industry Comment Request Process.
Classified as items that require comments from the industry to determine consensus.

    If the DSMO categorize a Change Request as Category H, more information is needed from the industry and …will be obtained within 45 days by polling the DSMO memberships and possibly holding hearings in conjunction with NCVHS.  Once additional information is obtained, the DSMO will discuss and categorize the change.

I. Recommendation for adoption of new/modified HIPAA standard.
Classified as items that result in the recommendation to the National Committee on Vital and Health Statistics for the adoption of a new/modified HIPAA standard. Examples might include a request for a new transaction, or a new version or release of an already-named standard for a given transaction(s).

J. Out of DSMO Scope.
Classified as items that are not in the scope of the DSMO. An example is change requests for modifications to transactions not named in HIPAA.

Appeal Categories
Appeal Outcome Available Soon
Appeal Withdrawn
Appeal Upheld
Appeal Denied
Appeal Remanded