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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes a number of provisions that significantly affect health care plans. This article outlines key aspects of these changes, which apply to all health care plans, including those covering multiemployer, governmental and church groups.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools to meet evolving health policy goals. This interpretation could clarify future health policy debates about appropriate federal and state responsibilities. We also report on the insurance environments and the HIPAA implementation choices of thirteen states. We conclude with criteria for judging the success of HIPAA and the evolving federal/state partnership in health insurance regulation.
The Health Insurance Portability and Accountability Act of 1996 may well be the most significant increase ever in the federal government's health care fraud and abuse enforcement authority. This new authority coupled with increased scrutiny of the health care industry generally creates a compelling incentive for health care facilities to develop corporate compliance programs.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) significantly changed the federal laws prohibiting Medicare fraud and abuse. It helps health care providers by requiring the Secretary of Health and Human Services to issue advisory opinions on transactions that may violate the fraud and abuse laws. But, overall, the changes greatly expand the government's ability to prosecute violations of the fraud and abuse laws. This article provides an overview of the fraud and abuse laws, discusses the changes made by the HIPAA, and concludes by suggesting the need for an effective plan to ensure compliance with these laws.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA; PL 104-191), popularly known as the Kassebaum-Kennedy legislation, contains a broad array of provisions with collective implications for a large segment of the population. The legislation contains provisions affecting the private insurance markets, the federal tax code, and strategies for decreasing fraud and abuse and for increasing the simplification of administrative procedures. Two objectives hold together the disparate pieces of this legislation. The first objective is to improve the accessibility of insurance for individuals with preexisting medical conditions. The second objective is to make health insurance and health services more affordable. This article is designed to provide an overview of the multiple components of HIPAA, and to identify the parties that are likely to be affected by each component. It concludes with a discussion of how well HIPAA can be expected to fulfill its two goals.
In 1996, the federal Health Insurance Portability and Accountability Act (HIPAA) was adopted as a step toward reshaping government health care. Referred to as the HIPAA, it enables portability of health care insurance coverage for workers and their families when they change or lose their jobs (Title I), sets a standard or benchmark for safeguarding electronic and paper exchange of health information, and requires national identifiers for providers, health plans, and employers (Title II). The final policy implementation rule outlines the entities affected by the legislation as health care providers, health plans, health care clearinghouses, and vendors offering computer software applications to providers and those billing for health services (Health Privacy Project, 2002; Public Law 104-191 1996; Rules and Regulations, 2003; U.S. Department of Labor, 2005). Aside from the federal law, some entities and even states have set standards more stringent than those promulgated by the federal mandate (U.S. Department of Health and Human Services 2004; 2005a).
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When it enacted The Health Insurance Portability and Accountability Act of 1996, Congress mandated establishment of privacy regulations covering individual health information. Title II of HIPAA, the Privacy Rule that became effective on April 14, 2001, offers Americans the first-ever set of comprehensive protections against the unintended and/or inappropriate disclosure of personal health information. Provisions of the Privacy Rule and its associated regulations include patient control over the use of health information, patient rights to information on the disclosure policies of the health-care provider, patient rights to review and amend one's medical information, standards for limiting the scope of data disclosed to other health-care providers, and penalties for noncompliance with the law. This paper presents a summary of the need for protection of personal health information and an overview of the provisions of this legislative foundation for protecting personal health records--the HIPAA Privacy Rule.
Ms. Heitzman addresses in her article the impact of the Administration Simplification statute of the Health Insurance Portability and Accountability Act of 1996 on the protection of health information by third parties to health care transactions. These regulations were enacted, in part, to increase consumers' trust in the health care system. However, their impact on business associates that come into contact with the health care entities has been a source of contention and confusion since they were drafted. This article concludes that the current regulations are too ambiguous and complex to achieve the goals of protection of privacy and Congress' goal of simplifying administration.
OBJECTIVE: To summarize and analyze the key provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the impact on pharmacies, health plans, pharmacy benefit managers, and others involved in the delivery of pharmacy services and managed pharmacy benefits. BACKGROUND: HIPAA was enacted by Congress in 1996 with the goals of administrative simplification in the health care system as well as protecting the privacy of individuals. HIPAA imposes new standards for health care transactions and patient privacy and defines new patient rights regarding their health care information. Transaction standards took effect October 16, 2002, while the privacy standards have a compliance date of April 14, 2003. Regulations, or.standards,. will apply to health plans, pharmacies, and other health care providers and other businesses involved in the delivery of health care services. Failure to comply will be punishable under the law. The U.S. Department of Health and Human Services estimated the 10-year cost of compliance to be $17.6 billion US dollars. CONCLUSION: HIPAA's new requirements will demand significant effort and expense for systems and business process development. Businesses from the smallest independent pharmacy to the largest health plans must be compliant by the deadlines imposed by HIPAA.
As small business employers, physician group practices will be subject to provisions of the Health Insurance Portability and Accountability Act of 1996 related to coverage guarantees. The act prevents currently insured individuals from losing coverage if they change jobs, limits insurance exclusions related to preexisting conditions, and requires insurers that offer small group coverage to make such policies available to all small employers. While the act's coverage guarantees may help group practices to attract good employees who formerly feared losing their coverage if they changed jobs, it also is likely to increase administrative costs, lead to premium increases, and limit to the choices for practices that must shop for health plans. Practices planning to purchase health insurance can ensure that they receive the best coverage possible by carefully comparing policy features and the claims services potential insurers provide.
Attorney Rovner presents a very detailed accounting of the impacts of the Health Insurance Portability and Accountability Act as it relates to group health insurance including provisions that concern pre-existing conditions, special enrollment rights, premium discrimination, maternity lengths of stay, parity for mental health benefits and small groups coverage. The article concludes with a discussion of the federalism question as it relates to regulation of private market health financing.
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In the short time since it became effective for health care organizations, a privacy regulation issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has had a significant adverse impact on the conduct of clinical research in the United States, without a substantial corresponding increase in privacy protection for research participants. Some of the problems associated with HIPAA have been resolved through revisions since the regulation's initial promulgation in December 2000, and other problems can be addressed by better educating health care providers and researchers about its requirements and available alternatives for compliance; however, considerable structural challenges remain. These constitute substantial barriers to research and resulting medical advances. Additional revisions to HIPAA based on the principles and trade-offs reflected in the Common Rule-which responsibly balances an individual's interest in privacy protection with the public interest in gaining knowledge through biomedical research-can go a long way to remedying remaining flaws in the system.
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The purpose of this article is to provide a general overview and reference source for the Health Insurance Portability and Accountability Act, which was signed into law by President Clinton last August. The focus of the article is on Title I--Improved Availability and Portability of Health Insurance Coverage, and on Title III--Tax-Related Health Provisions. The author points out that due to the trend towards an incremental approach to health care legislation, this act must be viewed as one of a series of initiatives being taken by the federal government intended to impact the cost of the U.S. health care delivery system.
OBJECTIVES: To assess the likely effects of the 1996 Health Insurance Portability and Accessibility Act (HIPAA), based on small firms' experiences under state small group insurance reforms that were similar in design to HIPAA. METHODS: Data on 17,818 small businesses (range, 2-50 employees) nationwide from the 1994 National Employer Health Insurance Survey were analyzed to examine the effects of state small group reforms on the following: (1) employers' provision of coverage; (2) the percentage of workers in insured firms who were covered by plans; and (3) insurer practices of "enrollee exclusion." Logistic regression models were estimated and used to quantify the marginal effects of state small-group reform. Reform effects were examined for all small firms, for small firms by size category, and for small firms in redlined industries. RESULTS: Under full reform for at least 3 years (full reform includes guaranteed issue and renewal, portability, limits on pre-existing condition waits, and rating restrictions), employers were slightly more likely to sponsor health plans; however, employee participation in employer plans was no higher and the prevalence of enrollee-exclusion provisions was unchanged. Businesses in redlined industries clearly benefitted from all types of small group reform. For other subgroups of businesses, however, there were advantages and disadvantages associated with reforms, which varied with the scope of the measures and time since their implementation. CONCLUSION: Widespread small group reform may eventually help raise the proportion of small firms that sponsor health benefits, but not by much.
This proposed rule would revise the OIG's civil money penalty (CMP) authorities, in conjunction with new and revised provisions set forth in the Health Insurance Portability and Accountability Act of 1996. Among other provisions, this proposed rulemaking would codify new CMPs for: Excluded individuals retaining ownership or control interest in an entity; upcoding and claims for medically unnecessary services; offering inducements to beneficiaries; and false certification of eligibility for home health services. This rule would also codify a number of technical and conforming changes consistent with the OIG's existing sanction authorities.