Hipaa

The Health Insurance Portability and Accountability Act (HIPAA) is a United States federal statute enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. The primary purpose of HIPAA is to improve the portability and accountability of health insurance coverage for employees between jobs, combat waste, fraud, and abuse in health insurance and healthcare delivery, and simplify the administration of health insurance.

Title I: Health Care Access, Portability, and Renewability

Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. It limits restrictions that a group health plan can place on benefits for preexisting conditions and prohibits discrimination against employees and their dependents based on their health status.

Preexisting Conditions

HIPAA restricts the ability of group health plans to impose preexisting condition exclusions. A preexisting condition exclusion is a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date.

Special Enrollment Rights

HIPAA provides special enrollment rights for individuals who lose other health coverage or experience certain life events. These rights allow individuals to enroll in a group health plan without having to wait for an open enrollment period.

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform

Title II of HIPAA, also known as the Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. It also addresses the security and privacy of health data.

Privacy Rule

The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information. It applies to health plans, health care clearinghouses, and health care providers that conduct certain health care transactions electronically. The Privacy Rule requires appropriate safeguards to protect the privacy of personal health information and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization.

Security Rule

The HIPAA Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information (e-PHI).

Transactions and Code Sets Standards

HIPAA requires the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions and code sets to improve the efficiency and effectiveness of the health care system.

Unique Identifiers

HIPAA mandates the adoption of unique identifiers for health care providers, health plans, and employers. The National Provider Identifier (NPI) is a standard unique identifier for health care providers.

Title III: Tax-Related Health Provisions

Title III of HIPAA includes tax-related provisions and guidelines for medical savings accounts (MSAs). It also includes provisions for the deduction of health insurance premiums by the self-employed.

Title IV: Application and Enforcement of Group Health Plan Requirements

Title IV of HIPAA clarifies the application and enforcement of group health plan requirements, including those related to preexisting conditions and discrimination based on health status.

Title V: Revenue Offsets

Title V of HIPAA includes provisions related to company-owned life insurance and the treatment of individuals who lose U.S. citizenship for income tax purposes.

Impact and Compliance

HIPAA has had a significant impact on the health care industry, particularly in the areas of privacy and security of health information. Compliance with HIPAA regulations is mandatory for covered entities and business associates, and violations can result in significant penalties.

See Also

• Electronic Health Record
• Patient privacy
• Health Information Technology

References

• U.S. Department of Health & Human Services - HIPAA
• Congress.gov - HIPAA Legislation

External Links

• HIPAA for Professionals
• HIPAA for Individuals