A lot of regulation has followed passage of the Health Insurance Portability and Accountability Act (HIPAA), which has been called "one-third of the President's health care reform' effort."

The needle on the government's jargon meter is about to bust with "Revised PRO Sanctions for Failing to Meet Statutory Obligations," "Joint Interim Rules for Portability of Group Health Plans," "Notification Procedures for States Implementing 'Alternative Mechanisms' in the Individual Market," and even "Negotiated Rulemaking for the Shared Risk Exception."

If this kind of thing floats your boat, grab a beverage and cozy up to the screen to read all about it. Then get some help!

• Federal Register
  • Medicare Program; Definition of Provider-Sponsored Organization and Related Requirements[Federal Register: April 14, 1998 (Volume 63, Number 71)][Rules and Regulations] [Page 18124-18135] This interim final rule with comment period defines the term ``provider-sponsored organization'' for purposes of the Medicare program and establishes requirements related to meeting this definition.
  • Health Care Programs: Fraud and Abuse; Revised OIG Civil Money Penalties Resulting From the Health Insurance Portability and Accountability Act of 1996 [Federal Register: March 25, 1998 (Volume 63, Number 57)] [Proposed Rules] [Page 14393-14402] This proposed rulemaking would codify new civil monetary penalties (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.
  • Medicare Program; Medicare Integrity Program, Intermediary and Carrier Functions, and Conflict of Interest Requirements [Federal Register: March 20, 1998 (Volume 63, Number 54)][Proposed Rules] [Page 13590-13608] Would implement section 1893 of the Social Security Act (the Act) by establishing the Medicare integrity program (MIP) to carry out Medicare program integrity activities that are funded from the Medicare Trust Funds.
  • Publication of the OIG Compliance Program Guidance for Hospitals [Federal Register: February 23, 1998 (Volume 63, Number 35)][Notices] [Page 8987-8998] Many providers and provider organizations have expressed an interest in better protecting their operations from fraud and abuse through the adoption of voluntary compliance programs.
  • Continuation Coverage Requirements of Group Health Plans [Federal Register: January 7, 1998 (Volume 63, Number 4)] [Proposed Rules] [Page 708-712] The regulations will generally affect sponsors of and participants in group health plans, and they provide plan sponsors and plan administrators with guidance necessary to comply with the law.
  • Qualified Long-Term Care Insurance Contracts [Federal Register: January 2, 1998 (Volume 63, Number 1)][Proposed Rules] [Page 35-39] The regulations affect issuers of long-term care insurance contracts and individuals entitled to receive payments under these contracts. The regulations are necessary to provide these taxpayers with guidance needed to comply with these changes.
  • Health Care Programs: Fraud and Abuse; Revised PRO Sanctions for Failing To Meet Statutory Obligations, [Federal Register: April 29, 1997 (Volume 62, Number 82)] [Rules and Regulations] [Page 23140-23144]. This final rule addresses revised procedures governing the imposition and adjudication of program sanctions, based on recommendations from State utilization and quality control peer review organizations (PROs), resulting from enactment of sections 214 and 231(f) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
  • Joint Interim Rules for Health Insurance Portability for Group Health Plans [Federal Register: April 8, 1997 (Volume 62, Number 67)] [Rules and Regulations] [Page 16893-16976]. AGENCIES: Internal Revenue Service, Department of the Treasury; Pension and Welfare Benefits Administration, Department of Labor; Health Care Financing Administration, Department of Health and Human Services. ACTION: Interim rules with request for comments.
  • Notification Procedures for States Implementing ``Alternative Mechanisms'' in the Individual Health Insurance Market, [Federal Register: January 13, 1997 (Volume 62, Number 8)] [Notices] [Page 1768-1776]. This notice generally describes the statutory provisions under section 111 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that guarantee availability of individual health insurance coverage to certain individuals with prior group coverage.
  • Health Care Programs, Fraud and Abuse; Intent To Form the Negotiated Rulemaking Committee for the Shared Risk Exception, [Federal Register: May 23, 1997 (Volume 62, Number 100)] [Proposed Rules] [Page 28410-28413]. We have been statutorily-mandated under section 216 of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, to establish a negotiated rulemaking committee in accordance with the Negotiated Rulemaking Act and the Federal Advisory Committee Act (FACA).
  • Medicare and State Health Care Programs: Fraud and Abuse; Issuance of Advisory Opinions by the OIG, [Federal Register: February 19, 1997 (Volume 62, Number 33)] [Rules and Regulations] [Page 7350-7360]. In accordance with section 205 of the Health Insurance Portability and Accountability Act of 1996, this final rule establishes a new part 1008 in 42 CFR chapter V to address the new OIG advisory opinion process.
  • Individual Market Health Insurance Reform: Portability From Group to Individual Coverage; Federal Rules for Access in the Individual Market; State Alternative Mechanisms to Federal Rules, [Federal Register: April 8, 1997 (Volume 62, Number 67)] [Rules and Regulations] [Page 16985-17004]. This interim final rule with comment period implements section 111 of the Health Insurance Portability and Accountability Act of 1996, which sets forth Federal requirements designed to improve access to the individual health insurance market.
• GAO Reports
  • Health Insurance Standards: New Federal Law Creates Challenges for Consumers, Insurers, Regulators. HEHS-98-67. 30 pp. plus 6 appendices (18 pp.) February 25, 1998. Reviews the implementation of the Health Insurance Portability and Accountability Act (HIPAA), focusing on issues affecting: (1) consumers; (2) issuers of health coverage, including employers and insurance carriers; (3) state insurance regulators; and (4) federal regulators.
  • Health Insurance Portability: Reform Could Ensure Continued Coverage for Up to 25 Million Americans (Letter Report, 09/19/95, GAO/HEHS-95-257). Pursuant to a congressional request, GAO provided information on: (1) the protections offered by current state and federal health insurance portability reforms; (2) the number of people who could be affected by broader national portability standards; and (3) other issues related to the design of national portability standards.
  • Health Insurance Regulation: Variation in Recent State Small Employer Health Insurance Reforms (Fact Sheet, 06/12/95, GAO/HEHS-95-161FS). Pursuant to a congressional request, GAO provided information on state legislation to improve portability, access, and rating practices for the small-employer and individual health insurance markets.
• HCFA
  • HCFA: HIPAA Fact Sheet
  • HCFA: HIPAA Questions - Employers
  • HCFA: HIPAA Questions - Consumers
• HHS
  • HHS: HIPAA Fact Sheet
  • HHS: Health Insurance Portability and Accountability Act of 1996
• Presidential
  • Remarks by the President: HIPAA
  • Statement by the President: HIPAA
  • HIPAA Press Briefing
• Search
  • AltaVista: Portability Act
  • Excite!: Portability Act
  • HotBot: Portability Act
• Health Hippo
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STATEMENT BY DONNA E. SHALALA

SECRETARY OF HEALTH AND HUMAN SERVICES

ON THE ANNIVERSARY OF THE HEALTH INSURANCE PORTABILITY AND

ACCOUNTABILITY ACT OF 1996 (HIPAA)

"This anniversary marks the enactment of landmark legislation that has given millions of working people the comfort of knowing that if they change jobs, they need not lose their health insurance. This is an important step that demonstrates our commitment to improve access to high-quality health care for all Americans.

"This legislation provides that a woman with a sick child can move from one group plan to another without a lapse in health insurance, and without paying more than other employees for coverage. And it gives small businesses access to health insurance programs to provide their employees with the coverage they need and deserve.

"In addition to providing health care portability, this legislation created a stable source of funding for fraud control activities, and giving us new resources to attack fraudulent health care providers, and develop new management tools and techniques. Funded by these critical resources, today I was pleased to award more than $2.25 million in grants for new programs that will strengthen our ongoing anti-fraud efforts."

To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. <<NOTE: Aug. 21, 1996 - [H.R. 3103]>>

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled <<NOTE: Health Insurance Portability and Accountability Act of 1996.>> ,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS <<NOTE: 42 USC 201 note.>>.

• (a) Short Title.--This Act may be cited as the "Health Insurance Portability and Accountability Act of 1996''.
• (b) Table of Contents.--The table of contents of this Act is as follows:

TITLE I--HEALTH CARE ACCESS, PORTABILITY, AND RENEWABILITY

• Subtitle A--Group Market Rules
• Part 1--Portability, Access, and Renewability Requirements
  • Sec. 101. Through the Employee Retirement Income Security Act of 1974.
• Part 7--Group Health Plan Portability, Access, and Renewability Requirements
  • Sec. 701. Increased portability through limitation on preexisting condition exclusions.
  • Sec. 702. Prohibiting discrimination against individual participants and beneficiaries based on health status.
  • Sec. 703. Guaranteed renewability in multiemployer plans and multiple employer welfare arrangements.
  • Sec. 704. Preemption; State flexibility; construction.
  • Sec. 705. Special rules relating to group health plans.
  • Sec. 706. Definitions.
  • Sec. 707. Regulations.
  • Sec. 102. Through the Public Health Service Act.
• TITLE XXVII--ASSURING PORTABILITY, AVAILABILITY, AND RENEWABILITY OF HEALTH INSURANCE COVERAGE
• Part A--Group Market Reforms
• Subpart 1--Portability, Access, and Renewability Requirements
  • Sec. 2701. Increased portability through limitation on preexisting condition exclusions.
  • Sec. 2702. Prohibiting discrimination against individual participants and beneficiaries based on health status.
• Subpart 2--Provisions Applicable Only to Health Insurance Issuers
  • Sec. 2711. Guaranteed availability of coverage for employers in the group market.
  • Sec. 2712. Guaranteed renewability of coverage for employers in the group market.
  • Sec. 2713. Disclosure of information.
• Subpart 3--Exclusion of Plans; Enforcement; Preemption
  • Sec. 2721. Exclusion of certain plans.
  • Sec. 2722. Enforcement.
  • Sec. 2723. Preemption; State flexibility; construction.
• Part C--Definitions; Miscellaneous Provisions
  • Sec. 2791. Definitions.
  • Sec. 2792. Regulations.''.
  • Sec. 103. Reference to implementation through the Internal Revenue Code of 1986.
  • Sec. 104. Assuring coordination.
• Subtitle B--Individual Market Rules
  • Sec. 111. Amendment to Public Health Service Act.
• Part B--Individual Market Rules
  • Sec. 2741. Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage.
  • Sec. 2742. Guaranteed renewability of individual health insurance coverage.
  • Sec. 2743. Certification of coverage.
  • Sec. 2744. State flexibility in individual market reforms.
  • Sec. 2745. Enforcement.
  • Sec. 2746. Preemption.
  • Sec. 2747. "General exceptions.''
• Subtitle C--General and Miscellaneous Provisions
  • Sec. 191. Health coverage availability studies.
  • Sec. 192. Report on Medicare reimbursement of telemedicine.
  • Sec. 193. Allowing federally-qualified HMOs to offer high deductible plans.
  • Sec. 194. Volunteer services provided by health professionals at free clinics.
  • Sec. 195. Findings; severability.

TITLE II--PREVENTING HEALTH CARE FRAUD AND ABUSE; ADMINISTRATIVE SIMPLIFICATION; MEDICAL LIABILITY REFORM

• Sec. 200. References in title.

• Subtitle A--Fraud and Abuse Control Program
  • Sec. 201. Fraud and abuse control program.
  • Sec. 202. Medicare integrity program.
  • Sec. 203. Beneficiary incentive programs.
  • Sec. 204. Application of certain health antifraud and abuse sanctions to fraud and abuse against Federal health care programs.
  • Sec. 205. Guidance regarding application of health care fraud and abuse sanctions.
• Subtitle B--Revisions to Current Sanctions for Fraud and Abuse
  • Sec. 211. Mandatory exclusion from participation in Medicare and State health care programs.
  • Sec. 212. Establishment of minimum period of exclusion for certain individuals and entities subject to permissive exclusion from Medicare and State health care programs.
  • Sec. 213. Permissive exclusion of individuals with ownership or control interest in sanctioned entities.
  • Sec. 214. Sanctions against practitioners and persons for failure to comply with statutory obligations.
  • Sec. 215. Intermediate sanctions for Medicare health maintenance organizations.
  • Sec. 216. Additional exception to anti-kickback penalties for risk- sharing arrangements.
  • Sec. 217. Criminal penalty for fraudulent disposition of assets in order to obtain Medicaid benefits.
  • Sec. 218. Effective date.
• Subtitle C--Data Collection
  • Sec. 221. Establishment of the health care fraud and abuse data collection program.
  • Subtitle D--Civil Monetary Penalties
  • Sec. 231. Social Security Act civil monetary penalties.
  • Sec. 232. Penalty for false certification for home health services.
• Subtitle E--Revisions to Criminal Law
  • Sec. 241. Definitions relating to Federal health care offense.
  • Sec. 242. Health care fraud.
  • Sec. 243. Theft or embezzlement.
  • Sec. 244. False statements.
  • Sec. 245. Obstruction of criminal investigations of health care offenses.
  • Sec. 246. Laundering of monetary instruments.
  • Sec. 247. Injunctive relief relating to health care offenses.
  • Sec. 248. Authorized investigative demand procedures.
  • Sec. 249. Forfeitures for Federal health care offenses.
  • Sec. 250. Relation to ERISA authority.
• Subtitle F--Administrative Simplification
  • Sec. 261. Purpose.
  • Sec. 262. Administrative simplification.
• Part C--Administrative Simplification
  • Sec. 1171. Definitions.
  • Sec. 1172. General requirements for adoption of standards.
  • Sec. 1173. Standards for information transactions and data elements.
  • Sec. 1174. Timetables for adoption of standards.
  • Sec. 1175. Requirements.
  • Sec. 1176. General penalty for failure to comply with requirements and standards.
  • Sec. 1177. Wrongful disclosure of individually identifiable health information.
  • Sec. 1178. Effect on State law.
  • Sec. 1179. Processing payment transactions.''.
  • Sec. 263. Changes in membership and duties of National Committee on Vital and Health Statistics.
  • Sec. 264. Recommendations with respect to privacy of certain health information.
  • Subtitle G--Duplication and Coordination of Medicare-Related Plans
  • Sec. 271. Duplication and coordination of Medicare-related plans.

TITLE III--TAX-RELATED HEALTH PROVISIONS

• Sec. 300. Amendment of 1986 Code.

• Subtitle A--Medical Savings Accounts
  • Sec. 301. Medical savings accounts.
• Subtitle B--Increase in Deduction for Health Insurance Costs of Self- Employed Individuals
  • Sec. 311. Increase in deduction for health insurance costs of self- employed indi- viduals.
• Subtitle C--Long-Term Care Services and Contracts
• Part I--General Provisions
  • Sec. 321. Treatment of long-term care insurance.
  • Sec. 322. Qualified long-term care services treated as medical care.
  • Sec. 323. Reporting requirements.
• Part II--Consumer Protection Provisions
  • Sec. 325. Policy requirements.
  • Sec. 326. Requirements for issuers of qualified long-term care insurance contracts.
  • Sec. 327. Effective dates.
• Subtitle D--Treatment of Accelerated Death Benefits
  • Sec. 331. Treatment of accelerated death benefits by recipient.
  • Sec. 332. Tax treatment of companies issuing qualified accelerated death benefit riders.
• Subtitle E--State Insurance Pools
  • Sec. 341. Exemption from income tax for State-sponsored organizations providing health coverage for high-risk individuals.
  • Sec. 342. Exemption from income tax for State-sponsored workmen's compensation reinsurance organizations.
• Subtitle F--Organizations Subject to Section 833
  • Sec. 351. Organizations subject to section 833.
• Subtitle G--IRA Distributions to the Unemployed
  • Sec. 361. Distributions from certain plans may be used without additional tax to pay financially devastating medical expenses.
• Subtitle H--Organ and Tissue Donation Information Included With Income Tax Refund Payments
  • Sec. 371. Organ and tissue donation information included with income tax refund payments.

TITLE IV--APPLICATION AND ENFORCEMENT OF GROUP HEALTH PLAN REQUIREMENTS

• Subtitle A--Application and Enforcement of Group Health Plan Requirements
  • Sec. 401. Group health plan portability, access, and renewability requirements.
  • Sec. 402. Penalty on failure to meet certain group health plan requirements.
• Subtitle B--Clarification of Certain Continuation Coverage Requirements
  • Sec. 421. COBRA clarifications.

TITLE V--REVENUE OFFSETS

• Sec. 500. Amendment of 1986 Code.

• Subtitle A--Company-Owned Life Insurance
  • Sec. 501. Denial of deduction for interest on loans with respect to company-owned life insurance.
• Subtitle B--Treatment of Individuals Who Lose United States Citizenship
  • Sec. 511. Revision of income, estate, and gift taxes on individuals who lose United States citizenship.
  • Sec. 512. Information on individuals losing United States citizenship.
  • Sec. 513. Report on tax compliance by United States citizens and residents living abroad.
• Subtitle C--Repeal of Financial Institution Transition Rule to Interest Allocation Rules
  • Sec. 521. Repeal of financial institution transition rule to interest allocation rules.
• LEGISLATIVE HISTORY

• Background:
  • Question: How many words and lines are in the Health Insurance Portability and Accountability Act?
    • Answer: About 73,840 words, 5704 lines (Source: MS WORD: Word Count)
  • Question: How many sections are missing from the THOMAS links to the Health Insurance Portability and Accountability Act?
    • Answer: HR 3103, Health Insurance Portability At least three, including links to the new safe harbor provisions, the new criminal penalties for medical assistance transfers and the new law relating to volunteer services provided by health professionals at free clinics.
  • Question: When was the law signed by the President?
    • Answer: LEGISLATIVE HISTORY August 21, 1996
  • Question: How many titles make up the new law (not counting the short title)?
    • Answer: Five
    • TITLE I--HEALTH CARE ACCESS, PORTABILITY, AND RENEWABILITY
    • TITLE II--PREVENTING HEALTH CARE FRAUD AND ABUSE; ADMINISTRATIVE SIMPLIFICATION; MEDICAL LIABILITY REFORM
    • TITLE III--TAX-RELATED HEALTH PROVISIONS
    • TITLE IV--APPLICATION AND ENFORCEMENT OF GROUP HEALTH PLAN REQUIREMENTS
    • TITLE V--REVENUE OFFSETS
• Access to Health Care
  • Question: What is a "preexisting condition" under the new law?
    • Answer: Sec. 701 "A condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date."
  • Question: How long may a person be denied health insurance coverage for a preexisting condition?
    • Answer: Sec. 701 12 months (or 18 months for a "late enrollee")
  • Question: How is genetic information treated under the law?
    • Answer: Sec. 702 "Genetic information shall not be treated as a condition ... in the absence of a diagnosis of the condition related to such information."
  • Question: Are states free to implement alternative health reform schemes?
    • Answer: Yes, upon application and with many restrictions. See Sec. 2744, 42 USC 300gg-44
  • Question: Every new law has to require a study. What is the Secretary of Health and Human Services supposed to study?
    • Answer: 1) Effectiveness of reforms, and; 2) Impact on access and choice. Sec. 191 In addition, HCFA is to complete its study on Medicare reimbursement for telemedicine. Sec. 192
• Fraud & Abuse
  • Question: What are the primary activities to be conducted by DHHS under the Medicare Integrity Program?
    • Answer: Sec. 202 (1) Review of activities of individuals and entities furnishing items and services including medical and utilization review and fraud review; (2) Audit of cost reports; (3) Determinations as to whether payment should not be, or should not have been, made and recovery of payments that should not have been made; (4) Education of providers of services, beneficiaries, and other persons with respect to payment integrity and benefit quality assurance issues, and; (5) Developing (and periodically updating) a list of items of durable medical equipment which are subject to prior authorization under such section.
  • Question: Can individuals be paid for reporting health care fraud or suggestions that result in program savings?
    • Answer: Sec. 203 Yes. Payments may be made at the Secretary's discretion.
  • Question: Will the Secretary accept suggestions for new fraud and abuse safe harbors?
    • Answer: Sec. 203 Of course. The Secretary will annually request proposals for new safe harbors, which will be evaluated based on their impact on: (A) access to health care services; (B) quality of health care services; (C) patient freedom of choice; (D) competition among health care providers; (E) medically underserved areas or to medically underserved populations; (F) cost to Federal health care programs; (G) overutilization of health care services; (H) financial benefit to a health care professional or provider (I) Any other factors the Secretary deems appropriate. The Secretary, in consultation with the Attorney General, may issue advisory opinions on what constitutes fraud and abuse and may continue to issue "Special Fraud Alerts."
  • Question: Can risk-bearing individuals and entities be subject to penalties under the Anti-Kickback Statute?
    • Answer: Sec. 216 Sure, but a new exception exists for "any remuneration between an organization and an individual or entity providing items or services, or a combination thereof, pursuant to a written agreement between the organization and the individual or entity if the organization is an eligible organization under section 1876 or if the written agreement, through a risk-sharing arrangement, places the individual or entity at substantial financial risk for the cost or utilization of the items or services, or a combination thereof, which the individual or entity is obligated to provide" and expedited rules will be issued using a negotiated rulemaking process.
  • Question: What is the legal standard for conviction of health fraud as a result of transferal assets to obtain eligibility for medical assistance?
    • Answer: Sec. 217 "[K]knowingly and willfully dispos[ing] of assets (including by any transfer in trust) in order for an individual to become eligible for medical assistance under a State plan under title XIX, if disposing of the assets results in the imposition of a period of ineligibility for such assistance." 42 U.S.C. 1320a-7b(a)
  • Question: Will the National Practitioner Data Bank be opened to the public?
    • Answer: Sec. 221 Not yet, but the Secretary will establish a new Fraud & Abuse Data Bank with similar restrictions on public access.
  • Question: What was the effective date of these the new fraud provisions?
    • Answer: Sec. 218 Many of the provisions were effective on enactment, others were effective January 1, 1997.
  • Question: How much is being spent to beef up health care fraud and abuse enforcement?
    • Answer: Sec. 201 The administration and operation of the health care fraud and abuse control program includes the costs of-- (i) prosecuting health care matters (through criminal, civil, and administrative proceedings); (ii) investigations; (iii) financial and performance audits of health care programs and operations; (iv) inspections and other evaluations; and (v) provider and consumer education. The FBI is appropriated $434 million to the year 2002 for this program. DHHS and the Attorney General are appropriated $104 million in 1997, with increases of 15% until the year 2003. Approximately 60-70% of the DHHS appropriations go directly to the Office of the Inspector General.
• Tax-Related Provisions
  • Question: Did Medical Savings Accounts make it into the law?
    • Answer: Yes. The new laws relating to Medical Savings Accounts can be found at Sec. 301.
  • Question: Will there be a tax-break for long-term care insurance or services?
    • Answer: Long-term care insurance will be treated like health and accident insurance, Sec. 321, and long-term care services will be treated as medical care for tax purposes. Sec. 322
  • Question: What is the tax treatment of viatical settlements?
    • Answer: Viatical settlements for terminally ill individuals will be treated the same as insurance payments made on the death of the insured. Sec. 331 Qualified accelerated death benefit riders will be treated as life insurance. Sec. 332
  • Question: Is there a way to make the public aware of the critical need for organ and tissue donors?
    • Answer: Sec. 371 Information on organ and tissue donations will be included with all income tax refund payments under the new law.