Health Insurance Portability and Accountability Act

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The Health Insurance Portability and Accountability Act (HIPAA) is a piece of federal legislation that was signed into law in 1996. The major provisions of the law created a mechanism for maintaining health insurance coverage when changing jobs and established national standards for the privacy and security of electronic health information.

Many of HIPAA's requirements for group health plans were extended to the individual market by the Affordable Care Act, such as the ability to enroll in health coverage during a special enrollment period.

HIGHLIGHTS

* HIPAA prohibited insurers from denying individuals for pre-existing conditions under an employer-sponsored group health plan.

* Under HIPAA, providers are also legally responsible for protecting identifiable electronic health information from computer viruses, other patients, and even some employees.

* Under HIPAA, patients also have the right to prevent their health information from being used for research.

## Contents

* 1 Major provisions
* 1.1 Portability
* 1.2 Privacy
* 2 See also
* 3 External links
* 4 Footnotes

## Major provisions[edit]

### Portability[edit]

Title I of the Health Insurance Portability and Accountability Act (HIPAA) established new rules for group health plans for the purpose of preventing individuals from experiencing gaps in coverage, especially those with pre-existing conditions. Health insurance coverage that is maintained through various life events, like job loss, is referred to as portable health insurance.[1]

In order to improve the portability of health insurance, HIPAA prohibited insurers from denying individuals for pre-existing conditions under an employer-sponsored group health plan. So, for example, if a person changed jobs, the health plan at their new employer would not be able to deny them coverage for prior health conditions. The law also prohibited insurers from varying premiums in group health plans based on such conditions or health status.[1]

Under HIPAA, the maximum wait time before coverage specific to the pre-existing condition begins was limited to 12 months, or 18 months for those signing up outside of the open enrollment period. However, this length of time could be reduced under a "credible coverage" provision. Credible coverage referred to an individual's previously, and continuously, held health coverage; the length of time of that coverage could be applied to the pre-existing condition waiting period of the new coverage in order to shorten it. Prior credible coverage of a year or more would eliminate the waiting period entirely.[1][2]

HIPAA also required insurers to administer special enrollment periods for group health plans. Special enrollment periods allowed an individual who previously declined insurance to enroll outside of the open enrollment period. The law limited special enrollment periods to people who experienced a qualifying life event, such as a loss of other coverage, a divorce, or a move out of the coverage area.[3]

### Privacy[edit]

Title II of the Health Insurance Portability and Accountability Act (HIPAA) established national standards for the privacy and security of electronic health information. Traditionally, medical records and patient information were stored in paper files at physician offices. However, in the 1990s, the use of computers was becoming more widespread, and patient health records more frequently were being stored electronically. The electronic storage of health data raised new concerns over patient privacy, and policymakers determined that paper-based privacy laws were no longer sufficient.[1]

Screenshots from an electronic health records system

HIPAA therefore established four sets of standards. The first set, known as the Transactions and Code Sets Rule, regulated electronic healthcare-related transactions, such as enrolling in health insurance and paying the monthly premium. HIPAA required Medicare and Medicaid to use such systems, meaning providers who contract with either program had to use them too. Providers that contracted solely with commercial insurance were not required to use electronic systems. However, if they chose to do so, the transactions were required to be made in the same format to enable the sharing of information across systems.[1]

The second set of standards, known as the Unique Identifier Rule, established unique national provider identifiers (NPI) for all healthcare providers and health insurers with electronic systems. The 10-digit number is used as a log in credential to access the system. Its purpose was to reduce confusion and error by distinguishing between healthcare systems during electronic transactions.[1]

The third set of standards, known as the Security Rule, involved the security of Electronic Protected Health Information, which is any information that could identify a patient. This information includes demographic information, medical records held by providers, and payment records held by insurers. Under these standards, protected health information that is stored electronically is required to retain the utmost confidentiality. Providers are also legally responsible for protecting identifiable electronic health information from computer viruses, other patients, and even some employees.[1][4][5]

The fourth set of standards, known as the Privacy Rule, involved the privacy rights of patients regarding all forms of their health information, including information stored on paper. These were the most substantial provisions of HIPAA and they came with complex compliance requirements. Under these rules, patients retain full access to their health records and can restrict their disclosure and use. The law also requires the use and disclosure of protected health information to be limited to the minimum amount necessary to treat the patient and bill for services. Under HIPAA, patients also have the right to prevent their health information from being used for research.[1][6]

## See also[edit]

* U.S. Department of Health and Human Services

* Affordable Care Act

* Electronic health records

## External links[edit]

* How Stuff Works, "Health Insurance Portability and Accountability Act"
* Health Information & the Law, "Health Insurance Portability and Accountability Act of 1996 (HIPAA)"
* U.S. Department of Health and Human Services

## Footnotes[edit]

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 How Stuff Works, "HIPAA's Title I," accessed June 2, 2016
2. ↑ Health Information & the Law, "Health Insurance Portability and Accountability Act of 1996 (HIPAA)," accessed June 2, 2006
3. ↑ United States Department of Labor, "FAQs about Portability of Health Coverage and HIPAA," accessed June 3, 2016
4. ↑ Highmark, "HIPAA Titles," accessed June 3, 2016
5. ↑ Highmark, "HIPAA FAQs," accessed June 3, 2016
6. ↑ HIPAA, "HIPAA Disclosure," accessed June 3, 2016

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