Law Regulations That Address the HIPAA
- Patient records are confidential by law.medical inventory image by Pix by Marti from Fotolia.com
In 1996, Congress passed the Health Insurance Portability & Accountability Act, or HIPAA, into law. The purpose of the Act was to improve continuity of medical insurance coverage for those insured individually and in group markets. Waste, fraud, and abuse in the health care industry were other concerns. Congress also aimed to reduce the administrative strains and costs of health care by improving the efficiency of the operation of the health care system by regulating the interchange of electronic data and by protecting patient privacy. Patients should always be sure they receive documentation from their doctors indicating their compliance with HIPAA regulations. - Title IV of the Act defines rules for patient information protection. Privacy regulations of the HIPAA law call for all health care providers, organizations and government-provided health plans that obtain, store or relate patient health care information to fully comply with the rules. Some small, self-administered health organizations are exempt. In addition to federally ensuring patient privacy, the HIPAA law is designed to reduce unauthorized activity and promote more accurate data systems. It is estimated that providers save billions of dollars annually when they completely adhere to HIPAA regulations.
- When an employee loses health coverage perhaps through loss of employment, an enrollment opportunity is activated if the insured possessed health insurance coverage at the time of enrollment eligibility. The employee has 30 days to request special enrollment after loss of coverage. The new coverage must be effective no later than the first day of the month, which begins after the date the request for enrollment was given. Long-term health plans are excluded from Title I requirements as well as plans only covering dental or vision separately. If such coverage is part of the health plan, HIPAA would apply to those benefits.
- Restrictions group health plans put on coverage for pre-existing conditions is limited by Title I of HIPAA. As a general practice, group health plans deny benefits associated with pre-existing conditions for one year after enrollment or a year and a half if enrollment is late. HIPAA allows individuals to reduce this period as long as there was group coverage or health insurance before enrolling in the plan. Title I also permits individuals to reduce the exclusion period by the length of time the individual had "creditable coverage" before enrolling. "Creditable coverage" is a broad term that is inclusive to nearly all group and individual health plans.
