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Health Insurance Portability and Accountability Act of 1996 (HIPAA) - Overview

HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing the various unrelated provisions of HIPAA.

HIPAA may mean different things to different people, but simply put it has two major provisions. They are: 1) Health Insurance Reform, and 2) Administrative Simplification.

Additionally, there are three major amendments to HIPAA that may affect Health Insurance coverage for some people. They are 1) the Women's Health and Cancer Rights Act of 1998 (WHCRA), 2) the Mental Health Parity Act of 1996 (MHPA), and 3) the Newborns' and Mothers' Health Protection Act of 1996.

HIPAA Health Insurance Reform

Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. Provisions in Title I concern pre-existing conditions and portability of health insurance coverage.

See the HIPAA Insurance Reform Overview topic for complete information and links to more detailed topics concerning additional aspects of the Insurance Reform provisions of HIPAA.

HIPAA Administrative Simplification

The Administrative Simplification provisions in Title II of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data. Adopting these standards will improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in health care.

The Final Rule adopting HIPAA standards for the security of electronic health information was published in the Federal Register on February 20, 2003. The Final Rule adopting changes to the HIPAA Electronic Transactions and Code Set Standards was published in the Federal Register on February 20, 2003. October 16, 2003 is the compliance date for electronic transactions and code sets.

The Administrative Simplification provisions of HIPAA, while requiring an enormous amount of information technology systems effort by providers, health plans, and employers, have little or no direct impact on consumers.

WorkWORLD users who desire more information about the Administrative Simplification provisions of HIPAA should visit the CMS HIPAA Administrative Simplification website below for extensive coverage of the subject. The website is located at:
http://www.cms.hhs.gov/HIPAAGenInfo/

Women's Health and Cancer Rights Act of 1998 (WHCRA)

The Women's Health and Cancer Rights Act of 1998 (WHCRA) provides protections to patients who choose to have breast reconstruction in connection with a mastectomy. This law applies generally both to persons covered under group health plans and persons with individual health insurance coverage.

See the Women's Health and Cancer Rights Act of 1998 (WHCRA) topic for additional information.

Mental Health Parity Act of 1996 (MHPA)

The Mental Health Parity Act of 1996 (MHPA) may prevent your group health plan from placing annual or lifetime dollar limits on mental health benefits that are lower - less favorable - than annual or lifetime dollar limits for medical and surgical benefits offered under the plan. The law's requirements apply only to group health plans and their health insurance issuers that include mental health benefits in their benefits packages.

See the Mental Health Parity Act of 1996 (MHPA) topic for additional information.

Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)

The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. The law applies both to persons enrolled in group health plans and to persons who have individual health care coverage.

See the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) topic for additional information.

Additional Information

See the HIPAA Insurance Reform Overview topic for additional information and links to more detailed topics concerning aspects of the Insurance Reform provisions of HIPAA.

See the individual topics for more information about each of the three HIPAA amendments:

Women's Health and Cancer Rights Act of 1998 (WHCRA)

Mental Health Parity Act of 1996 (MHPA)

Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)

Source

Information in this topic was drawn from pages of the Centers for Medicare & Medicaid Services' Health Insurance Portability and Accountability Act of 1996 (HIPAA) website at:
http://www.cms.hhs.gov/HealthInsReformforConsume/

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