Civil money penalties: procedures for investigations, imposition of penalties, and hearings. Interim final rule; request for comments. (17/158)

This interim final rule establishes rules of procedure for the imposition, by the Secretary of Health and Human Services, of civil money penalties on entities that violate standards adopted by the Secretary under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). We intend that this be the first installment of a rule that we term the "Enforcement Rule." The Enforcement Rule, when issued in complete form, will set forth procedural and substantive requirements for imposition of civil money penalties. In the interim, we are issuing these rules of procedure to inform regulated entities of our approach to enforcement and to advise regulated entities of certain procedures that will be followed as we enforce the Administrative Simplification provisions of HIPAA.  (+info)

Guaranteed renewability and the problem of risk variation in individual health insurance markets. (18/158)

Consumers should be protected against fluctuations in premiums for private individual health insurance associated with the onset of high-cost chronic conditions. The most commonly discussed way to do so is through community rating, which provides protection but can require a heavy regulatory burden and can create incentives for adverse selection and cream skimming. This paper describes an alternative method of providing the same type of protection: insurance contract provisions that guarantee renewability for the next coverage period at class-average rates. Drawing on recent work in insurance theory, the paper shows that such protection is feasible in competitive insurance markets. Guaranteed renewability, which is required of all individual health insurance by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, is incomplete because the law fails to require that premiums be the same for all insured persons in a rating class. However, the paper reports the results of a recent survey of state insurance regulation, which indicates that all but three state insurance departments report having such a requirement. The paper concludes with a discussion of possible threats to the protection guaranteed renewability provides against risk segmentation.  (+info)

Joint custody: bipartisan interest expands scope of tax-credit proposals. (19/158)

The Bush administration's proposal to use tax credits to cover the uninsured has not attracted enough bipartisan support to make headway in a divided Congress. Democratic objections have centered on the administration's insistence that the credits be used primarily in the individual market. But bipartisan exploration of alternative credit designs has continued on Capitol Hill. Democratic proposals to include health coverage for laid-off workers in debate over the post-September 11 economic stimulus package and more recently in the Trade Adjustment Assistance Act have resulted in increased awareness that tax credits might be used for employer groups as well as in the nongroup market.  (+info)

Competitive markets for individual health insurance. (20/158)

A more dynamic individual insurance market could match benefits with individual preferences, provide more portable and permanent coverage, and stimulate consumer-focused service. Necessary reforms, such as tax parity and targeted assistance to high-risk pools, would enable individual coverage to expand efficiently. In contrast, requirements for guaranteed issue and community rating drive low-risk persons out of voluntary individual markets and raise overall premiums. Guaranteed renewability and switching costs would stabilize individual-market risk pools. As the individual market becomes more representative of the overall population, insurers' perceived needs to underwrite and market selectively will lessen, making administrative loading factors less significant.  (+info)

HIPAA privacy rule and public health. Guidance from CDC and the U.S. Department of Health and Human Services. (21/158)

New national health information privacy standards have been issued by the U.S. Department of Health and Human Services (DHHS), pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The new regulations provide protection for the privacy of certain individually identifiable health data, referred to as protected health information (PHI). Balancing the protection of individual health information with the need to protect public health, the Privacy Rule expressly permits disclosures without individual authorization to public health authorities authorized by law to collect or receive the information for the purpose of preventing or controlling disease, injury or disability including but not limited to public health surveillance, investigation, and intervention. Public health practice often requires the acquisition, use, and exchange of PHI to perform public health activities (e.g., public health surveillance, program evaluation, terrorism preparedness, outbreak investigations, direct health services, and public health research). Such information enables public health authorities to implement mandated activities (e.g., identifying, monitoring, and responding to death, disease, and disability among populations) and accomplish public health objectives. Public health authorities have a long history of respecting the confidentiality of PHI, and the majority of states as well as the federal government have laws that govern the use of, and serve to protect, identifiable information collected by public health authorities. The purpose of this report is to help public health agencies and others understand and interpret their responsibilities under the Privacy Rule. Elsewhere, comprehensive DHHS guidance is located at the HIPAA website of the Office for Civil Rights (http://www. hhs.gov/ocr/hipaa/).  (+info)

Statutory basis for public health reporting beyond specific diseases. (22/158)

Statutory authority for public health surveillance is necessarily broad as previously uncharacterized diseases are regularly discovered. This article provides specific information about general disease reporting provisions in each state. The intent of these reporting laws and the Health Insurance Portability and Accountability Act Privacy Rule is to support this critical disease surveillance function for the benefit of the entire population.  (+info)

Federal health information policy: a case of arrested development. (23/158)

Computerized patient records (CPRs) have reached a state of technical maturity that makes them an essential component of modern patient care. However, because uniform technical standards do not exist, CPRs constructed by different vendors do not convey clinical information easily from provider to provider. Moreover, unequal access to capital may mean a two-tier clinical information environment in the future. HIPAA, while important, did not anticipate the CPR revolution. New federal activism is required to assure not only interoperability of clinical data systems, but also that providers who lack capital and technical resources can make the needed digital conversion.  (+info)

Navigating the road to implementation of the Health Insurance Portability and Accountability Act. (24/158)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has a profound impact on safety net providers. To help agencies afford expert consultation and provide the opportunity for collaboration, a regional health foundation has created the first model in the nation to bring together safety net providers to work toward implementation of the HIPAA.  (+info)