The Health Insurance Portability and Accountability Act
P.L. 104-191, Enacted August 21, 1996

Insurance Coverage Provisions

1. Insurance Reform --Small firms have health insurance coverage regardless of staff health status.
2. Tax Deduction --Up to 80% of insurance costs by the year 2006 for self-employed individuals.
3. Medical Savings Accounts --Small firms can establish tax-favored medical savings accounts (MSAs).
4. Fraud and Abuse Provisions--Greater sanctions against health care fraud and abuse by providers.
5. Long-Term Care Insurance Provisions--The bill sets standards and contains additional tax provisions.
6. Medigap Anti-Duplication Provisions--Policies that pay benefits without regard to other coverage would no longer be considered to duplicate Medicare or other insurance coverage.

Administrative Simplification Provisions

1. Standards for electronic health information transactions. Within 18 months of enactment (by 2/21/98), the Secretary of HHS must adopt standards from among those approved by private standards developing organizations for certain uniform financial and administrative transactions and data elements, including claims, enrollment, eligibility, payment, coordination of benefits, and for the security of electronic health information systems. The Act also addresses safeguards of information, electronic signatures, and transfer of information among health plans. Providers and health plans are required to use the standards 24 months after adoption. Standards for claims attachments will be adopted within 30 months (by 2/21/99).



2. Unique Health Identifier. Within 18 months, the Secretary must adopt standards providing for a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system.



3. Code Sets. Within 18 months, the Secretary must select code sets for appropriate data elements for the transactions from among the code sets that have been developed by private and public entities, if they exist, or establish code sets for the elements if they have not been developed, and establish efficient and low-cost procedures for their distribution (including electronically).



4. Privacy of Health Information. Within 12 months, the Secretary of HHS must recommend privacy standards for individually identifiable health information to Congress. If Congress does not enact privacy legislation within 3 years, the Secretary will promulgate regulations. The recommendations will address at least the following: The rights that an individual who is a subject of individually identifiable health information should have, the procedures that should be established for the exercise of such rights, and the uses and disclosures of such information that should be authorized or required.



5. Other. The Bill pre-empts State laws and imposes civil money penalties and prison for certain violations, including wrongful disclosure of individually identifiable health information. The Bill made some changes in the membership and duties of the National Committee on Vital and Health Statistics (NCVHS).
   
   Within 4 years, after a study of the issues, NCVHS will make recommendations and legislative proposals to the Secretary on the adoption of uniform data standards for patient medical record information and the electronic exchange of such information.



6. Public Health. "Nothing in this part shall be construed to invalidate or limit the authority, power, or procedures established under any law providing for the reporting of disease or injury, child abuse, birth, or death, public health surveillance, or public health investigation or intervention."



7. State Regulatory Reporting. "Nothing in this part shall limit the ability of a State to require a health plan to report, or to provide access to, information for management audits, financial audits, program monitoring and evaluation.