Term Paper on "HIPAA and the Medical Profession the 104th"

Term Paper 9 pages (2660 words) Sources: 1+

[EXCERPT] . . . .

HIPAA and the Medical Profession

The 104th Congress of the U.S. Senate and the House of Representatives enacted the Health Insurance Portability and Accountability Act of 1996 or HIPAA to improve the Medicare program under the Social Security Act, which was the Medicaid program, and the efficiency and effectiveness of the health care system (Public Law [HIDDEN] ). The setting up of standards and other requirements for the electronic transmission of health information was the perceived means in attaining these objectives. The Act amended the Internal Revenue Code of 1986 in aiming to improve portability and continuity of health insurance coverage for group and individual markets, control waste, fraud and abuse encountered in the delivery of health insurance and health care, encourage the use of medical savings accounts, improve access to long-term care services and coverage and simplify the administration of health insurance. It was signed into law on August 21, 1996.

HIPAA contains new and important protection provisions for the millions of working Americans and their families already suffering from medical conditions before its enactment or who might encounter discriminatory practices in their health coverage (Employee Benefits Security Administration). HIPAA's provisions have changed the requirements of employer-sponsored group health plans, insurance companies and health maintenance organizations. It limited the exceptions or exclusions for pre-existing medical conditions; prohibited discrimination against employees and their dependents' health status; assured that health coverage would be available and renewable; and offered protection by providing workers better access to health coverage. HIPAA now obliges group health plans and health insurance issuers to offer exclusions of pre-existing medical conditions only if the pre-existing exclusion was related to the condition for which the individual was receiving medical advice, diagnosis, care or treatment within the six-month period before the enrollment date; the pre-existing condition would not last for more than 12 months after the enrollment date; and that the 12-month period reduced by the number of days of the individual's previous creditable coverage (EBSA).

The health plans of some employers do not cover or allow pre-existing medical conditions but HIPAA limits their restrictions so that most of these should cover an employee's pre-existing condition after 12 months (EBSA). The law requires the employer to credit the employee for the duration of the employee's health coverage that will reduce this 12-month period. A change of job allows continuous health coverage if the employee already has 12 months of coverage and will not need to start filling in the 12-month exclusion requirement for any pre-existing conditions. HIPAA defines a "pre-existing" condition as one that is already present before the enrollment date of a new health plan and that it is excluded only if medical advice, diagnosis, care or treatment has been made for it within the six-month period that ends on the enrollment date. Other pre-existing condition exclusions to coverage include pregnancy, with or without previous coverage and extension of coverage to newborn or adopted children below 18 years old, unless the child is covered by the health plan within 30 days from birth, adoption or placement for adoption and provided that there is the interruption of coverage does not exceed 63 days (EBSA).

States may impose more stringent obligations on health insurers under certain circumstances (EBSA). These are the reduction of the six-month "looking back" period before the enrollment date in determining pre-existing conditions; the reduction of the 12-month and 18-month maximum pre-existing conclusion exclusion periods; increasing the 63-day significant break in the coverage period; increasing the 30-day period for newborn and adopted children and children placed for adoption; expanding or extending the prohibitions to those in whose cases these exceptions are applicable; requiring additional and special enrollment periods; and the reduction of the maximum HMO enrollment period to less than two months. These mean that an employee should check with his or her State for local provisions and if his or her health coverage is offered through an HMO or an insurance policy. If he or she has changed jobs, he or she must also into the health plan's provisions on pre-existing condition exclusions and the duration of the exclusion period. It should reflect the employee's right to prior creditable coverage to reduce the exclusion period. The plan should provide the information within a reasonable period after a certificate is issued or the creditable coverage information is given. If there is no change of job, the health plan may not exclude coverage for any pre-existing conditions for more than 12 months from the date it becomes subject to HIPAA provisions (EBSA).

HIPAA has been hailed for its response to the urgent call for medical privacy in the electronic age (Gellman 2003). Time was when confident medical and mental information was filed away and stored in cabinets and dusty shelves of clinics or a hospital's medical records department. Today, the same information has become widely available as data files to electronic researchers, mostly strangers, who are in the health care business or other businesses, out to make business out of the patient. HIPAA established a national standard to regulate the electronic transfers of such data in addressing the growing need for securing the privacy these data. The U.S. Department of Health and Human Services came up with the HIPAA Privacy Rule on April 14, 2003 for compliance by most health care providers, health plans and health care clearinghouses. It places the interests of the health industry, the government and the public over the patient's desire for privacy and confidentiality between him or her and the physician.

The HIPAA Privacy Rule not only establishes a national standard in accessing and handling confidential medical and mental health information and aligns with the State's local regulations and provisions, which cannot eliminate or oppose the basic rights established by HIPAA (Gellman 2003). HIPAA guarantees everyone the right to view, copy or request to change his or her own medical records, something not granted by federal law before the enactment of HIPAA. The individual, however, has no right to sue the HIPAA for violations against privacy: only the Department of Health and Human Services or the Department of Labor has the right to file actions in violation of the Privacy Rule. An individual is allowed only to complain against the violator or with the DHHS. Businesses can access or acquire an individual's medical or mental health information or they may obtain it from the person's doctor or share it with business associates, who include billing personnel, lawyers, accountants, data processors and software sellers. The doctor may sign a written agreement on the release of the information but he does not have to check out if it is being correctly handled (Gellman).

The National Association of Health Underwriters strongly endorsed the HIPAA for enforcing the Association's long-standing legislative objectives and for realizing its health reform (Legislative and Government Affairs 2003). It specifically supported HIPAA's provisions for small-group and individual market reforms, the long-term care insurance tax incentives, the medical savings account demonstration project, and the standards for the electronic transmission of health information.

The federal law that previously required standard formats in obtaining health care transactions through electronic means and protecting patient privacy will enforce a new security mandate by April 2005 (Chin 2004). It will require doctors and other covered persons to undertake measures in safeguarding the confidentiality, integrity and availability of electronic health data at their clinics or offices. Dr. David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians said that physicians should begin complying with security requirements now in order to avoid the difficulties and stress they encountered in conducting HIPAA transactions and meeting privacy rules in 2003. Dr. Steve Lazarus, president of the Boundary Information Group, also clarified that HIPAA applies to physicians who transmit standard transactions electronically and who use a billing service. HIPAA affects them and their electronically protected health data, even if these are only in their billing system or when it is used only to transmit claims to Medicare (Chin).

HIPAA requires physicians, first of all, to conduct a risk analysis by reviewing their information systems and identifying security risks. This means comparing the physician's current position with what the rule exacts (Chin 2004). Tom Walsh Consulting emphasized that the purpose is to point out areas of highest risk and to outline an approach for them, which will involve a prioritization of tasks to address and address them according to priority. Paramore Consulting Inc. suggests that physicians first conduct the risk analysis and then prepare a plan to comply with the earlier privacy rule. It points out that the security processes mean to protect electronically protected health information as tightly associated with privacy processes involved in protecting written communication. The physician can then make the comparison and view the security risks against the security rule (Chin).

The HIPAA security rule also requires the selection or appointment of a chief security officer, who can be the physician himself or someone who can be hired on retainer basis and on-call when… READ MORE

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