Psychiatric News February 4, 2005
Volume 40 Number 3
© 2005 American Psychiatric Association
p. 8
HHS Tries to Make HIPAA More Consumer Friendly
Mark Moran
The final regulation is intended to bolster HIPAA's consumer
protections, according to the administrator of the Centers for Medicaid and
Medicare.
The Department of Health and Human Services (HHS) has issued a final
regulation that limits the use and duration of preexisting-condition
exclusions imposed by group health plans and group health insurance
issuers.
The final regulation, which implements provisions of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), also requires these
entities to offer an immediate "special enrollment" opportunity to
certain individuals who lose eligibility for other group health coverage or
other health insurance, and to otherwise eligible new dependents.
The regulation, which becomes effective for plan years starting on or after
July 1, finalizes an interim rule that was first published on April 8, 1997,
for public comment. In response to comments received during that period, the
final regulation contains features that are intended to bolster HIPAA's
consumer protections while minimizing the burdens imposed on group health
plans and group health insurance issuers, according to HHS.
"We have listened to public comment and worked to craft a rule that
will provide maximum protection for consumers, while minimizing the burden on
health plans," said Mark B. McClellan, M.D., Ph.D., administrator of the
Centers for Medicare and Medicaid Services.
These are among the provisions in the final regulation:
- Group health plans and group health insurance issuers are required to
include an educational statement on their HIPAA rights with the certificate of
creditable coverage provided to individuals when they lose coverage under the
plan, and includes model language for the statement. (A certificate of
creditable coverage is a document that reflects details about an individual's
prior health care coverage for purposes of reducing the extent to which
certain plans or insurers can apply preexisting condition exclusions. For
example, three months of creditable coverage may reduce a plan's preexisting
condition exclusion by that amount.)
- Health plans maintained by foreign governments and by the U.S. government
(such as Veterans Affairs coverage) are recognized as creditable coverage that
can be used to eliminate or reduce the length of a preexisting-condition
exclusion.
- Sample language is offered that plans and issuers can use when notifying
participants of preexisting-condition exclusions.
- The regulation clarifies that certain plan-benefit restrictions are in fact
preexisting-condition exclusions that must comply with HIPAA's rules.
HHS is also publishing a proposed regulation that solicits comments on some
potential additional aspects of HIPAA group health plan requirements. Among
its provisions:
- The regulation provides an extension of time for individuals to exercise
certain HIPAA portability rights, in situations in which the individual is not
promptly notified through a certificate of creditable coverage that he or she
has lost coverage.
- Group health plans and group health insurance issuers must provide a
certificate of creditable coverage when an individual leaves a group health
plan while taking leave under the Family and Medical Leave Act, and that any
period during which a person does not have coverage while under such leave
does not count against him with regard to HIPAA's protections.
The final regulation and proposed regulation are posted online at
<http://a257.g.akamaitech.net/7/257/2422/06jun20041800/edocket.access.gpo.gov/2004/04-28112.htm>.
Comments on the proposed regulation may be submitted at
<www.cms.hhs.gov/regulations/ecomments/default.asp>.
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