Health Insurance Portability and Accountability Act (HIPAA) 1996, aka the Kennedy–Kassebaum Act, is one important US bill that changed the way information about health care is managed. A law drafted by the 104th Congress and signed into law by President Bill Clinton on August 21, 1996, HIPAA had the purpose of enhancing healthcare coverage, keeping patients’ health information private, and streamlining the healthcare system.
In this article, we’ll discuss the main parts of HIPAA — its health insurance portability and responsibility provisions, protections for health information (PHI) and long-term effects for health care providers and individuals.
What is HIPAA?
Health Insurance Portability and Accountability Act (HIPAA) is meant to enhance healthcare efficiency, patient privacy, and the security of health data transfer. HIPAA regulates inter-organization transfers of healthcare data, enforces protections for health information of individuals, and restricts the sharing of protected information by covered organizations.
HIPAA has 5 main subtitles, which all concern different areas of healthcare and insurance. All titles are crucial to getting a full picture of the law, but Title I and Title II are most important for health insurance portability and data security.
Health Care Access, Portability, and Renewability, Title I (HCAP) 1.
Title I of HIPAA mostly addresses providing continuity of coverage for health insurance when individuals are transferring jobs or losing or switching jobs. This clause prevents an extremely common problem called “job lock” from occurring in which a worker can’t shift jobs as he or she is concerned they will lose their health insurance.
Key Provisions of Title I: Portability of Health Insurance: Title I permits workers and their families to continue to obtain health insurance when they move jobs or quit. It’s one of the most important parts of the act, as it ensures that individuals don’t get sick when they need it most.
Anti-Exclusion for Preexisting Conditions: Title I prohibits plans from making preexisting condition exclusions. : Group plans cannot exclude covered services for 12 months or more (or 18 months if you’re late in joining). But people can lower the exclusion time according to how long they had “creditable coverage” prior to switching plans.
Renewability of Coverage: Title I requires that health insurance plans be renewed by individuals as long as they remain eligible. Insurers can also’t charge premiums higher for a person’s medical condition.
These provisions have big implications for employers and employees, since they decrease the likelihood that workers will be left uninsured during transitions.
Section II: Prevention of Health Care Fraud and Abuse; Administrative Deregulation; Medical Liability Reform.
HIPAA Title II (“Administrative Simplification”) provisions affects the entire healthcare system. The bill, which will set national norms for electronic healthcare payments, make the healthcare system more efficient, and require privacy and security measures to ensure the security of patient health information, is its title.
Key Provisions of Title II:
Privacy and Security of Health Information: Title II requires health care providers, health insurance carriers, and other entities that are covered by it to have processes in place for the privacy and security of personally identifiable health information. That includes tight security measures in place to ensure the confidentiality of Protected Health Information (PHI).
Contrôle of Health Care Fraud and Abuse: HIPAA likewise has laws in place for healthcare fraud and abuse. They are meant to thwart fraud in the health system so that patients’ rights are maintained and resources are not misused.
HealthCare Transaction Simplification: By establishing national standards for electronic health care transactions, Title II will increase efficiency in billing, paperwork, and other areas of the healthcare industry. Health-related data transmissions to covered organizations, such as providers and insurers, must adhere to standard codes and formats.
Privacy Rule: HIPAA’s Backbone.
Perhaps the most popular section of HIPAA is the Privacy Rule (enacted in 2003). The Privacy Rule establishes federal standards for privacy protection of PHI and rules for what healthcare providers, insurers, and other organizations can do with PHI.
Some of the Key Findings of the Privacy Rule: Personal Rights: The Privacy Rule affords people the right to access health information, to correct it, and to have copies of their medical records. This transparency also gives patients control over their own health information.
PHI Disclosure: Per the Privacy Rule, covered entities can release PHI for limited uses, such as medical treatment, payment and operations. But they must get consent from patients before using it for any other purpose.
Minimal Necessary Level: When sharing PHI, covered entities are required to release only the minimum number of records necessary to accomplish the goal. This rule is meant to avoid unnecessary sharing of private health data.
Criminal Penalties for Infractions: There is a lot to lose in violation of the Privacy Rule and it can result in fines, including civil and criminal penalties. These fines are an annoyance to patients who violate patient confidentiality and encourage the safekeeping of private and confidential health information.
Health Insurance Portability: How HIPAA Will Affect It?
And with the introduction of HIPAA, the U.S. health insurance landscape changed completely, not least when it comes to portability. Before HIPAA, a person who changed jobs might struggle to get health insurance due to preexisting conditions or exclusions. Through HIPAA’s portability provisions, employees have continuous health insurance even if they move jobs, and workers are not denied essential care.
Specifically, Title I’s exclusions for preexisting conditions have made it possible to get health insurance even if you have chronic or chronic medical conditions. The law also outlaws employer coverage because of a person’s medical history, and health insurance is more available to those with varied medical requirements.
Challenges and Controversies
HIPAA has gotten a lot of things right with health information and portability, but the law has been plagued by flak for years. Others have had to navigate the complicated Privacy Rule and other administrative processes on their own. And the absence of evidence of effective enforcement and the complaint volume have left the healthcare system unclear as a whole.
What’s more, technology has changed too quickly, making health data more difficult to secure. As more and more patients access EHRs and telemedicine, it has become harder to maintain the confidentiality and safety of patient data.
Conclusion
Healthcare is one of the biggest changes the United States has undergone because the Health Insurance Portability and Accountability Act (HIPAA) was designed to make health insurance policies re-transferable and protect the privacy of health information. The fight is far from over, but HIPAA’s provisions, especially regarding portability and protection of PHI, have helped make progress toward a greater access, efficiency, and security to healthcare.
For people, HIPAA guarantees that their medical data won’t be lost, and their insurance won’t be at risk while they change jobs. Healthcare professionals and insurers have standard requirements for health data security in HIPAA that simplify business and prevent fraud. As the healthcare industry transforms, HIPAA will still be the basis of health information privacy and security in the US.
