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Hippa Privacy Regulations

The Actual HIPAA Regulations Themselves

In the August of 1996, the Health Insurance Portability and Accountability Act (HIPAA) was signed into law by President Bill Clinton. The HIPAA Act included provisions for:

  • "Health insurance portability"
  • "Fraud and abuse control"
  • "Tax related provisions"
  • "Group health plan requirements"
  • "Revenue offset provisions"
  • "Administrative simplification requirements"
Moreover, the act creates standards that are applicable nationwide so as to protect the medical records and personal health information of individuals. The aim of this act was to give more control to individuals so that they can make better choices for healthcare while keeping their personal healthcare information safe. An Announcement On the 12th of December 2006, the Departments of Treasury, Labor, and Health and Human Services announced that final regulations would carry into effect the HIPAA (Health Insurance Portability & Accountability Act) nondiscrimination provisions and would be applied to employee wellness programs. These amendments were made to replace the temporary nondiscrimination regulations and to complete wellness program rules issued in 2001. According to the Federal Register, new regulations do not change the previous wellness program rules and regulations of 2001, but make several alternations and precise some ambiguities Modifications Among the main modifications of HIPAA regulations to be mentioned is the rule which allows carrying unused HRA (Health Reimbursement Arrangement) amounts forward to the next year. This option is quite legal and doesn't break nondiscrimination provisions, despite the fact that amounts of reimbursement vary among employees. Another change is introducing additional examples of nondiscrimination wellness programs that specify the conditions for obtaining a reward which, according to the plan, must not exceed more than 20% of the total coverage cost. However, the nondiscrimination provisions of HIPAA have an exception which comes into force should an individual participate in some disease prevention or health promotion programs. For example, if the waiver of a cost-sharing requirement or a premium discount is based on the participation in one of these programs, the exception of the actual HIPAA regulations takes its effect. As for the programs, while producing a reward, they have to meet the health standards and to correspond to certain criteria. Thus, their activity has to be arranged in such a way that they prevent diseases and promote health. The reward is limited to a specified percentage. At least one time a year, eligible individuals are to obtain the right to assess the reward of the program. In addition, any program must offer an appropriate standard for those who cannot take part in it for medical reasons.

The HIPAA Privacy Rule
The Privacy Rule concerns health plans, different health care providers transmitting health information and health-care clearing houses. Health plans are applied to the medical care cost and covered entities. They include health, vision, drug and prescription drug insurers; Medicare supplement insurers and long-term care insurers except nursing home fixed indemnity policies; and health maintenance organizations like Medicaid, Medicare and Medicare + Choice.

Modifications in the HIPAA Privacy Rule
Another aspect of the actual HIPAA regulations is modifications in the HIPAA Privacy Rule. The standards for Privacy of Individually Identifiable Health Information were introduced to protect individuals' health information. The Privacy Rule brings to focus supplying all the necessary health information meant to ensure effective health care, as well as protecting people's privacy.
All the Health Care Providers who transmit private health information electronically or through their billing service are covered entities, i.e. the HIPAA Privacy Rule protects the data transmitted both by hospitals and other institutional providers and by non-institutional providers of medical and care services (e.g. dentists).

Health Care Clearinghouses are responsible for processing nonstandard information received from another entity into a standard format, and vice versa.

All in all, there are two types of protected information: individually identifiable health information referring to individuals' physical or mental health condition, provision of the health care and medical care payment; and de-identified health information considering formal determination and the removal of individuals' specified identifiers.

The Main Goal of Privacy Rule
The main goal of the Privacy Rule is to determine the circumstances in which individuals' health information is used or disclosed by covered entities which can disclose the protected data only if individuals or their personal representatives request the access to the private health information.

Final HIPAA Regulations
According to the final regulations, an alternative standard can include following the recommendations of the individual's physician. This is done for the health factor to be considered from the beginning. And finally, all the data concerning alternative standard has to be publicly available, so that any individual could obtain a reward. The final HIPAA regulations also clarify nondiscrimination requirements. For example, it is fixed that the medical expenses of employees are reimbursed by employers up to the maximum amount for the period determined by the employers' contribution in the HRA plan. Besides that, the remaining amounts are automatically carried forward and can be available to employees in the next year. The maximum medical care reimbursement depends on the claim amounts of employees. In contrast to the regulations of 2001, the actual regulations give examples of the carry forward of untapped amounts and emphasize that this rule doesn't contradict the HIPAA nondiscrimination requirements.

Summary of the HIPAA Act
Summing up the actual HIPAA regulations, two general points are required to be mentioned. The first one states, it is not required that specific plan materials describe a reasonable alternative standard. However, the other one stresses, all the plan materials concerning the general standard have to accentuate the availability of a reasonable alternative standard.

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