Topical Legal & Policy Research

Private Insurance

Health Insurance Portability and Accountability Act

What: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) accomplishes several things, including protecting individuals health care coverage when losing or changing jobs and authorizes the creation of national standards to ensure administrative efficiency. Responsibility for implementing various sections of HIPAA falls to the Centers for Medicare & Medicaid Services. The CMS HIPAA Web site provides comprehensive consumer, legal, and policy information. The Web site provides recent insurance coverage related legislation, including: Women's Health and Cancer Rights Act, Mental Health Parity Act, and Newborns' and Mothers' Health Protection Act.
How to search: The CMS site offers various levels of information, depending on who accesses the site. For consumer-ready information, CMS offers HIPAA Online, an interactive tool that helps answer questions regarding consumer protection and rights and the Consumer page, which provides other general information. CMS has also prepared information intended for Employers, State Regulators, Self-funded Nongovernmental plans, and employees of state or local governments under COBRA. The linked materials below, organized into sections relating to the insurance coverage and administrative simplification provisions of HIPPA, should prove useful:

HIPAA Insurance Coverage : Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps employees maintain health insurance coverage when they leave or lose their jobs.

Topic Search - Users may select from a pull down menu of topics to search. While the site does not provide for keyword or phrase searches of the HIPAA materials, the topical search helps focus research.
CMS Bulletins - Provides users access to CMS' policy positions on issues relating to the applicability of HIPAA. Organized by date of release, CMS provides the bulletins in PDF format for downloading.
State HIPAA Laws Database - A searchable index of state legislative compliance with HIPAA provisions. With pull-down menus, users enter a state (or all states), choose a market (individual, small, or large group) and select the HIPAA provision. A report will be produced providing state-specific citation information regarding the state statute, regulations and, bulletins.

HIPAA Administrative Simplification : The Administrative Simplification provisions of HIPAA (Title II) require the establishment of national standards for electronic health care transactions and national identifiers for providers, health plans, and employers.

Regulations and Standards - At this page, users may access HIPAA Compliance Deadlines and a report creating an inventory of health care information standards. These standards were compiled and organized into relevant HIPAA categories shortly after the passage of HIPAA. Users may also access the Administrative Simplification Compliance Act (ASCA; Public Law 107-105) in PDF format.
HIPAA Privacy Rule Implementation - Provides access to CMS guidance on implementation of HIPAA Privacy Standards for Fee-For-Service and Managed Care providers. Users may also access the Final Privacy Rule, broken into linked sections and parts, as published in the December 28, 2000 Federal Register. A link taking users off of CMS' Web site provides free access to all 12 HIPAA Implementation Guides and Addenda for downloading.
HIPAA-Covered Entity Tools - To determine whether a natural person, business, or government agency fits the HIPAA "covered entity" definition, users must complete a series short questions. Each question includes definitions, per HIPAA, of the terms used in the question.
Medicare Waivers for Small Providers - In Word document format, offers detailed information for small providers that intend to continue billing medical services on paper.

Helpful hints: While the CMS HIPAA Web site offers access to the statutes and regulations governing HIPAA in the form of downloadable PDF files, users may find it easier to use the Web sites (see above) offering better search tools. The CMS site also offers a glossary of terms common to HIPAA.
Other Web sites: In addition to accessing the HIPAA statute and regulation sections with other Web tools provided in this manual, users may access other HIPAA-related information at: