07-09: Health Insurance Portability and Accountability Act of 1996

To:          All Health Insurers

From:     Linda Bohrer, Director

Re:         Health Insurance Portability and Accountability Act of 1996 (HIPAA) Alternative

               Mechanism for Individual Market Reform        

Date:      December 3, 2007

The Insurance Market Regulation Division of the Missouri Department of Insurance, Financial Institutions & Professional Registration issues this bulletin to provide guidance as to the HIPAA portability provisions of HB 818, passed in 2007.    

HIPAA allows states to, among other things, establish a “state alternative mechanism” (SAM) to meet the requirements for guarantee issue access to individual health insurance coverage.  Missouri has designated the Missouri Health Insurance Pool (MHIP) as the SAM in Missouri.  While HB 818 has an effective date of January 1, 2008, Missouri must receive approval from the Centers of Medicare and Medicaid Services (CMS) to establish a SAM.  We are still in the process of applying for that approval and will notify insurers as soon as CMS has approved the use of MHIP as the SAM in Missouri.  Until that approval is granted carriers are still required to issue at least two contracts on a guarantee issue basis to HIPAA qualified applicants.