97-04: The Health Insurance Portability/Accountability Act of 1996

Bulletin Text | Amendment | HCFA Fact Sheet

To:           All Companies Writing Health Coverage

From:      Jay Angoff, Director

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

Date:       June 27, 1997

The Missouri legislature recently adjourned without taking any action relative to several bills pending before it that would have incorporated various requirements of HIPAA into Missouri law. As a result, the Health Care Financing Administration (HCFA) will be enforcing various group and individual market provisions of HIPAA in Missouri when they become effective July 1, 1997. (The requirements for issuance of certifications of creditable coverage became effective June 1, 1997.) Attached to this bulletin is some information we received from HCFA regarding its enforcement of these requirements.

It is important to note, however, that HCFA's enforcement of provisions of HIPAA does not generally affect the applicability and enforcement of Missouri's insurance laws by the Missouri Department of Insurance (the Department). By its terms, HIPAA is not to be construed to supersede any standard or requirement of state law "except to the extent that such standard or requirement prevents the application of a requirement of" HIPAA. Most provisions of Missouri law do not prevent the application of HIPAA requirements, so the Department is working closely with HCFA to coordinate our concurrent regulatory responsibilities under Missouri law and HIPAA. The concurrent responsibilities of the two agencies are distributed as follows:


Outline of Regulatory Responsibilities Under HIPAA

In conjunction with HCFA, the Department has developed the following outline of the relative regulatory responsibilities of the two agencies in both the group and individual markets. Although we have tried to include all of the major points in this outline, it should not be considered to be an exhaustive list.

HCFA: generally enforces the federal requirements to the extent that they exceed Missouri's requirements

Individual Market

Group Market - Large and Small

Small Group Market

The Missouri Department of Insurance: generally continues enforcing Missouri insurance laws to the extent that they do not prevent the application of federal requirements

Individual Market

Group Market - Large and Small

Small Group Market - 3 to 25 employees


Consumer Complaints

As July 1 rapidly approaches, the Department is receiving an ever increasing number of inquiries from consumers regarding their rights under HIPAA and under Missouri law. The Department is working closely with HCFA to coordinate our handling of complaints under both laws so as not to overburden insurers with multiple requests for information in response to such complaints. Given the overlap in regulatory authority between the two agencies, the Department will first attempt to resolve all complaints it receives where HIPAA aspects are involved. Where complaints are ultimately determined to involve violations only of HIPAA and not Missouri law, they will be transmitted to HCFA for enforcement action. Accordingly, we request your cooperation and assistance by quickly and accurately responding to requests from the Department's consumer services representatives for information relative to consumer complaints.


POLICY FORMS

Under Missouri law, the Department is only empowered to review and approve policy forms for compliance with Missouri law. Approval by the Department should not be construed as a determination that the forms are in compliance with HIPAA! As the Department's insurance product analysts review form filings for compliance with Missouri laws, however, they may notice provisions that do not comply with HIPAA requirements. When this happens, the analyst will bring the problem to the attention of both the filing company and HCFA so that the form may be corrected. Consistent with our joint regulatory efforts with HCFA, any failure to comply with HIPAA requirements that comes to our attention will be reported to HCFA for appropriate enforcement.

In its interim final regulations, HCFA has indicated that insurers in the individual market will be required to file documentation (including policy forms) for approval with HIPAA requirements in those states (such as Missouri) where HCFA is enforcing the federal fallback provisions. Please understand that a filing with the Department does not constitute a filing with HCFA for these purposes. HCFA will need much more information than is ordinarily included with a form filing in Missouri, so a separate filing with HCFA will be necessary. Please also understand that any changes to a Missouri approved form requested by HCFA will need to be refiled with the Department.

HCFA has indicated that insurers must begin complying with the guaranteed availability requirements of HIPAA for small employers and individuals beginning July 1, 1997. The Department has already received numerous form filings containing new HIPAA provisions in both the group and individual markets, and we expect that we will be receiving many more. We will try as much as possible to expedite our review and approval of these forms for compliance with Missouri law. Insurers must comply with the guaranteed availability requirements in the group and individual markets, however, regardless of whether they have had new HIPAA-complying forms approved. The Department believes insurers should be able to administratively handle any language in their current policy forms that conflicts with HIPAA requirements until such time as forms with new language are approved. For those insurers that wish to exercise an abundance of caution, however, we have developed the attached standard amendment form that may be used with any existing approved form for the remainder of 1997. Insurers need not file this standard form with the Department in order to use it. Use of this standard form should allow insurers sufficient time to make any necessary filings.

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MISSOURI HIPAA AMENDMENT

PLEASE NOTE

To the extent that the provisions of the policy or certificate to which this amendment is attached do not comply with any provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), they are hereby amended to comply.

HIPAA-MDI(6/97)

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FOR IMMEDIATE RELEASE Contact: HCFA Kansas City Regional Office
June 27, 1997 (816) 426-3406

FACT SHEET
Federal Enforcement of HIPAA Insurance Reform Standards in Missouri