HIPAA Stands For…

HIPAA Stands For

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. If you’re aware of the full name, you’re not likely to incorrectly spell the acronym – as many people do –  as “HIPPA.” What HIPAA stands for – “portability” and “accountability” – is discussed below.

What is the History of the HIPAA legislation?

HIPAA, 169 pages long, is a federal law. Federal laws contain both long titles and short titles. The long title is a description of the law. The short title contains the names of the legislators who sponsored the bill(s) that ultimately became the law. The short title of HIPAA is the “Kassebaum–Kennedy Act,” or  “Kennedy–Kassebaum Act.” The “Kennedy” is Ted Kennedy, the late Democratic senator from Massachusetts, and brother of President John F. Kennedy. The “Kassebaum” is Nancy Kassebaum, former Republican senator from Kansas. Nancy Kassebaum’s maiden name is Landon. She is the daughter of Alf Landon, whom Franklin D. Roosevelt defeated in the 1936 presidential election by a landslide (electoral college results: 523 to 8). 

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The bill was named after these two people because Kennedy and Kassebaum were the ranking member and chair, respectively, on the Senate Committee for Health and Human Services; each Senator introduced the legislation into their respective caucuses (the part of the committee containing a Senator’s fellow party members). 

It might be hard to imagine this happening today, but HIPAA was passed in the Senate by a unanimous vote of 98 to nothing, and was passed in the House with only two “no” votes.

What Does HIPAA Stand for? 

HIPAA stands for health insurance portability, and HIPAA stands for health insurance accountability. The long title of HIPAA is: “An Act To amend the Internal Revenue Code of 1996 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.”

That’s a mouthful, but it can be broken down piece by piece.

HIPAA Stands for Portability:

Health insurance portability is an employee’s legal right to maintain group health plan coverage when switching employers or leaving the workforce.

HIPAA Stands for Continuity:

Health insurance continuity is an employee’s legal right to obtain coverage, ensuring continuity of care, even if the employee has a pre-existing medical condition. Title I of HIPAA requires group health plans to enroll qualified individuals with pre-existing conditions. Title I of HIPAA also limits the restrictions that a group health plan may place on benefits for preexisting conditions.  A preexisting condition is a health problem an individual seeking to enroll in a group healthcare plan had, before the date the new coverage begins. Under Title I of HIPAA, a group health plan may only refuse to provide benefits that relate to preexisting conditions for 12 months after enrollment or 18 months after for late enrollment.

Title I of HIPAA also allows individuals to limit the “preexisting condition” exclusion period. Group health plans must take into account how long an individual was covered before enrolling in the new plan after any periods of a break in coverage.

Title I of HIPAA applies the concept of “creditable coverage” to preexisting exclusion periods. Creditable coverage is previous health coverage that meets certain requirements. This coverage can be applied, as a day-for-day credit, against the application of a preexisting condition exclusion period when an individual moves from one group health plan to another. The law requires a group health plan to apply day-for-day creditable coverage credit to reduce the preexisting condition exclusion, as long as the enrollee has not experienced a break in creditable coverage that amounts to less than 63 days.

HIPAA Stands for… Simplification of the Administration of Health Insurance:

The long title of HIPAA states that HIPAA was passed “to simplify the administration of health insurance.”

The HIPAA Administrative Simplification Rules were implemented to achieve this purpose. These rules establish nationwide standards for electronic transactions and code sets to maintain the privacy and security of protected health information (PHI). The standards are often referred to as electronic data interchange or EDI standards.

The HIPAA regulations – specifically those found in 45 C.F.R. § 162 (Title 45, Section 162, of the Code of Federal Regulations) simplify the administration of health insurance by streamlining the  paperwork associated with billing, verifying patient eligibility, and payment transactions.

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