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Health Insurance Portability and Accountability Act (HIPAA) of 1996
Chapter 19
Section 1
General
Revision:
1.0 Purpose
The
purpose of this chapter is to ensure compliance with the Health
Insurance Portability and Accountability Act (HIPAA) of 1996, including
the Administrative Simplification provisions, by TRICARE contractors.
2.0 Background
2.1 HIPAA
The
HIPAA of 1996 was introduced as the Kassebaum/Kennedy Bill and was
enacted on August 21, 1996, as Public Law 104-191. Public Law 104-191
is, “An Act to amend the Internal Revenue Code of 1986 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.”
2.2 Administrative Simplification
Through
subtitle F of Title II of the Act, Congress added to Title XI of
the Social Security Act a new Part C entitled, “Administrative Simplification.”
The purpose of this part is to improve the Medicare and Medicaid
programs under titles XVIII and XIX of the Social Security Act respectively
and improve the efficiency and effectiveness of the health care
system in general by encouraging the development of a health information
system through the establishment of standards and requirements to
enable the electronic exchange of certain health information.
2.3 Other Provisions
The
law requires the Secretary, Health and Human Services (HHS) to adopt
standards for financial and administrative transactions, and data
elements for those transactions, to enable health information to
be exchanged electronically. It requires the Secretary, HHS to adopt
standards for unique health identifiers for all individuals, employers,
health plans, and health care providers and to adopt standards for
security for health care information systems and for electronic
signatures. Congress also instructed the Secretary, HHS to promulgate
privacy standards for the protection of Individually Identifiable
Health Information (IIHI) should Congress fail to do so. The law
establishes civil monetary penalties for violations of the provisions
of Part C and establishes penalties for a knowing misuse of unique
health identifiers and IIHI.
2.4 TRICARE Operations Manual (TOM)
This
chapter incorporates, where required, instructions for each HIPAA-related
final rule as they are published by the Department of Health and
Human Services (DHHS).
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