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 HIPAA of 1996, including the Administrative Simplification
provisions, by TRICARE contractors.
2.0 BACKGROUND
2.1 HIPAA
HIPAA was introduced in 1996
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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