Quick Reference to HIPAA Compliance, 2012-2013 Edition

Quick Reference to HIPAA Compliance is a guide for human resources managers and employee benefits professionals who administer employer-sponsored health plans, health care providers, and anyone who needs to understand and comply with all the regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

It provides essential information in an easy-to-use format, and includes practical tools such as:

• Charts
• Checklists
• Sample notices
• Worksheets
• Flowcharts
• And more!

The 2012-2013 Edition has been updated to include:

• An enhanced section summarizing major points of National Health Care Reform, including changes effective from 2010 through 2014 and discussion of the recent Supreme Court landmark decision upholding the constitutionality of the mandate that individuals must purchase health insurance as of 2014
• Review of new proposed rules under the Health Information Technology for Economic and Clinical Health Act (HITECH) concerning the accounting of disclosures requirement, which would give individuals the right to obtain a report on the identity of anyone who has electronically accessed their protected health information
• Discussion of increasing responsibilities for business associates
• Discussion of increased enforcement efforts by HHS

• 1. OVERVIEW
• 2. REQUIREMENTS IMPOSED BY THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
  • Business Entities
  • Security Breach Notice Requirements
  • Individuals' Rights
  • Marketing
  • Increased Penalties
  • Effective Dates
• 3. COVERED PLANS
  • Group Health Plans
  • Exempt Plans
  • Excepted Benefits
• 4. LIMITATIONS ON PREEXISTING CONDITION EXCLUSIONS
  • General Rules
  • Six-Month Look-Back Rule
  • Maximum Length of Preexisting Condition Exclusion
  • Enrollment Definitions
  • Creditable Coverage Rules
  • Standard Method
  • Alternative Method
  • Certifying Coverage; General Rules
  • Exhibit - Job Aid for Deadlines for Providing Certificates
  • Certifying Coverage; Form and Content Requirements
  • Exhibit - Job Aid for Certificate Content Checklist
  • Exhibit - Job Aid for Model Certificate of Group Health Plan Coverage
  • Exhibit - Job Aid for Model Certificate for Categories of Benefits (Alternative Method)
  • Certifying Coverage; Procedural Requirements
  • Demonstrating Creditable Coverage
  • Determination, Notice of Creditable Coverage
  • Exceptions to Preexisting Condition Exclusions
  • Special Enrollment Periods for Individuals Who Lose Other Coverage
  • Special Enrollment Periods for Dependents
  • Exhibit - Job Aid for Notice of Enrollment Rights; Model Description
  • HMO Affiliation Periods
• 5. NONDISCRIMINATION RULES
  • Nondiscrimination in Eligibility
  • Nondiscrimination in Benefits
  • Nondiscrimination in Premiums or Contributions
  • Special Rules and Exceptions
  • Multiemployer and Multiple-Employer Plans
• 6. REPORTING AND DISCLOSURE REQUIREMENTS
  • Notice to Employees
  • SPD Requirements
• 7. RULES FOR GROUP HEALTH INSURERS
  • Guaranteed Renewability Requirements
  • Guaranteed Availability Requirements
  • Disclosure Requirements
• 8. HIPAA PRIVACY AND SECURITY REQUIREMENTS
  • Overview and Compliance Dates
  • Covered Entities
  • Effect of HIPAA on Fully Insured Plans
  • Business Associates
  • Protected Health Information
  • Disclosure of PHI
  • Plan Document Requirements
  • Privacy Notice
  • Individual's Rights to PHI
  • Administrative Requirements for Covered Entities to Ensure Privacy
  • Enforcement and Penalties
  • The Security Rule
  • How Does the Plan Sponsor Comply - A Practical Roadmap
  • Exhibit - Checklist to Determine Compliance with HIPAA Privacy Rule
  • Exhibit - Checklist to Determine Compliance with HIPAA Security Rule
• 9. PENALTIES FOR NONCOMPLIANCE
  • IRS Penalties; Corrections and Waivers
  • IRS Penalties; Minimum and Maximum Amounts
• 10. HIPAA AND OTHER LAWS
  • State Insurance Laws and ERISA Preemption
  • Consolidated Omnibus Budget Reconciliation Act
  • Exhibit - Job Aid: Life Events Compliance Checklist
  • Health Flexible Spending Accounts
• 11. FREQUENTLY ASKED QUESTIONS
  • Covered Plans
  • Portability Requirements
  • Nondiscrimination Rules
  • Privacy Rules
• 12. REGULATIONS, NOTICES, AND OTHER GOVERNMENT PUBLICATIONS
  • HIPAA Interim Final Rules and Proposed Rules
  • Notice of Changes Under HIPAA to COBRA
  • HIPAA Final Rules, Privacy Standards
  • HIPAA Final Rules, Portability
  • HIPAA Final Rules, Administrative Simplification Enforcement
  • HIPAA Final Rules, Nondiscrimination and Wellness Benefits
  • American Recovery and Reinvestment Act of 2009, Privacy
  • Health Breach Notification, Proposed Rules
• 13. OTHER MAJOR HEALTH PLAN LAWS
  • Consolidated Omnibus Budget Reconciliation Act
  • Mental Health Parity Act
  • Newborns' and Mothers' Health Protection Act
  • Women's Health and Cancer Rights Act
  • Children's Health Insurance Program Reauthorization Act
  • National Health Care Reform