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The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 and includes five primary sections or “titles”:

• Title I: Health Care Access, Portability, and Renewability
• Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification
• Title III: Tax-Related Health Provisions
• Title IV: Application and Enforcement of Group Health Plan Requirements
• Title V: Revenue Offsets

Title I provides new protections for Americans against loss of insurance coverage because of illness or change in employment. Specific protections include the following:

• Limits on health care coverage exclusions because of pre-existing conditions
• Guarantees that individuals and certain small employers have the right to purchase health insurance when other health coverage is lost
• Guarantees that employers or individuals can renew health care coverage regardless of health conditions, in most cases

Title II of HIPAA addresses administrative simplification of health care transactions and includes a detailed discussion of required standards for electronic transmission of health information. This has been the most complicated and controversial portion of HIPAA. There are four major sections of Title II, including:

• Electronic Health Transactions Standards (final deadline for compliance is October 16, 2003)
• Unique Employer Identifiers (compliance required by August 1, 2005, for small health plans, July 30, 2004, for all other covered entities)
• Security & Electronic Signature Standards (compliance required by April 21, 2006, for small health plans, April 21, 2005, for all other covered entities)
• Privacy & Confidentiality Standards (compliance required by April 14, 2004, for small health plans, April 14, 2003, for all other covered entities)

Specific details for Title II have been delivered in phases.

The first two major sections of Title II on electronic health transaction standards and unique identifiers were motivated by the spiraling health costs. Administrative health care costs in the United States are estimated to be 25% of all health care costs. One contributing factor is the growing number of claims filed each year, with relatively few being filed electronically. The existence of over 400 different formats for filing claims is another factor. The U.S. government estimates that cost savings from [Page 262]compliance with Title II will be approximately $9 billion per year.

The privacy and confidentiality standards under Title II are designed to protect personal health information accessible through health plans, health care providers, and health care clearinghouses. All forms of data, including electronic, paper, and verbally communicated data, are covered under the HIPAA. The specific concern is for protection of individually identifiable health information (IIHI), including the following:

• Demographic information
• Information created or received from a health plan, health care provider, or health care clearinghouse
• Information related to the past, present, or future physical or mental health or condition of individuals, the provision of care to individuals and the past, present, or future payment for provision of health care

In general, Title II has several important implications for the health care community. First, there is a relatively short time frame for compliance with standards once they are put into place. Specifically, organizations generally have two to three years to comply with new regulations as they become available. Title II legislation has a broad scope: All functions, processes, and systems that store, handle, or generate health information are affected, making quick compliance even more challenging. Because Title II mandates standard formats for the most common transactions among health care organizations and also requires health care organizations to rethink how they protect the security and privacy of patients and consumers, many health care organizations will need to replace or substantially change current systems and processes to comply.

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