Ann & Natalie's Compliance Corner
Welcome back to Ann & Natalie's Compliance Corner! This month, we bring you guidance on the release of the final rules on complying with the Health Insurance Portability and Accountability Act's (HIPAA) nondiscrimination provisions. Missed last month's discussion of the Department of Health and Human Services' (DHHS) response to the President's August executive order on improving transparency and quality in health care? Click here.
The U. S. Department of Labor's Employee Benefits Security Administration (EBSA), Internal Revenue Service, and DHHS recently announced the December 13, 2006 publication in the Federal Register of final rules addressing compliance with HIPAA's nondiscrimination provisions.
The joint press release issued by the federal agencies explained that, "HIPAA's nondiscrimination provisions generally prohibit a group health plan or group health insurance issuer from denying an individual eligibility for benefits based on a health factor and from charging an individual a higher premium than a similarly situated individual based on a health factor." As defined under HIPAA, health factors include health status, medical condition (including both physical and mental illnesses), claims experience, receipt of healthcare, medical history, genetic information, disability, and evidence of insurability.
Interim final regulations were published in January 2001 on several issues under the HIPAA nondiscrimination provisions, along with proposed regulations on wellness programs under these nondiscrimination provisions. The final rules also address the implementation of wellness programs.
In reference to the wellness programs, the final rules "clarify some ambiguities in the proposed regulations, make some changes in terminology and organization, and add a description of wellness programs not required to satisfy additional standards."
While the final rules do not change the 2001 interim rules or proposed rules on the wellness program, they do "republish, and slightly modify, the special transitional rule for self-funded nonfederal governmental plans that had denied any individual coverage due to the plan's election to opt out of the nondiscrimination requirements . . . in cases where the plan sponsor subsequently chooses to bring the plan into compliance with those requirements."
The "source-of-injury" provisions applied to the timing of a diagnosis of a medical condition are also clarified in the final rules. The rules do not change the prior requirement that a plan may not exclude coverage for self-inflicted injuries if the individual's injuries are otherwise covered by the group plan and if the injuries are the result of a medical condition. They do indicate, however, that benefits may not be denied for injuries resulting from such medical condition, even if the condition was not diagnosed prior to the injury.
The final rules will be effective on the first day of the plan year beginning on or after July 1, 2007. For calendar year plans, the final rules generally apply beginning January 1, 2008.
To read DHHS' press release, click here.
To read the text of the final rules, click here.
Disclaimer: The content of Compliance Corner is for general informational purposes only and should not be interpreted as compliance guidance or advice. Consult your compliance advisor or attorney for compliance or legal advice on specific issues related to your practice or compliance program.
