States Move To Comply With HIPAA Rules Covering Small-Group, Individual Policies

Coming into compliance with the requirements of the federal Health Insurance Portability and Accountability Act (HIPAA, the Kennedy-Kassebaum bill) of 1996 is a top legislative priority in a host of state capitals. Most states will have to change their existing market reform statutes to meet the requirements of the new law or face the possible loss of state authority to enforce HIPAA mandates.

“States will spend a lot of time this year passing legislation of all different sizes and shapes to come into compliance with both the small-group and individual market requirements of the federal law,” says Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association (BCBSA).

HIPAA guarantees access to health coverage for groups of 2 to 50 employees; requires health plans to guarantee renewal of all group products, including those sponsored by large employers; and limits to 12 months waiting periods imposed on pre-existing conditions diagnosed or treated within the past six months.

At least 19 states are expected to pass laws or amend existing guaranteed-issue laws for small groups, according to a recent state survey of Blue Cross and Blue Shield Plans undertaken by BCBSA. While some of these states already have laws requiring health plans to guarantee the issuance of selected products, states may interpret the law as requiring health plans to guarantee issuance of all products to small groups.

Another 16 states will probably bring their laws into compliance with HIPAA’s guaranteed renewal requirement, ac- cording to the survey, and more than 20 will enact or amend statutes limiting pre-existing-condition waiting periods in the group market.

Service of HMOs In Massachusetts To Be Assessed

By naming a panel to study HMO service, Massachusetts Republican Gov. William F. Weld has temporarily defused a conflict between the state’s HMOs and lawmakers who are considering dozens of regulatory bills.

Weld told the 15-member commission to report within six months, and he didn’t say what he thought of the bills in the hopper. Some legislators say six months is too long to wait.

One bill with considerable backing would require responses to denial of care within 15 days, and would expand the Health Department’s ability to oversee HMOs.

Patient Rights Bill Introduced In Nine States

Patient rights legislation developed by Women in Government, a nonpartisan group of women elected to or working in state government, has been introduced in nine states–Alaska, New Jersey, Texas, Colorado, Georgia, Kansas, Ohio, Oregon and Tennessee.

The only state where it has moved forward at all is Kansas, where it passed the Senate.

In its original form, the bill addresses clinical decision-making, access to personnel and facilities, choice of provider, grievance procedures and quality of care based on clinical outcomes. It requires managed care plans to give clear definitions of coverage rules for experimental treatments and timely written explanations to the patient if such treatments are not authorized by the HMO.

In addition, it prohibits “gag rules,” eases some HMO rules restricting coverage of emergency care and provides patients with access to all FDA-approved drugs and devices. These provisions are not likely to appeal to health plans.

“Ensuring enrollee satisfaction and quality of care is simply good business,” said New Jersey Republican Assemblywoman Barbara Wright, R.N., a sponsor of the legislation.

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