Health Insurance Portability

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Chapter IV

DEPARTMENT OF LABOR

Pension and Welfare Benefits Administration

29 CFR Chapter XXV

DEPARTMENT OF THE TREASURY

Internal Revenue Service

26 CFR Chapter I

Health Insurance Portability

AGENCY: Department of Health and Human Services, Health Care Financing

Administration; Department of Labor, Pension and Welfare Benefits

Administration; and Department of the Treasury, Office of Tax Policy

and Internal Revenue Service (the Agencies).

ACTION: Solicitation of comments.

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SUMMARY: The Agencies have received comments from the public on a

number of issues arising under the portability, access, and

renewability provisions of the Health Insurance Portability and

Accountability Act of 1996. Further comments from the public are

welcome.

DATES: The Agencies have requested that comments be submitted on or

before February 3, 1997.

ADDRESSES: For convenience, written comments should be submitted with a

signed original and 3 copies to the Health Care Financing

Administration (HCFA) at the address specified below. HCFA will provide

copies to each of the Agencies for their consideration. All comments

will be available for public inspection and copying in their entirety.

Health Care Financing Administration, Department of Health and Human

Services, Attention: BPD-886-N, P.O. Box 26688, Baltimore, Maryland

21207

If you prefer, you may deliver your written comments (1 original

and 3 copies) to one of the following addresses:

Room 309-G, Hubert Humphrey Building, 200 Independence Avenue, SW.,

Washington, D.C. 20201, or

Room C5-09-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850

Alternatively, comments may be submitted electronically via the

HCFA e-mail address at: [email protected]. Because of staffing and

resource limitations, we cannot accept comments by facsimile (FAX)

transmission. In commenting, please refer to file code BPD-886-N.

Comments received timely will be available for public inspection as

they are received, generally beginning approximately 3 weeks after

publication of a document, in Room 309-G of the Department of Health

and Human Services offices at 200 Independence Avenue, SW., Washington,

DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.

(phone (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Suzanne Long, Health Care Financing

Administration, at 410-786-0970 (not a toll-free number); Diane

Pedulla, Department of Labor, Office of the Solicitor, Plan Benefits

Security Division, at 202-219-4597 (not a toll-free number); or Russ

Weinheimer, Internal Revenue Service, at 202-622-4695 (not a toll-free

number).

SUPPLEMENTARY INFORMATION:

Background

The Health Insurance Portability and Accountability Act of 1996

(HIPAA) was enacted on August 21, 1996 (Public Law 104-191). HIPAA

amended the Public Health Service Act (PHSA), the Employee Retirement

Income Security Act of 1974 (ERISA), and the Internal Revenue Code of

1986 (Code) to provide for, among other things, improved portability

and continuity of health insurance coverage in the group and the

individual insurance markets, including group health plan coverage

provided in connection with employment. Health coverage is regulated in

part by the Federal government, under the PHSA, ERISA, the Code, and

other Federal provisions, and in part by the States.

The portability, access, and renewability provisions of HIPAA are

set forth in Title XXVII of the PHSA, Part 7 of Subtitle B of Title I

of ERISA, and Subtitle K of the Code (referred to below as the HIPAA

portability provisions). The HIPAA portability provisions are designed

to improve the availability and portability of health insurance

coverage by limiting exclusions for preexisting conditions and

providing credit for prior coverage, guaranteeing availability of

health coverage for small employers, prohibiting discrimination against

employees and dependents based on health status, and guaranteeing

renewability of health coverage for employers and individuals. The

HIPAA

[[Page 68698]]

portability provisions also include rules for the group and individual

insurance markets that guarantee access to individual coverage for

people who lose their group coverage. These provisions also set forth

requirements imposed on health insurance issuers.

Sections 101(g)(4), 102(c)(4), and 401(c)(4) of HIPAA provide that

the Secretaries of Health and Human Services, Labor, and Treasury shall

each issue, not later than April 1, 1997, such regulations as may be

necessary to carry out these provisions. The Agencies have been working

actively to develop these regulations.

Comments

Comments have been received from the public on a number of issues

arising under the HIPAA portability provisions. The purpose of this

announcement is to advise the public that further comments on all

issues under the HIPAA portability provisions are welcome in order that

comments may be taken into account, to the extent practicable, before

April 1, 1997.

In particular, in response to questions already received, the

Agencies are considering whether to include in the regulations a model

certification that generally could be used to certify an individual's

period of creditable coverage. Under sections 2701(e)(1) and 2743 of

the PHSA, section 701(e)(1) of ERISA, and section 9801(e)(1) of the

Code, a certification of creditable coverage is required to be provided

on certain occasions, such as when an individual loses coverage. The

model certification might include information identifying the parties

involved, whether the individual has at least 18 months of coverage

under the plan without a 63-day break, and, if not, the start and end

dates of coverage periods (and any related waiting period), but not

information about the particular benefits provided under the plan.

(Under this approach, information about the particular benefits

provided under a plan would have to be furnished only in the event that

another plan or issuer, after receiving the model certification,

requests additional information under section 2701(e)(2) of the PHSA,

section 701(e)(2) of ERISA, and section 9801(e)(2) of the Code.)

Comments are invited on whether a model certification of an

individual's period of creditable coverage would be helpful.

Signed at Washington, DC this 24th day of December 1996.

Bruce Vladeck,

Administrator, Health Care Financing Administration, Department of

Health and Human Services.

Robert J. Doyle,

Director, Office of Regulations and Interpretations, Pension and

Welfare Benefits Administration, Department of Labor.

J. Mark Iwry,

Associate Chief Counsel, Office of Tax Policy, Department of the

Treasury.

Sarah Hall Ingram,

Associate Chief Counsel, (Employee Benefits and Exempt Organizations),

Internal Revenue Service, Department of the Treasury.

[FR Doc. 96-33293 Filed 12-27-96; 8:45 am]

BILLING CODE 4120-01-M; 4830-01-M; 4510-29-M