+++
INTRODUCTION AND HISTORY
++
Key Points
The Healthcare Insurance Portability and Accountability Act (HIPAA) legislation as we know it represents the marriage of two very different legislative efforts.
The portability component was intended to prevent workers from losing health coverage when they transitioned between jobs.
Accountability relates to the increasing vulnerability of health information in the electronic age and the responsibility health care workers have to protect it.
++
The HIPAA act of 1996 was designed to protect workers from losing their ability to be covered by health insurance (portability) on leaving a job, and to protect the integrity, confidentiality, and availability of electronic health information (accountability). Because of its complexity, resistance, and the difficulty and cost of implementation, several delays took place prior to its final implementation which is not surprising given the fact that the initial roots of the act go back several decades.
++
In 1975, a group of health care providers met with payers to discuss the creation of a standard hospital claim form. This was obviously well before the beginning of the personal computer era and the Internet; but the committee that resulted, the National Uniform Billing Committee, created a form called the UB-82 claim form which became an industry standard.
++
While standardization was the initial goal, other drivers began to emerge for health care efficiency as costs began to escalate in the latter part of the 1980s. In the early 1990s, the first Bush administration called together a group of industry leaders to address approaches to the reduction of health care costs. One of the conclusions of the group was that electronic data interchange should lead to the elimination of paper claims submission. Interestingly, an American Hospital Association study done in 1988 indicate that more than 60% of the insurance claims were submitted electronically at that point, using the UB-82 form.
++
The Workgroup for Electronic Data Interchange (WEDI) resulted from the Bush era initiative and, after a good deal of study, recommended that federal legislation should be enacted describing consistent national standards for electronic data interchange. These recommendations were included in the Clinton health plan, which failed to pass Congress; however, they ultimately became a part of the House version of the HIPAA legislation passed in 1996.
++
The HIPAA law is more commonly thought of as being the product of efforts by Senators Edward Kennedy and Nancy Kassebaum, who created legislation designed to ensure the portability of health insurance. The need for laws of this sort emerged, again due to escalating health care costs, as health insurers began to refuse coverage to vulnerable parties such as those with preexisting conditions, pregnancy, or transitions between jobs.
++
The electronic data interchange and health care portability aspects of the HIPAA legislation were married when the former was attached to the latter during its passage through Congress (Table 15-1), largely due to the ...