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Latest News:

Federal Health Care Reform and Washington State Insurance Law. On March 23rd President Obama signed the health care reform legislation - Patient Protection and Affordable Care Act (PPACA). Congress has also passed the "reconciliation" bill that amends the PPACA. Reconciliation Act and Health Care Reform Legislation

For Washingtonians this may be a "deja vu" moment; since, most of the reforms look and sound like the 1993 state health care reform which was repealed in bits and pieces over the years leaving some health insurance reforms. As a result, most of the short term insurance reforms are minor upgrades to Washington law which take effect in September. Below are a list of the significant insurance reforms as they relate to Washington.

Dependent coverage
Health plans must permit parents to keep children covered under the parents' plan until the "child" reaches age 26. However, this "dependent" coverage need not be offered to a "child" eligible for employer coverage of their own. [Title I §2714 as modified by §2301 of the Reconciliation Act (RA)]

Washington requires health plans to permit parents to keep unmarried dependents under the age of 25 on the parents' plan. Thus, individual and group health plans must extend dependent coverage by one year and remove the restriction on "unmarried" dependents. (e.g. RCW 48.44.215)

Preexisting Condition Limits for Children
Health plans may not impose a preexisting condition limit on a child under the age of 19.

(Editor note: this provision is very hard to piece together.) [§ 2301 of the RA and page 777 of H.R. 3590 amending §1253 of the PPACA]. The administration has acknowledged these problems.

Despite the proclamations, there is a difference between "guaranteed issue" and "preexisting conditions" limits. Banning preexisting condtiion exclusions for children IS NOT the same as banning "medical underwriting" for children which would require insurers to issue coverage without regard to a child's health status. (For example, compare Washington RCW 48.43.012 which allows insurers a limited right to deny coverage in the individual market and RCW 48.43.035 which requires insurers to issue coverage in the group market without regard to the group members' health.)

While Washington limits preexisting condition limits, the federal law eliminates pre-ex on children.

Waiting Periods
Health plan coverage waiting periods for preexisting conditions are shortened from 12 months in group plans to 3 months. [§ 2301 of the RA and  §2708 PPACA]

Washington limits preexisting condition waiting periods in the individual and group markets. The federal reforms shorten these periods.

No termination based upon Health
Health plans may not terminate coverage for a person for health reasons. [§ 2301 of the RA and § 2712 of PPACA]

Washington does not permit this now.

No lifetime benefit limit
Health plans may not contain an overall lifetime benefit maximum in a health plan. [§ 2301 of the RA and § 2712 of PPACA]

Washington has no similar ban.

High Risk Pool
A temporary high risk health insurance pool is created for those rejected by insurers for health underwriting reasons with initial funding of $5 billion. The program may contract with state high risk health pools and is scheduled to end when the Health Insurance Exchange has been implemented in 2013. [Title I §1101]

Washington has a high risk health pool. (Chapter 48.41 RCW)

Read John Conniff's Health Care Reform Blog

Health Care Practitioners - National Provider Identification numbers booklet available. HIPAA mandated the adoption of a standard, unique health identifier for every health care provider. CMS (the Centers for Medicare and Medicaid Services) has just published an informational booklet on the NPI for providers wishing to learn more. NPI Booklet

HHS Issues new regulations increasing HIPAA violation penalties - On October 30 [Happy Halloween], the U.S. Department of Health and Human Services issued new interim final regulations substantially increasing penalties for HIPAA violations and removing some defenses against penalties. These changes follow Congressional action earlier in the year that beefed up HIPAA standards and enforcement. You will be punished for violations that occur after February 18, 2009, as follows:

• If you did not know of the violation and would not have known even with reasonable diligence, the civil fine is at least $100 for each violation up to $50,000 for each violation.
• If the violation was due to "reasonable cause" but not "willful neglect", the civil fine is at least $1,000 for each violation.
• If the violation was a result of "willful neglect" and the problem is fixed within 30 days of violation, the minimum fine is $10,000 for each violation.
• If the violation was a result of "willful neglect" and the problem is not fixed within 30 days of violation, the minimum fine is $50,000 for each violation.
• There is an annual limit of $1.5 million in fines for identical violations.

You may still avoid penalties if you correct the problems within 30 days and the violation is not due to "willful neglect." Willful neglect means in essence, that you just didn't care whether you met your obligations under HIPAA. Read the Regulation

Information:

Electronic Medical Records - A very useful guide to electronic medical records has been developed by the Texas Medical Association. With permission, we have included a link to the report here. The Electronic Medical Record Implementation Guide, The Link to a Better Future was developed by the Texas Medical Association Special Funds Foundation through a grant from The Physicians Foundation. The Physicians Foundation devotes its resources to helping practicing physicians improve the care they deliver to their patients. The Foundation provides grants to nonprofit organizations for practice-based, innovative projects that improve the quality of healthcare. For more information visit: www.physiciansfoundation.org.

OIG & CMS Gear up for HIPAA security audits - Lawyers for health care practitioners are getting ready to defend against federal audits of health care practitioners and hospitals for compliance with HIPAA security regulations.  While HIPAA compliance is scalable, if you have not done a self-audit of your clinic or facility, now is the time. Also, if you have not trained you staff as required by HIPAA, HCCS has  an interactive course to train staff in HIPAA Privacy and Security which has been updated within recent months. HIPAA Training