Educate your admitters on new insurance rules
Educate your admitters on new insurance rules
Some provisions take effect June 1
Important new protections allowing millions of workers to get and maintain health insurance if they change or lose their jobs will add another twist to the myriad rules admitters must keep in mind while registering patients.
The good news for hospitals is that some patients who might otherwise fall into the self-pay and often uncollectible category will find it easier to remain insured.
Access managers should be aware of the new provisions, which will be phased in beginning June 1, and educate their staffs accordingly, advises Jack Duffy, director of patient financial services for ScrippsHealth in San Diego.
Announced by the departments of Health and Human Services (HHS), Labor, and Treasury, the regulations are the first steps in implementing key provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which President Clinton signed into law Aug. 21, 1996. The regulations focus on limiting exclusions for pre-existing medical conditions, prohibiting discrimination against employees and dependents based on their health status, guaranteeing availability of health insurance to small employers, and guaranteeing renewability of insurance to all employers regardless of size.
Certificates will be issued
The provisions are required to be phased in before June 30, 1998. Exact dates will depend on when insurers’ new plan years begin and on insurance-related changes that states might make.
The first provision was issued jointly by HHS and the departments of Labor and Treasury. It applies to the group health insurance market and details how an individual’s previous health coverage is counted and documented when changing to a new plan or policy.
Under HIPAA, employees and their dependents will be issued "certificates of creditable coverage" by their current plan or policy when they cease coverage. Admitters should be familiar with these certificates, Duffy notes, suggesting that professional organizations might want to lead the effort to educate their members on what the certificate looks like and what it means.
Other issues that might surface include policies hospitals might establish regarding paying patients’ insurance premiums, if necessary, to continue their coverage a practice that some institutions followed in connection with COBRA insurance regulations, Duffy says.
"How does this compare to COBRA?" he asks. "Are there ethical and legal guidelines that come into play?"
The first regulation interprets HIPAA provisions that limit how long coverage and payment limits can be imposed because of a pre-existing condition and prohibit discrimination in group health insurance based on health status. The law does not, however, regulate the premiums of an individual employer’s plan, which remain subject to state law.
Another regulation, to be administered by the Health Care Financing Administration (HCFA) in conjunction with the states, details protections in the individual health insurance market for eligible individuals who lose group coverage and seek insurance in the individual market.
"Implementation of these provisions requires HCFA to develop a new level of partnership with the states in relationship to state regulation of health insurance," HCFA Administrator Bruce C. Vladeck said in a statement. "This increased cooperation is consistent with our commitment to improve access to health insurance for all Americans."
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