Implementation of HIPAA: Progress Slow in Enforcing Federal Standards in Nonconforming States

HEHS-00-85 Published: Mar 31, 2000. Publicly Released: Apr 25, 2000.
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Highlights

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), focusing on: (1) HCFA's progress in enforcing HIPAA and related laws in states lacking conforming statutes; (2) HCFA's role in enforcing HIPAA for state and local government health plans; and (3) the status of pending federal regulations regarding HIPAA's nondiscrimination provisions that restrict health plans from excluding employees, or varying benefits, premiums, or employer contributions, on the basis of health status.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Care Financing Administration The Administrator, HCFA, should complete the established federal process for determining whether federal enforcement will be required in additional states as quickly as possible, to include developing a consistent strategy and time period for enforcing HIPAA and the related laws' provisions in the states that lack conforming enforcement authority.
Closed - Implemented
As reported in GAO-01-652R, CMS completed a review of state laws related to three of the four federal laws and identified states where it was necessary for it to enforce at least one of the federal standards. To varying degrees, CMS has undertaken enforcement actions in these states. Before fully determining state conformance with the Mental Health Parity Act, CMS is waiting to see whether Congress reauthorizes the law, which is to sunset on September 30, 2001. To satisfy its statutory obligations, CMS will assess state enforcement of these federal standards on an ongoing basis.
Department of Labor HCFA, Labor, and Treasury should promptly complete regulations related to HIPAA's nondiscrimination provisions.
Closed - Implemented
The interim final rules on nondiscrimination in health coverage in the group market were issued January 8, 2001.
Department of the Treasury HCFA, Labor, and Treasury should promptly complete regulations related to HIPAA's nondiscrimination provisions.
Closed - Implemented
The interim final rules on nondiscrimination in health coverage in the group market were issued January 8, 2001.
Health Care Financing Administration HCFA, Labor, and Treasury should promptly complete regulations related to HIPAA's nondiscrimination provisions.
Closed - Implemented
The interim final rules on nondiscrimination in health coverage in the group market were issued January 8, 2001.

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