HEALTH INSURANCE PORTABILITY AND …

1 PUBLIC LAW 104 191 AUG. 21, 1996 HEALTH INSURANCE PORTABILITY ANDACCOUNTABILITY ACT OF 1996110 STAT. 1936 PUBLIC LAW 104 191 AUG. 21, 1996 Public Law 104 191104th CongressAn ActTo amend the Internal Revenue Code of 1986 to improve PORTABILITY and continuityof HEALTH INSURANCE coverage in the group and individual markets, to combatwaste, fraud, and abuse in HEALTH INSURANCE and HEALTH care delivery, to promotethe use of medical savings accounts, to improve access to long-term care servicesand coverage, to simplify the administration of HEALTH INSURANCE , and for it enacted by the Senate and House of Representatives ofthe United States of America in Congress assembled,SECTION 1. SHORT TITLE; TABLE OF CONTENTS.(a) SHORTTITLE. This Act may be cited as the HEALTH Insur-ance PORTABILITY and Accountability Act of 1996.

2 (b) TABLE OFCONTENTS. The table of contents of this Actis as follows:Sec. 1. Short title; table of I HEALTH CARE ACCESS, PORTABILITY , AND RENEWABILITYS ubtitle A Group Market RulesPART1 PORTABILITY , ACCESS, ANDRENEWABILITYREQUIREMENTSSec. 101. Through the Employee Retirement Income Security Act of 1974. PART7 GROUPHEALTHPLANPORTABILITY, ACCESS, ANDRENEWABILITYREQUIREMENTS Sec. 701. Increased PORTABILITY through limitation on preexisting condition ex-clusions. Sec. 702. Prohibiting discrimination against individual participants and bene-ficiaries based on HEALTH status. Sec. 703. Guaranteed renewability in multiemployer plans and multiple em-ployer welfare arrangements. Sec. 704. Preemption; State flexibility; construction. Sec. 705. Special rules relating to group HEALTH plans. Sec. 706. Definitions.

3 Sec. 707. Regulations..Sec. 102. Through the Public HEALTH Service Act. TITLE XXVII ASSURING PORTABILITY , AVAILABILITY, ANDRENEWABILITY OF HEALTH INSURANCE COVERAGE PARTA GROUPMARKETREFORMS Subpart 1 PORTABILITY , Access, and Renewability Requirements Sec. 2701. Increased PORTABILITY through limitation on preexisting conditionexclusions. Sec. 2702. Prohibiting discrimination against individual participants andbeneficiaries based on HEALTH status. Subpart 2 Provisions Applicable Only to HEALTH INSURANCE Issuers Sec. 2711. Guaranteed availability of coverage for employers in the USC 201 InsurancePortability andAccountabilityAct of 21, 1996[ 3103]110 STAT. 1937 PUBLIC LAW 104 191 AUG. 21, 1996 Sec. 2712. Guaranteed renewability of coverage for employers in the groupmarket. Sec. 2713. Disclosure of information.

4 Subpart 3 Exclusion of Plans; Enforcement; Preemption Sec. 2721. Exclusion of certain plans. Sec. 2722. Enforcement. Sec. 2723. Preemption; State flexibility; construction. PARTC DEFINITIONS; MISCELLANEOUSPROVISIONS Sec. 2791. Definitions. Sec. 2792. Regulations..Sec. 103. Reference to implementation through the Internal Revenue Code of 104. Assuring B Individual Market RulesSec. 111. Amendment to Public HEALTH Service Act. PARTB INDIVIDUALMARKETRULES Sec. 2741. Guaranteed availability of individual HEALTH INSURANCE coverage tocertain individuals with prior group coverage. Sec. 2742. Guaranteed renewability of individual HEALTH INSURANCE coverage. Sec. 2743. Certification of coverage. Sec. 2744. State flexibility in individual market reforms. Sec. 2745. Enforcement. Sec. 2746. Preemption.

5 Sec. 2747. General exceptions..Subtitle C General and Miscellaneous ProvisionsSec. 191. HEALTH coverage availability 192. Report on Medicare reimbursement of 193. Allowing federally-qualified HMOs to offer high deductible 194. Volunteer services provided by HEALTH professionals at free 195. Findings; II PREVENTING HEALTH CARE FRAUD AND ABUSE;ADMINISTRATIVE SIMPLIFICATION; MEDICAL LIABILITY REFORMSec. 200. References in A Fraud and Abuse Control ProgramSec. 201. Fraud and abuse control 202. Medicare integrity 203. Beneficiary incentive 204. Application of certain HEALTH antifraud and abuse sanctions to fraud andabuse against Federal HEALTH care 205. Guidance regarding application of HEALTH care fraud and abuse B Revisions to Current Sanctions for Fraud and AbuseSec. 211. Mandatory exclusion from participation in Medicare and State healthcare 212.

6 Establishment of minimum period of exclusion for certain individuals andentities subject to permissive exclusion from Medicare and State healthcare 213. Permissive exclusion of individuals with ownership or control interest insanctioned 214. Sanctions against practitioners and persons for failure to comply withstatutory 215. Intermediate sanctions for Medicare HEALTH maintenance 216. Additional exception to anti-kickback penalties for risk-sharing 217. Criminal penalty for fraudulent disposition of assets in order to obtainmedicaid 218. Effective C Data CollectionSec. 221. Establishment of the HEALTH care fraud and abuse data D Civil Monetary PenaltiesSec. 231. Social Security Act civil monetary STAT. 1938 PUBLIC LAW 104 191 AUG. 21, 1996 Sec. 232. Penalty for false certification for home HEALTH E Revisions to Criminal LawSec.

7 241. Definitions relating to Federal HEALTH care 242. HEALTH care 243. Theft or 244. False 245. Obstruction of criminal investigations of HEALTH care 246. Laundering of monetary 247. Injunctive relief relating to HEALTH care 248. Authorized investigative demand 249. Forfeitures for Federal HEALTH care 250. Relation to ERISA F Administrative SimplificationSec. 261. 262. Administrative simplification. PARTC ADMINISTRATIVESIMPLIFICATION Sec. 1171. Definitions. Sec. 1172. General requirements for adoption of standards. Sec. 1173. Standards for information transactions and data elements. Sec. 1174. Timetables for adoption of standards. Sec. 1175. Requirements. Sec. 1176. General penalty for failure to comply with requirements and stand-ards. Sec. 1177. Wrongful disclosure of individually identifiable HEALTH information.

8 Sec. 1178. Effect on State law. Sec. 1179. Processing payment transactions..Sec. 263. Changes in membership and duties of National Committee on Vital andHealth 264. Recommendations with respect to privacy of certain HEALTH G Duplication and Coordination of Medicare-Related PlansSec. 271. Duplication and coordination of Medicare-related III TAX-RELATED HEALTH PROVISIONSSec. 300. Amendment of 1986 A Medical Savings AccountsSec. 301. Medical savings B Increase in Deduction for HEALTH INSURANCE Costs of Self-EmployedIndividualsSec. 311. Increase in deduction for HEALTH INSURANCE costs of self-employed C Long-Term Care Services and ContractsPARTI GENERALPROVISIONSSec. 321. Treatment of long-term care 322. Qualified long-term care services treated as medical 323. Reporting CONSUMERPROTECTIONPROVISIONSSec.

9 325. Policy 326. Requirements for issuers of qualified long-term care INSURANCE 327. Effective D Treatment of Accelerated Death BenefitsSec. 331. Treatment of accelerated death benefits by 332. Tax treatment of companies issuing qualified accelerated death E State INSURANCE PoolsSec. 341. Exemption from income tax for State-sponsored organizations providinghealth coverage for high-risk 342. Exemption from income tax for State-sponsored workmen s compensationreinsurance STAT. 1939 PUBLIC LAW 104 191 AUG. 21, 1996 Subtitle F Organizations Subject to Section 833 Sec. 351. Organizations subject to section G IRA Distributions to the UnemployedSec. 361. Distributions from certain plans may be used without additional tax topay financially devastating medical H Organ and Tissue Donation Information Included With Income TaxRefund PaymentsSec.

10 371. Organ and tissue donation information included with income tax IV APPLICATION AND ENFORCEMENT OF GROUP HEALTH PLANREQUIREMENTSS ubtitle A Application and Enforcement of Group HEALTH Plan RequirementsSec. 401. Group HEALTH plan PORTABILITY , access, and renewability 402. Penalty on failure to meet certain group HEALTH plan B Clarification of Certain Continuation Coverage RequirementsSec. 421. COBRA V REVENUE OFFSETSSec. 500. Amendment of 1986 A Company-Owned Life InsuranceSec. 501. Denial of deduction for interest on loans with respect to company-ownedlife B Treatment of Individuals Who Lose United States CitizenshipSec. 511. Revision of income, estate, and gift taxes on individuals who lose UnitedStates 512. Information on individuals losing United States 513. Report on tax compliance by United States citizens and residents C Repeal of Financial Institution Transition Rule to Interest AllocationRulesSec.