Direct EnforcementThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) established minimum federal standards regarding access to and the portability and renewability of private health insurance, including provisions that assist individuals who change or lose their jobs in maintaining health coverage. The Congress also enacted a number of amendments to HIPAA, which provided additional federal standards. These amendments included the Mental Health Parity Act of 1996, the Newborns’ and Mothers’ Health Protection Act of 1996, and the Women’s Health and Cancer Rights Act of 1998. These amendments addressed private health insurance coverage of mental health, maternity and newborn, and post-mastectomy reconstructive surgical benefits. In States that have standards that substantially conform to or exceed these federal standards, or States that otherwise enforce the federal standards, State insurance regulators have primary enforcement authority for insurance carriers. For those States that do not have such standards, HCFA "directly" enforces HIPAA and the related amendments. Currently, HCFA's Kansas City Regional Office is enforcing all aspects of Title I of HIPAA in Missouri in the small group, large group and individual markets. Therefore, the Kansas City Regional Office is responsible for ensuring that issuers, in the group market or the individual market, comply with the HIPAA requirements. The Regional Office also enforces the Newborns' and Mothers' Health Protection Act in Wisconsin and the Women's Health and Cancer Rights Act in Massachusetts, Delaware, North Dakota, and Colorado. HCFA is also responsible for enforcing these standards for nonfederal governmental plans in all States.
*North Dakota has recently enacted legislation which requires health insurance issuers to comply with WHCRA with respect to any policy, health service contract, or evidence of coverage delivered, issued, executed, or renewed on or after August 8, 2001. Therefore, enforcement of WHCRA will be transitioning back to the State at such time. In States in which HCFA is responsible for direct enforcement, HCFA has assumed many of the responsibilities undertaken by State insurance regulators, such as responding to consumers’ inquiries and complaints, reviewing issuers’ policy forms and business practices, performing market conduct examinations, and imposing civil money penalties, if necessary, for violations of HIPAA and the amendments. Enforcement Activities:
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