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Women's Health and Cancer Rights Act Newborn's and Mother's Health Protection Act Features |
Direct Enforcement
The 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, CMS "directly" enforces HIPAA and the related amendments.
Currently, CMS'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 and 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, Colorado, Wisconsin and Rhode Island. CMS is also responsible for enforcing these standards for nonfederal governmental plans in all States.
| CMS's Direct Enforcement Presence | |||
|---|---|---|---|
| State | HIPAA | Newborns' and Mothers' Health Protection Act |
Women's Health
and Cancer Rights Act |
| Colorado | X | ||
| Massachusetts | X | ||
| Missouri | X | ||
| Wisconsin | X | X | |
| Rhode Island | X | ||
In States in which CMS is responsible for direct enforcement, CMS 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:
- Enforcement Regulation PDF 167K
- Bulletins
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Market Conduct Examinations
- Blue Cross and Blue Shield of Missouri, 7/2000 PDF 359K
- Healthy Alliance Life, 7/2000 PDF 382K
- HMO Missouri, Inc., 7/2000 PDF 455K
- Healthlink, 8/2000 PDF 178K
- Kaiser Foundation Health Plan, 11/2000 PDF 122K
- Blue Cross and Blue Shield of Kansas City, 5/2001 PDF 369K
- TriSource HealthCare, Inc., 5/2001 PDF 330K
- United HealthCare of the Midwest, Inc., 10/2001 PDF 260K
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Fortis Insurance Company, 3/2002
- NMHPA - Wisconsin PDF 253K
- WHCRA - Massachusetts PDF 479K
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