Magazine article Policy & Practice of Public Human Services

On the Road to Compliance: Implementing HIPAA

Magazine article Policy & Practice of Public Human Services

On the Road to Compliance: Implementing HIPAA

Article excerpt

State and local government agencies that provide health care can expect a new tidal wave of change brought on by the Health Insurance Portability and Accountability Act (HIPAA), which was originally dubbed the Kennedy-Kassebaum Health Care Reform Act. Signed into law in 1996, the law has several goals, including improving the portability and continuity of health care benefits, ensuring greater accountability in the area of health care fraud, and simplifying the administration of health insurance.

Title II of the law, Administrative Simplification, has resulted in new regulations mandating compliance with a wide range of health information management, security, and privacy standards. To succeed, HIPAA must bring the entire nation onto a federally required standard for compatible electronic coding. That requirement applies across the board, from huge state Medicaid systems to small health insurance carriers, some local governments, and even individual doctor offices across the nation.

To learn more about HIPAA, POLICY & PRACTICE talked with Burt Cohen, acting director of the California Office of HIPAA Implementation (CalOHI). The office was created by the administration and the legislature to be the focal point for managing California's implementation of HIPAA. While direct implementation of federal HIPAA regulations is being done by line departments, CalOHI provides leadership, policy formulation, oversight, information, and coordination to ensure uniformity and effectiveness. Cohen worked with the legislature to create the statutory framework and funding for the office while serving as assistant secretary at California's Health and Human Services Agency in Sacramento.

P&P: HIPAA is such a complex law, with many components. Your office assumed leadership for California's HIPAA compliance. How did you start?

Cohen: We started in our Department of Health Services, which is our biggest health department and where HIPAA would have the most impact. Health Services has not only our Medicaid program, which we call Medi-Cal, but also all the public health programs and family health programs. We called upon some of the people who had experience managing Y2K here. Although HIPAA is not exactly like Y2K, the staff we called upon had experience managing a big project that affected many programs. We also involved some of our information technology people and our program specialists in the different programs to establish a project office within the Department of Health Services, the Office of HIPAA Compliance. We then established a statewide work group consisting of other departments where there was a likely HIPAA impact because we wanted to have collaboration among departments. Later, the California Office of HIPAA Implementation was established.

P&P: Not all the HIPAA regulations have been finalized, and some have yet to be issued. How has this serialization affected your implementation strategy?

Cohen: The National Governors Association asked HHS to delay the compliance dates until all the rules had been issued. It's less costly to make all the changes at once to an IT system, for example. But I think HHS was probably more interested in establishing a beachhead.

P&P: Determining who is a "covered entity" under HIPAA has not been an easy task. While it is clear that Medicaid and SCHIP are covered in HIPAA, it is not as clear for some other services. How is California making that determination for its agencies and programs?

Cohen: HIPAA originated in the private sector, and it's written in the language of the private sector. For example, HIPAA says, "You're a covered entity if you're a provider of health care services who bills electronically, or you're a health plan, or you're a clearinghouse." In the private health world, it's clear who's a provider, who's a health plan, and who's a clearinghouse. But government programs, especially social services, don't fit as neatly into those categories. …

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